Prognostic Significance of Visit‐to‐Visit Systolic Blood Pressure Variability: A Meta‐Analysis of 77,299 Patients

Tai, Chenhui; Sun, Yuxi; Dai, Neng; Xu, Dan; Chen, Wei; Wang, Ji‐Guang; Protogerou, Athanase D.; Sloten, Thomas T. van; Blacher, Jacques; Safar, Michel E.; Zhang, Yi; Xu, Yawei

doi:10.1111/jch.12484

Cited by 76 publications

(62 citation statements)

References 48 publications

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“…Esta variabilidad intraindividual en varias medidas fisiológicas ha cobrado cada vez más interés en los últimos años debido a que tanto la disminución de la variabilidad de la frecuencia cardíaca como el aumento de la variabilidad de la presión arterial estuvieron reiteradamente relacionados con resultados adversos como eventos vasculares, deterioro cognitivo, y mortalidad. [2][3][4][5][6] Sin embargo, poco se sabe acerca de la variabilidad del colesterol, la cual puede ser considerable aún a diario. 7,8 La evidencia reciente indica que, en sujetos con arteriopatía coronaria, una mayor variabilidad entre una visita y otra en el colesterol de lipoproteínas de baja densidad (LDL-C) está asociada con mayores riesgos de eventos coronarios y otros eventos cardiovasculares, accidente cerebrovascular, y mortalidad independientemente de los niveles medios de LDL-C. 9 Actualmente se desconoce si la variabilidad del LDL-C entre una visita y otra está asociada con el rendimiento cognitivo.…”

Section: Conclusionesunclassified

Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance, Lower Cerebral Blood Flow, and Greater White Matter Hyperintensity Load in Older Subjects

et al. 2016

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Background: Recently, it was shown that intraindividual variation in low-density lipoprotein cholesterol (LDL-C) predicts both cerebrovascular and cardiovascular events. We aimed to examine whether this extends to cognitive function and examined possible pathways using a magnetic resonance imaging substudy. Methods: We investigated the association between LDL-C variability and 4 cognitive domains at month 30 in 4428 participants of PROSPER (PROspective Study of Pravastatin in the Elderly at Risk). Additionally, we assessed the association of LDL-C variability with neuroimaging outcomes in a subset of 535 participants. LDL-C variability was defined as the intraindividual standard deviation over 4 postbaseline LDL-C measurements, and all analyses were adjusted for mean LDL-C levels and cardiovascular risk factors. Results: Higher LDL-C variability was associated with lower cognitive function in both the placebo and pravastatin treatment arms. Associations were present for selective attention ( P =0.017 and P =0.11, respectively), processing speed ( P =0.20 and P =0.029), and memory (immediate recall, P =0.002 and P =0.006; delayed recall, P =0.001 and P ≤0.001). Furthermore, higher LDL-C variability was associated with lower cerebral blood flow in both trial arms ( P =0.031 and P =0.050) and with greater white matter hyperintensity load in the pravastatin arm ( P =0.046). No evidence was found for interaction between LDL-C variability and pravastatin treatment for both cognitive and magnetic resonance imaging outcomes. Conclusions: We found that higher visit-to-visit variability in LDL-C, independently of mean LDL-C levels and statin treatment, is associated with lower cognitive performance, lower cerebral blood flow, and greater white matter hyperintensity load.

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Section: Conclusionesunclassified

Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance, Lower Cerebral Blood Flow, and Greater White Matter Hyperintensity Load in Older Subjects

et al. 2016

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“…The majority of studies (21,22) have analysed sensitivity of many different parameters of visit-to-visit BPV concerning the estimation of prediction of cardiovascular events (CVE): standard deviation, standard deviation independent of the mean (SDIM), coefficient of variation (CV), successive variation (SV), average real variability (ARV), range. We followed the standard deviation of SBP, as it was the simplest and the best indicator of future CVE due to the fact that other parameters of BPV were closely correlated and give similar reflections of BPV.…”

Section: Discussionmentioning

confidence: 99%

“…Prospektivna studija je obuhvatila tri posete u ambulanti za hipertenziju tokom perioda prać enja od 22 …”

