Association between short-term pulse pressure variability and cardiovascular death among normotensive adults

Abstract Background Short-term systolic and diastolic blood pressure variability have been associated with adverse cardiovascular (CVD) outcomes, especially in conjunction with traditional CVD risk factors. However, there are limited data on the relationship between short-term pulse pressure (systolic minus diastolic blood pressure) variability (PPV) and mortality. Purpose We examined the association between PPV and death due to cardiovascular causes. Methods Data from the United States National Health and Nutrition Examination Surveys (NHANES-III, 1988–1994) were linked to death certificates from the National Death Index until December 31, 2015. A total of 6,340 adults (2,981 men and 3,359 non-pregnant women) aged ≥20 years who were normotensive (BP<140/90, without history of hypertension and not taking antihypertensive medication) were followed for an average of 22.3 years. Individuals with any self-reported history of CVD (heart failure, myocardial infarction, stroke) were excluded. PPV was calculated as the standard deviation of six pulse pressure measurements across two visits less than two weeks apart. PPV was categorized into quartiles: Q1: ≤4, Q2: 4.1–6, Q3: 6.1–8, Q4: >8 mmHg. The primary outcome was CVD mortality. Cox proportional hazards models were used to determine hazard ratios, adjusting for demographics & sociobehavioral factors (age, race, ethnicity, poverty-income ratio, smoking status), cardiometabolic factors (waist circumference, HDL, triglycerides, microalbuminuria, diabetes status), BP-related factors (mean pulse pressure, between-visit variability), and accounting for the complex survey design. Results Whereas the proportion of CVD death among men was similar across quartiles, women in Q4 had significantly higher proportion of CVD death (Figure 1; p=0.0055). Women in Q4 of PPV had significantly higher risk of CVD mortality (unadjusted HR 3.63, 95% CI 1.66, 7.90) compared to Q1, even after 1) adjustment for demographics & sociobehavioral factors (HR 2.80, CI 1.40, 5.60), 2) additional adjustment for cardiometabolic factors (HR 2.59, CI 1.33, 5.05), and 3) additional adjustment for mean pulse pressure and between visit variability (HR 2.71, CI 1.42, 5.17). Men in Q4 also had increased, but insignificant, risk of CVD mortality (adjusted HR 1.06, CI 0.38, 2.96). Gender significantly modified the effect of PPV on CVD mortality (p=0.036 for interaction term). When looking at the first visit alone, every 1 mmHg increase in PPV was associated with a 11% significant increase in risk of cardiovascular mortality in females (1.11 [1.03, 1.19]), but only a 1% insignificant increase in males (1.01 [0.91, 1.12]). Conclusions These NHANES data with an average 22.3 years of follow-up indicate that two visit pulse pressure variability is associated with cardiovascular death and that this effect is more pronounced in women. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Pulse Pressure Variability and Mortality

Download Full-text

The impact of systolic and diastolic blood pressure variability on mortality is age dependent: Data from the Dublin Outcome Study

European Journal of Preventive Cardiology ◽

10.1177/2047487319872572 ◽

2019 ◽

Vol 27 (4) ◽

pp. 355-364 ◽

Cited By ~ 3

Author(s):

Grzegorz Bilo ◽

Eamon Dolan ◽

Eoin O'Brien ◽

Rita Facchetti ◽

Davide Soranna ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Confidence Interval ◽

Diastolic Blood Pressure ◽

Cardiovascular Mortality ◽

Blood Pressure Variability ◽

Strong Predictor ◽

Outcome Study ◽

Short Term ◽

The Impact

Background Twenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importance of systolic and diastolic BPV. The aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 h with cardiovascular mortality in untreated subjects is affected by age. Design and methods The study included 9154 untreated individuals assessed for hypertension between 1982 and 2002 in the frame of the Dublin Outcome Study, in which 24 h ambulatory blood pressure monitoring was obtained (age 54.1 ± 14.3 years, 47% males). The association of short-term systolic and diastolic blood pressure variability with cardiovascular and all-cause mortality in the entire sample and separately in younger and older age subgroups was assessed over a median follow-up period of 6.3 years. Results Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for daytime standard deviation 1.16 (95% confidence interval 1.08–1.26)) with no significant differences among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for daytime standard deviation 1.72 (95% confidence interval 1.33–2.23)), superseding the predictive value of diastolic BPV in this group. Conclusions Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.

Download Full-text

24-Hour blood pressure variability as a predictor of short-term echocardiographic changes in normotensive women with past history of preeclampsia/eclampsia

Pregnancy Hypertension ◽

10.1016/j.preghy.2018.04.017 ◽

2018 ◽

Vol 13 ◽

pp. 72-78 ◽

Cited By ~ 2

Author(s):

Mohammad AbdelKader AbdelWahab ◽

Hazem Mohammad-Ali Farrag ◽

Cristina Eid Saied

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Past History ◽

Short Term ◽

History Of

Download Full-text

The value of blood pressure variability in clinical practice. Opportunities of amlodipine in reducing blood pressure variability (based on the Russian program «VARIATIONS»)

Systemic Hypertension ◽

10.26442/sg29000 ◽

2014 ◽

Vol 11 (1) ◽

pp. 11-16

Author(s):

O D Ostroumova ◽

O V Bondarets ◽

T F Guseva

Keyword(s):

Blood Pressure ◽

Clinical Practice ◽

Diastolic Blood Pressure ◽

Blood Pressure Variability ◽

Short Term ◽

Different Types ◽

Practice Opportunities ◽

The Impact ◽

Dose Dependent ◽

Russian Program

The article discusses the importance of different types of variability in blood pressure (BP) as an independent risk factor for stroke and myocardial infarction in patients with arterial hypertension. The results of the Russian observation program (1500 patients) on the impact of amlodipine show BP variability in real clinical practice. According to the results, amlodipine 5-10 mg after 2 weeks of treatment significantly reduces the variability of systolic and diastolic blood pressure in both sexes. His influence on the short-term variability in diastolic blood pressure is dose-dependent.

