Office blood pressure variability as a predictor of acute myocardial infarction in elderly patients receiving antihypertensive therapy

Hata, Yoichi; Muratani, Hiromi; Kimura, Yorio; Fukiyama, Koshiro; Kawano, Yuhei; Ashida, Thulaseedharan Sarojadevi; Yokouchi, Masatoshi; Imai, Yutaka; Ozawa, Toshio; Fujii, Jun; Omae, T

doi:10.1038/sj.jhh.1001301

Cited by 74 publications

(61 citation statements)

References 12 publications

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“…20,21 Further, it has been suggested that increased blood pressure variability may additionally be a manifestation of baroreflex regulation of blood pressure. 3,22 However, previous evidence indicates that decreased (not increased) heart rate variability is associated with an increased risk of mortality, suggesting that heart rate variability does not play a role in the relationship between blood pressure variability and mortality in the current study. 23 Although some have suggested that higher blood pressure variability might identify people with subclinical inflammation, 24 elevated CRP was not associated with increased visit-to-visit variability in systolic blood pressure in the current analysis.…”

Section: Discussioncontrasting

confidence: 48%

“…11,17,22,26 In a study of 1433 men from the Honolulu Heart Program, visit-to-visit variability in systolic blood pressure was associated with incident coronary heart disease events, even after controlling for potential confounders including average systolic blood pressure across study visits. 27 In a recent publication including the secondary analysis of several randomized controlled trials, higher visit-to-visit variability in systolic blood pressure was associated with an increased incidence of stroke in a cohort of subjects who had previously experienced a transient ischemic attack.…”

Section: Muntner Et Al Visit-to-visit Variability In Blood Pressurementioning

confidence: 99%

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The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population

et al. 2011

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Abstract-Recent data suggest that visit-to-visit variability of blood pressure is associated with stroke incidence. Correlates of increased visit-to-visit variability in blood pressure and the relationship between variability and all-cause mortality were examined using data on US adults Ն20 years of age from the Third National Health and Nutrition Examination Survey (nϭ956). Three consecutive blood pressure readings were taken during 3 separate study visits from 1988 to 1994. Based on the mean of the second and third measurements from each visit, visit-to-visit blood pressure variability for each participant was defined using the standard deviation and coefficient of variation across visits. Mortality was assessed through December 31, 2006 (median follow-upϭ14 years; nϭ240 deaths). The mean of the standard deviation for systolic blood pressure across visits was 7.7 mm Hg. After multivariable adjustment, older age, female gender, history of myocardial infarction, higher mean systolic blood pressure and pulse pressure, and use of angiotensin converting enzyme inhibitors were associated with higher standard deviation in systolic blood pressure. The multivariable adjusted hazard ratios for all-cause mortality associated with a standard deviation of systolic blood pressure of 4.80 to 8.34 mm Hg and Ն8.35 mm Hg, versus Ͻ4.80 mm Hg, were 1.57 (95% CI, 1.07 to 2.18) and 1.50 (95% CI, 1.03 to 2.18), respectively. Results were similar when coefficient of variation for systolic blood pressure was evaluated. Visit-to-visit variability for diastolic blood pressure was not associated with mortality. In this populationbased study of US adults, higher levels of short-term visit-to-visit variability in systolic blood pressure were associated with increased all-cause mortality. (Hypertension. 2011;57:160-166.) • Online Data Supplement

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Section: Discussioncontrasting

confidence: 48%

Section: Muntner Et Al Visit-to-visit Variability In Blood Pressurementioning

confidence: 99%

The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population

et al. 2011

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“…There are many different ways of expressing blood pressure variability, ranging from beat-to-beat changes 9 to long-term changes between office visits. 10 Although there have been some studies supporting a pathological role of increased variability, 10,11 it remains unclear to what extent such adverse effects are a manifestation of more extensive target organ damage impairing the baroreflex regulation of blood pressure (and hence increasing blood pressure variability) as opposed to a direct effect of the variability itself.…”

Section: Importance Of Blood Pressure Variabilitymentioning

confidence: 99%

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Pickering¹,

Hall²,

Appel³

et al. 2005

Hypertension

2,054

963

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Abstract-Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.

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“…[7][8][9][10] One drawback of the application of visit-to-visit office BPV for the routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to evaluate day-by-day home BPV, because this selfmeasurement makes it possible to obtain multiple BP values in a relatively short period under well-controlled conditions.…”

mentioning

confidence: 99%

Combined Effect of Angiotensin II Receptor Blocker and Either a Calcium Channel Blocker or Diuretic on Day-by-Day Variability of Home Blood Pressure

Matsui

O’Rourke²,

Hoshide³

et al. 2012

Hypertension

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Abstract-Day-by-day home blood pressure (BP) variability (BPV) was reported to be associated with increased cardiovascular risk. We aimed to test the hypothesis that the angiotensin II receptor blocker/calcium-channel blocker combination decreases day-by-day BPV more than the angiotensin II receptor blocker/diuretic combination does and investigated the mechanism underlying the former reduction. We enrolled 207 hypertensive subjects treated with olmesartan monotherapy for 12 weeks. The subjects were randomly assigned to treatment with hydrochlorothiazide (nϭ104) or azelnidipine (nϭ103) for 24 weeks. Home BP was taken in triplicate with a memory-equipped device in the morning and evening, respectively, for 5 consecutive days before each visit. Visits occurred at 4-week intervals. Home BPV was defined as within-individual SD of the 5-day home BP. Arterial stiffness was assessed by aortic pulse wave velocity at baseline and 24 weeks later. The reductions in home systolic BP were similar between the 2 groups, whereas the SD of home systolic BP decreased more in the azelnidipine group than in the hydrochlorothiazide group during the follow-up period (follow-up mean: 6.3 versus 7.1 mm Hg; Pϭ0.007). In the azelnidipine group, the change in aortic pulse wave velocity was independently associated with the change in SD of home systolic BP (regression coefficientϮSEϭ0. 79Ϯ0.37; Pϭ0.036). This study demonstrated that the angiotensin II receptor blocker/calciumchannel blocker combination improved home BPV in addition to home BP reduction and that the reduction in home BPV was partly attributable to the arterial stiffness reduction by this combination. (Hypertension. 2012;59:1132-1138.) • Online Data Supplement Key Words: home blood pressure Ⅲ day-by-day home blood pressure variability Ⅲ calcium channel blocker Ⅲ thiazide diuretic Ⅲ angiotensin II receptor blocker Ⅲ pulse wave velocity T here is a growing body of evidence that visit-to-visit blood pressure (BP) variability (BPV) in a clinical setting was significantly associated with target organ damage [1][2][3][4][5][6] and that it could predict cardiovascular events independent of mean office BP level.7-10 One drawback of the application of visit-to-visit office BPV for the routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to evaluate day-by-day home BPV, because this selfmeasurement makes it possible to obtain multiple BP values in a relatively short period under well-controlled conditions. 11It was reported recently that the increased day-by-day home BPV, calculated as the SD of home BP, was associated with the severity of target organ damage in patients with hypertension 12 or diabetes mellitus 13 and with cardiovascular mortality in a community-dwelling population.14 After treat- Thus, these results 15,16 raised speculation that the difference in cardiovascular events that favored the CCB regimen was not explained by BP differences but, rather, by the favorable effect...

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Office blood pressure variability as a predictor of acute myocardial infarction in elderly patients receiving antihypertensive therapy

Cited by 74 publications

References 12 publications

The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population

The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Combined Effect of Angiotensin II Receptor Blocker and Either a Calcium Channel Blocker or Diuretic on Day-by-Day Variability of Home Blood Pressure

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