Redefined Blood Pressure Variability Measure and Its Association With Mortality in Elderly Primary Care Patients

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 64; no. 1; pp. 45 - 52
• Main Authors: Gao, Sujuan, Hendrie, Hugh C, Wang, Chenkun, Stump, Timothy E, Stewart, Jesse C, Kesterson, Joe, Clark, Daniel O, Callahan, Christopher M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01-07-2014; Lippincott Williams & Wilkins
• Subjects: Aged; Aged, 80 and over; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Determination; Cardiology. Vascular system; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Female; Humans; Hypertension - mortality; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Office Visits; Primary Health Care; Prospective Studies; Risk; Human; Hypertension; Prognosis; Primary health care; Mortality; Variability; Cardiovascular disease; cardiovascular diseases; Epidemiology; Association; Cohort study; cohort studies; Arterial pressure; Blood pressure; Hemodynamics; Circulatory system; Cardiology; Elderly; Public health; mortality; blood pressure
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.114.03576

Visit-to-visit blood pressure (BP) variability has received considerable attention recently. The objective of our study is to define a variability measure that is independent of change over time and determine the association between longitudinal summary measures of BP measurements and mortality risk. Data for the study came from a prospective cohort of 2906 adults, aged ≥60 years, in an urban primary care system with ≤15 years of follow-up. Dates of death for deceased participants were retrieved from the National Death Index. Systolic and diastolic BP measurements from outpatient clinic visits were extracted from the Regenstrief Medical Record System. For each patient, the intercept, regression slope, and root mean square error for visit-to-visit variability were derived using linear regression models and used as independent variables in Cox proportional hazards models for both all-cause mortality and mortality attributable to coronary heart disease or stroke. Rate of change was associated with mortality risk in a U-shaped relationship and that participants with little or no change in BP had the lowest mortality risk. BP variability was not an independent predictor of mortality risk. By separating change over time from visit-to-visit variability in studies with relatively long follow-up, we demonstrated in this elderly primary care patient population that BP changes over time, not variability, were associated with greater mortality risk. Future research is needed to confirm our findings in other populations.