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Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients

Citation

Chowdhury, EK and Owen, A and Krum, H and Wing, LMH and Nelson, MR and Reid, CM, on behalf of the Second Australian National Blood Pressure Study Management Committee, Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients, Journal of Hypertension, 32, (3) pp. 525-533. ISSN 0263-6352 (2014) [Refereed Article]

Copyright Statement

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

DOI: doi:10.1097/HJH.0000000000000028

Abstract

Obectives: In hypertensive persons aged 60 years or below, visit-to-visit SBP variability is directly associated with cardiovascular events, especially stroke. It is unclear whether such a relationship exists for older persons. We investigated whether there is a relationship between visit-to-visit SBP variability and cardiovascular events in an elderly population, and identified the factors associated with increased SBP variability. Methods: Information from 49771 visits of 5880 patients aged at least 65 years being treated for hypertension in the Second Australian National Blood Pressure study was used. Patients were followed for 4.1 (median) years and had eight (median) doctor visits during the study. SBP variability was defined as within-individual SD of SBP across study follow-up visits. Results: Increased visit-to-visit SBP variability was found to be a strong predictor for future cardiovascular events in this elderly population. The hazard ratio (95% confidence interval) for any first fatal/nonfatal cardiovascular event for highest decile compared with lowest decile of SBP variability was 2.18 (1.52-3.13) after adjusting for sex, age, treatment including other baseline variables, and average on-treatment SBP. A similar effect was observed for stroke (hazard ratio 2.78, 1.28-6.05), myocardial infarction (hazard ratio 4.11, 1.87-9.06), and heart failure (hazard ratio 4.79, 1.82-12.62). Highest SBP variability was also a predictor of post-trial fatal cardiovascular events. Increased visit-to-visit SBP variability was related to age, pulse pressure, changing physicians, smoking, treatment allocation, and the use of multiple BP-lowering drugs. Conclusion: These findings suggest that reducing visit-to-visit SBP variability might be an important objective in addition to conventional blood pressure-lowering in elderly hypertensive patients.

Item Details

Item Type:Refereed Article
Keywords:Blood pressure; Blood pressure variability; Cardiovascular events; Elderly; Hypertension
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Nelson, MR (Professor Mark Nelson)
ID Code:91344
Year Published:2014
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-05-14
Last Modified:2017-10-31
Downloads:0

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