Section: Sa Prevalencijom Gojaznosti I Svih Prateć Ih Zdravstvenih Riunclassified

The Association Between Obesity and Visit-to-Visit Variability in Systolic Blood Pressure: A Prospective Study

Stojanović

Ilic

Ilić

et al. 2020

Serbian Journal of Experimental and Clinical Research

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With the prevalence of obesity and all accompanying health risks, both prevention and health education, as well as identifying predictors for the development of obesity-related diseases are primary. Th e pathophysiological relationship between obesity and visit-to-visit variability in systolic blood pressure (SBPV) has not been completely resolved.To 11.00±5.64 vs 7.34±3.96; p<0.01 SAŽETAK Sa prevalencijom gojaznosti i svih prateć ih zdravstvenih rizika, primarna je preventivna i zdravstvena edukacija, kao i identifi kovanje prediktora za razvoj bolesti povezanih sa gojaznošć u. Patofi ziološki odnos između gojaznosti i varijabilnosti sistolnog krvnog pritiska prilikom poseta pacijenta (SBPV) nije u potpunosti jasan. Istražiti povezanost između gojaznosti i SBPV kod hipertenzivnih pacijenata.Prospektivna studija je obuhvatila tri posete u ambulanti za hipertenziju tokom perioda prać enja od 22 meseca u period od marta 2014 i januara 2016 godine.U ovoj randomiziranoj studiji uključeno je 300 hipertenzivnih pacijenata (prosečne starosti 67,76 ± 9,84 godina), koji su podeljeni u grupu gojaznih i negojaznih ispitanika. SBPV je defi nisan kao standardna devijacija (SD) tri vrednosti SBP.Vrednosti SBP i SBP-SD bile su znatno već e u grupi gojaznih hipertenzivnih pacijenata nego u grupi ne-gojaznih pacijenata (126.67 ± 8.22 vs. 120.45 ± 7.79 mmHg, 11.00 ± 5.64 vs 7.34 ± 3.96, p <0.01 ). Najveć i SBPV zabeležen je u četvrtom kvartilu kod gojaznih pacijenata (43,13 ± 7,50 mmHg). Dokazana je statistički jaka korelacija između SBPV i BMI / obim struka (OS) (ro = 0,425 / ro = 0,356, p <0,01

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“…12 It is possible that higher levels of SD BPV increase stroke risk in population samples 16 and that CV-BPV is less strongly related to stroke risk than SD BPV. The meta-analysis by Tai et al 20 showed that a 1% increased risk of stroke was attributable to a 1 mm Hg increase in SD BPV; however, only 2 included studies used this method. Another difference with prior research is that we included participants without cardiovascular comorbidities, whereas several prior studies have included participants with varying levels of stroke risk.…”

Section: -25mentioning

confidence: 99%

“…The meta-analysis by Tai et al 20 showed that no prospective cohort study has used the coefficient of variation method (CV-BPV) in relation to stroke. Intraindividual fluctuations in BP over 4 years with measurements at 2-year intervals was calculated using CV-BPV (please see online-only Data Supplement).…”

Section: Assessment Of Drug Exposure and Bpmentioning

confidence: 99%

Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults

Tully

Debette

Dartigues

et al. 2016

Stroke

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Background and Purpose-The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged ≥65 years. Methods-The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPV reg ). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPV reg , covariates, and delayed entry bias. Results-There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05-2.40; P=0.03). Conclusions-The angiotensin receptor blocker and β-blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke. .).The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

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Prognostic Significance of Visit‐to‐Visit Systolic Blood Pressure Variability: A Meta‐Analysis of 77,299 Patients

Cited by 76 publications

References 48 publications

Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance, Lower Cerebral Blood Flow, and Greater White Matter Hyperintensity Load in Older Subjects

Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance, Lower Cerebral Blood Flow, and Greater White Matter Hyperintensity Load in Older Subjects

The Association Between Obesity and Visit-to-Visit Variability in Systolic Blood Pressure: A Prospective Study

Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults

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