Download Full-text

PULSE PRESSURE IS MORE RELEVANT THAN SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN PATIENTS WITH TYPE 2 DIABETES AND CARDIOVASCULAR DISEASE

Medicine and Pharmacy Reports ◽

10.15386/cjmed-972 ◽

2018 ◽

Vol 91 (4) ◽

pp. 408-413

Author(s):

Vlad Alexandru Buda ◽

Dana Mihaela Ciobanu ◽

Gabriela Roman

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Diastolic Blood Pressure ◽

Pulse Pressure ◽

Blood Pressure Variability ◽

Blood Pressure Monitoring ◽

Study Groups ◽

Atherosclerotic Cardiovascular Disease

Background and aims. The parameters evaluated during 24-hour ambulatory blood pressure monitoring were reported to be predictors of cardiovascular events. We aimed to investigate mean blood pressure, blood pressure variability and pulse pressure during 24-hour ambulatory blood pressure monitoring in type 2 diabetes patients and to establish their relationship with the presence of atherosclerotic cardiovascular disease (CVD).Methods. The observational study included type 2 diabetes patients randomly selected and distributed in 2 study groups depending on the presence of atherosclerotic cardiovascular disease: CVD(-), n=90, and CVD(+), n=87. Daytime, nighttime and 24-hour systolic and diastolic blood pressure were monitored and mean blood pressure, blood pressure variability and pulse pressure were calculated. Results. The study groups were comparable as age, gender ratio, smoking status, body mass index and abdominal circumference. Diabetes and hypertension duration were significantly higher in the CVD(+) group. Mean systolic and diastolic blood pressure, blood variability, dipper prevalence did not differ between study groups. Pulse pressure was significantly higher in the CVD(+) group compared to CVD(-) group (daytime pulse pressure 56.2±13.1 vs. 50.6±11.3 mmHg, p=0.003; nighttime pulse pressure 56.5±14.2 vs. 50.7±12.4 mmHg, p=0.005; 24-hour pulse pressure 54.7±13.6 vs. 49.0±12.0 mmHg, p=0.003). Conclusions. Ambulatory pulse pressure was significantly higher in patients with type 2 diabetes and atherosclerotic cardiovascular disease compared to those without cardiovascular disease, although mean systolic and diastolic blood pressure and blood pressure variability were similar.

Download Full-text

Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.2738 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Kim ◽

H Jung ◽

P.S Yang ◽

H.T Yu ◽

T.H Kim ◽

...

Keyword(s):

Blood Pressure ◽

Pulse Pressure ◽

Middle Age ◽

Population Based ◽

Entire Cohort ◽

Incident Dementia ◽

Increased Risk ◽

Diagnosis Of Dementia ◽

History Of ◽

The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p<0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p<0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

Download Full-text

The Effects of Short-Term Changes in Sodium Intake on Plasma Marinobufagenin Levels in Patients with Primary Salt-Sensitive and Salt-Insensitive Hypertension

Nutrients ◽

10.3390/nu13051502 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1502

Author(s):

Katarzyna Łabno-Kirszniok ◽

Agata Kujawa-Szewieczek ◽

Andrzej Wiecek ◽

Grzegorz Piecha

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Sodium Intake ◽

Left Ventricular ◽

Primary Hypertension ◽

Dietary Sodium ◽

Sodium Restriction ◽

Short Term ◽

Salt Loading ◽

Dietary Sodium Restriction

Increased marinobufagenin (MBG) synthesis has been suggested in response to high dietary salt intake. The aim of this study was to determine the effects of short-term changes in sodium intake on plasma MBG levels in patients with primary salt-sensitive and salt-insensitive hypertension. In total, 51 patients with primary hypertension were evaluated during acute sodium restriction and sodium loading. Plasma or serum concentrations of MBG, natriuretic pro-peptides, aldosterone, sodium, potassium, as well as hematocrit (Hct) value, plasma renin activity (PRA) and urinary sodium and potassium excretion were measured. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed at baseline. In salt-sensitive patients with primary hypertension plasma MBG correlated positively with diastolic blood pressure (ABPM) and serum NT-proANP concentration at baseline and with serum NT-proANP concentration after dietary sodium restriction. In this subgroup plasma MBG concentration decreased during sodium restriction, and a parallel increase of PRA was observed. Acute salt loading further decreased plasma MBG concentration in salt-sensitive subjects in contrast to salt insensitive patients. No correlation was found between plasma MBG concentration and left ventricular mass index. In conclusion, in salt-sensitive hypertensive patients plasma MBG concentration correlates with 24-h diastolic blood pressure and dietary sodium restriction reduces plasma MBG levels. Decreased MBG secretion in response to acute salt loading may play an important role in the pathogenesis of salt sensitivity.

Download Full-text