scholarly journals Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review

2020 ◽  
Vol 49 (2) ◽  
pp. 184-192
Author(s):  
Toby O Smith ◽  
Julia Ann Sillito ◽  
Choon-Hian Goh ◽  
Abdel-Rahman Abdel-Fattah ◽  
Alice Einarsson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Moderate Quality ◽  
Home Based ◽  
Potential Association ◽  
All Cause Mortality ◽  
Incident Cardiovascular Disease ◽  
Quality Evidence

Abstract Background Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality. Methods Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised. Results Sixty-one studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, “day-by-day” and “week-to-week” variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed). Conclusion An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes were not possible.

The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients

2018 ◽  
Vol 34 (3) ◽  
pp. 515-523 ◽  
Author(s):  
Pantelis A Sarafidis ◽  
Charalampos Loutradis ◽  
Antonios Karpetas ◽  
Georgios Tzanis ◽  
Athanasios Bikos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
All Cause Mortality

scholarly journals Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-14
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Shaobin Yu ◽  
Stephen Salerno ◽  
Yi Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Cardiovascular Mortality ◽  
Coefficient Of Variation ◽  
Blood Pressure Variability ◽  
Meta Analysis ◽  
Cochrane Library ◽  
All Cause Mortality ◽  
The Cochrane Library ◽  
Stratified Analysis

<b><i>Background:</i></b> The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population. <b><i>Methods:</i></b> Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included. <b><i>Results:</i></b> A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07–1.19; <i>p</i> &#x3c; 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10–1.22; <i>p</i> &#x3c; 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05–1.17; <i>p</i> = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06–1.22; <i>p</i> &#x3c; 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (<i>p</i> = 0.01) and cardiovascular (<i>p</i> = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01–1.17; <i>p</i> = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52–1.42; <i>p</i> = 0.56). <b><i>Conclusions:</i></b> This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).

scholarly journals The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients

2018 ◽  
Vol 35 (7) ◽  
pp. 1277-1277
Author(s):  
Pantelis A Sarafidis ◽  
Charalampos Loutradis ◽  
Antonios Karpetas ◽  
Georgios Tzanis ◽  
Athanasios Bikos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
All Cause Mortality

SHORT-TERM BLOOD PRESSURE VARIABILITY PREDICTS CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e12-e13
Author(s):  
P.A. Sarafidis ◽  
C. Loutradis ◽  
A. Karpetas ◽  
E. Papadopoulou ◽  
G. Tzanis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Hemodialysis Patients ◽  
Short Term ◽  
All Cause Mortality

Abstract 5066: The Treatment Effect of Perindopril is Consistent in All Patients with Vascular Disease or High Risk of Vascular Disease: A Combined Analysis of Three Perindopril Trials

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jasper J Brugts ◽  
Eric Boersma ◽  
Jaap W Deckers ◽  
Willem Remme ◽  
Michel Bertrand ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Vascular Disease ◽  
Cardiovascular Mortality ◽  
Treatment Effect ◽  
Cardiovascular Events ◽  
Treatment Benefit ◽  
Combined Analysis ◽  
All Cause Mortality

The beneficial effect of the ACE-inhibitor perindopril has been demonstrated in large placebo-controlled clinical trials consisting of patients with stable CAD without overt heart failure (EUROPA), history of stroke (PROGRESS) and diabetes mellitus (ADVANCE). EUROPA investigated the effect of perindopril 8 mg during a mean follow-up of 4.2 years. PROGRESS investigated a perindopril 4mg/indapamide regimen during 4 years of follow-up and ADVANCE studied a perindopril 4 mg/indapamide regimen during 4.3 years of follow-up. In the three trials, mean blood pressure reduction was respectively, 5/2 mmHg, 9/4 mmHg and 6/2 mmHg. In all three trials, perindopril significantly reduced major cardiovascular events independent of baseline blood pressure levels. For this meta-analysis, we analyzed the treatment effect of the three trials combined on the shared endpoints of all-cause mortality and cardiovascular mortality & MI. Table 1 shows an analysis of three perindopril trials (EUROPA, PROGRESS and ADVANCE). When these findings were combined (n=29493), perindopril significantly reduced all-cause mortality (OR 0.89, 95% CI 0.82– 0.97), and cardiovascular mortality, MI (OR 0.82, 95% CI 0.74 – 0.90). This combined analysis shows that perindopril reduced cardiovascular events by 11–18% irrespective of risk level or the type of patients, which is in line with prior meta-analyses and risk models. This treatment benefit by perindopril is consistent among all patients with vascular disease or high risk of vascular disease. The treatment benefit by perindopril among patients with vascular disease or high-risk vascular disease.

