scholarly journals Associations between Five-Year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality

2020 ◽  
Author(s):  
Jiandong Zhou ◽  
Sharen Lee ◽  
Wing Tak Wong ◽  
William KK Wu ◽  
Wai Kit Ming ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Pressure Measurements ◽  
Time To Death ◽  
All Cause Mortality ◽  
Maximum Minimum

AbstractIntroductionBlood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes.MethodsThe retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of >=5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/stroke, with follow-up until 31 December 2019.ResultsThis study included 37540 patients (n=29597 patients with >=3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (P<0.001). Higher variance/SD/CV/variability score of both systolic and diastolic blood pressure was significantly associated with increased risks of all-cause mortality and heart failure, acute myocardial infarction and TIA/stroke (P<0.001). Low baseline/latest/maximum/minimum/mean/median/RMS systolic blood pressure was significantly associated with shorter time-to-death for all-cause mortality (P<0.001).ConclusionNonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke.

scholarly journals BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF IN-HOSPITAL CARDIO-RENAL OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

2019 ◽  
Vol 37 ◽  
pp. e83
Author(s):  
E. Mantzouranis ◽  
C. Tsioufis ◽  
K. Konstantinou ◽  
A. Koumelli ◽  
N. Vogiatzakis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Blood Pressure Variability ◽  
Renal Outcomes

Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

2020 ◽  
Vol 41 (17) ◽  
pp. 1673-1683 ◽  
Author(s):  
Michael Böhm ◽  
João Pedro Ferreira ◽  
Felix Mahfoud ◽  
Kevin Duarte ◽  
Bertram Pitt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP &lt;70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P &lt; 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P &lt; 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P &lt; 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316880 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Shanjie Wang ◽  
Jinxin Liu ◽  
Yini Wang ◽  
Hengxuan Cai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Plaque Rupture ◽  
Risk Of Death ◽  
Increased Risk ◽  
Clinical Covariates ◽  
All Cause Mortality ◽  
D Dimer

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.MethodsWe enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.ResultsOver a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.ConclusionsD-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

scholarly journals Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study

2013 ◽  
Vol 26 (10) ◽  
pp. 1210-1217 ◽  
Author(s):  
Astrid M. Suchy-Dicey ◽  
Erin R. Wallace ◽  
Mitchell S. Elkind ◽  
Maria Aguilar ◽  
Rebecca F. Gottesman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
All Cause Mortality

scholarly journals BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIOVASCULAR OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

2019 ◽  
Vol 37 ◽  
pp. e301
Author(s):  
K. Konstantinou ◽  
C. Tsioufis ◽  
E. Mantzouranis ◽  
A. Koumelli ◽  
A. Kasiakogias ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Blood Pressure Variability ◽  
Cardiovascular Outcomes

Within-Visit Blood Pressure Variability in an Unselected Adult Population

2021 ◽  
Vol 34 (10) ◽  
pp. 1125-1126
Author(s):  
Xin Chen ◽  
Shao-kun Xu ◽  
Yan Li ◽  
Zhe Hu ◽  
Hong-yu Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Coefficient Of Variation ◽  
Blood Pressure Variability ◽  
Adult Population ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Pressure Measurements

Abstract Background To investigate blood pressure variability among 3 successive blood pressure measurements in an unselected nationwide population in China. Methods A total of 77,549 participants were included from measurements in May 2017 in China. Blood pressure was measured 3 times consecutively with a half minute interval. Blood pressure variability was estimated with the standard deviation and coefficient of variation of the systolic and diastolic blood pressure. Results Not all participants showed a decreasing trend with increasing number of measurements. In fact, 14% of the participants showed at least 5 mm Hg increase in systolic blood pressure. The coefficient of variation of systolic and diastolic blood pressure in women was higher than in men [(4.2 ± 3.3)% vs. (4.1 ± 3.3)%, (4.7 ± 4.0)% vs. (4.6 ± 4.1)%; P &lt; 0.05]. The differences were significant (P &lt; 0.01) among different groups of age and blood pressure levels. Multiple linear regression analysis showed that the systolic blood pressure variability indexes were inversely associated with age but positively associated with the level of the first systolic blood pressure reading (P &lt; 0.01). The systolic blood pressure standard deviation and coefficient of variation in females were higher than in males (P &lt; 0.01). Conclusions Not all subjects demonstrate a decreasing trend with increasing number of blood pressure measurements. Within-visit blood pressure variability varies with age, gender, and blood pressure.

IN-HOSPITAL BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIO-RENAL OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e218
Author(s):  
K. Konstantinou ◽  
K. Tsioufis ◽  
K. Dimitriadis ◽  
M. Mantzouranis ◽  
A. Koumelli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Blood Pressure Variability ◽  
Renal Outcomes
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