scholarly journals Blood Pressure Variability and Outcomes in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 45 (5) ◽  
pp. 631-644
Author(s):  
Huihui Li ◽  
Jing Xue ◽  
Wenjie Dai ◽  
Xiaohua Liao ◽  
Peng Zhu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Random Effects Models ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

Objective: Previous studies have suggested that blood pressure variability (BPV) is associated with an increased risk of mortality and cardiovascular events in patients on dialysis. However, the results are inconsistent. A comprehensive literature review was conducted to analyze the association between BPV and outcomes in patients on dialysis. Methods: Articles in Embase, Medline, and Web of Science from the date of inception through January 1, 2020, were identified. The outcomes were all-cause and cardiovascular mortality and cardiovascular events. The risk of bias was assessed using the Newcastle-Ottawa scale tool. Random effects models were used to pool the overall effect sizes. Two reviewers extracted the data independently. Meta-regression and subgroup analyses were performed to explore potential heterogeneity. Results: Fifteen eligible studies were included, and all enrolled hemodialysis recipients only. The overall risk of bias for the included studies was low. A 1-SD increase in systolic BPV was associated with higher risks of all-cause mortality (HR = 1.18; 95% CI 1.11–1.26, I2 = 53.8%), cardiovascular mortality (HR = 1.23; 95% CI 1.10–1.37, I2 = 57.2%), and cardiovascular events (HR = 1.27; 95% CI 1.07–1.51, I2 = 69.3%). Likewise, a 1-SD increase in diastolic BPV was associated with higher HR for all-cause and cardiovascular mortality (HR = 1.14; 95% CI 1.05–1.23, I2 = 0.0%, and HR = 1.14; 95% CI 0.94–1.38, I2 = 0.0%, respectively). Conclusions: A greater BPV is associated with higher risks of cardiovascular and mortality outcomes in patients on hemodialysis. Further research is required to determine whether BPV may be useful either as a marker enabling individualized treatment of cardiovascular risk or as a treatment target in its own right.

scholarly journals Association of Ambulatory Blood Pressure with All-Cause Mortality and Cardiovascular Outcomes in Peritoneal Dialysis Patients

2020 ◽  
Vol 45 (6) ◽  
pp. 890-899
Author(s):  
Shuqi Dai ◽  
Yun Chen ◽  
Da Shang ◽  
Xiaolin Ge ◽  
Qionghong Xie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Ambulatory Blood Pressure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
All Cause Mortality

<b><i>Background:</i></b> Ambulatory blood pressure monitoring is the gold standard for the diagnosis of hypertension, but its effects on all-cause mortality and cardiovascular outcomes in peritoneal dialysis (PD) patients remain uncertain. We aimed to investigate the association between ambulatory blood pressure and clinical outcomes in PD patients. <b><i>Methods:</i></b> A prospective, observational cohort study was conducted in PD patients enrolled from March 2001 to July 2018 and followed until October 2019. Blood pressure was evaluated using 24-h ambulatory blood pressure monitoring. The endpoints included all-cause mortality, cardiovascular mortality, and cardiovascular events. Multivariable Cox regression was used to identify the associations between ambulatory blood pressure and endpoints. Subsequently, multivariable logistic regression was conducted to identify factors associated with elevated pulse pressure (PP). <b><i>Results:</i></b> A total of 260 PD patients (154 men, 59.2%) were recruited. The median follow-up duration was 40.7 months. Our studies revealed that PP was an independent predictor of all-cause mortality (hazard ratio [HR], 1.018; 95% CI, 1.001–1.034; <i>p</i> = 0.032), cardiovascular mortality (HR, 1.039; 95% CI, 1.017–1.061; <i>p</i> &#x3c; 0.001), and cardiovascular events (HR, 1.028; 95% CI, 1.011–1.046; <i>p</i> = 0.001). Systolic blood pressure was an independent predictor of cardiovascular mortality (HR, 1.023; 95% CI, 1.007–1.040; <i>p</i> = 0.005) and cardiovascular events (HR, 1.018; 95% CI, 1.006–1.030; <i>p</i> = 0.003). Vascular calcification was significantly associated with elevated PP (OR, 3.069; 95% CI, 1.632–5.772; <i>p</i> = 0.001). <b><i>Conclusion:</i></b> 24-h ambulatory PP was the most significant predictor of all blood pressure indicators for clinical outcomes in PD patients.

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