The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population

Introduction: Blood pressure trajectories have been associated with cardiovascular disease (CVD) in observational studies. It is unclear whether these associations are independent of average blood pressure over time. Methods: We used data from SPRINT to identify systolic blood pressure (SBP) trajectories among a cohort of 8901 participants by incorporating SBP measures during the first 12 months of the trial post randomization. Trajectories were identified using latent class based modeling. Study outcomes included incident CVD, defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death attributable to CVD, and all-cause mortality. Cox proportional hazards models were used to evaluate associations between SBP trajectories and our outcomes of interest. Results: Four distinct SBP trajectories were identified: ‘low decline’ (40%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%) (Figure 1). Relative to the low decline group, the low stable group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the high stable group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68) after baseline multivariable adjustment. Relative to the low stable group, the high stable group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). When adjusting for average blood pressure across the 12 month time period, there were no significant differences in outcomes. Conclusion: We identified 4 SBP trajectories using data from SPRINT and found differences in the risk of CVD and all-cause mortality after baseline adjustment. However, there were no differences in the risk of these outcomes after adjusting for average blood pressure over time. These results suggest that the pattern of blood pressure control may not be relevant as long as the target blood pressure is achieved.

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Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

European Journal of Preventive Cardiology ◽

10.1177/2047487319877268 ◽

2019 ◽

Vol 27 (9) ◽

pp. 978-987 ◽

Cited By ~ 4

Author(s):

Kristofer Hedman ◽

Nicholas Cauwenberghs ◽

Jeffrey W Christle ◽

Tatiana Kuznetsova ◽

Francois Haddad ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Exercise Testing ◽

Lower Risk ◽

Metabolic Equivalents ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Clinical Exercise Testing

Aims The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. Methods and results Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan–Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects ( n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08–1.32) and 1.20 (1.10–1.31), respectively). In subjects with high fitness, a SBP/MET-slope > 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12–1.45)). Conclusion In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.

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Modifying Effect of Statins on Fatal Outcomes in Chronic Kidney Disease Patients in the Systolic Blood Pressure Intervention Trial: A Post Hoc Analysis

American Journal of Nephrology ◽

10.1159/000499188 ◽

2019 ◽

Vol 49 (4) ◽

pp. 297-306 ◽

Cited By ~ 1

Author(s):

Manuel Rivera ◽

Leonardo Tamariz ◽

Maritza Suarez ◽

Gabriel Contreras

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Statin Therapy ◽

Statin Group ◽

All Cause Mortality ◽

Modifying Effect ◽

Post Hoc ◽

Event Rates

Background: Management of chronic kidney disease (CKD) patients includes efforts directed toward modifying traditional cardiovascular risk factors. Such efforts include optimal management of hypertension together with the initiation of statin therapy. Methods: In this observational study, we determine the modifying effect of statins on the relationship of systolic blood pressure (SBP) goal with mortality and other outcomes in patients with CKD participating in a clinical trial. At baseline, 2,646 CKD patients (estimated glomerular filtration rate < 60 mL/min/1.73 m2) were randomized to an intensive SBP goal < 120 mm Hg or standard SBP goal <140 mm Hg. One thousand two hundred and seventy-three were not on statin, 1,354 were on a statin, and in 19 the use of statin was unknown. The 2 primary outcomes were all-cause mortality and cardiovascular disease (CVD) mortality. Results: The relationships of SBP goal with all-cause mortality (interaction p = 0.009) and cardiovascular (CV) mortality (interaction p = 0.021) were modified by the use of statin after adjusting for age, gender, race, CVD history, smoking, aspirin use, and blood pressure at baseline. In the statin group, targeting SBP to < 120 mm Hg compared to SBP < 140 mm Hg significantly reduced the risk of all-cause mortality (adjusted hazard ratio [aHR] 0.44 [0.28–0.71]; event rates 1.16 vs. 2.5 per 100 patient-years) and CV mortality (aHR 0.29 [0.12–0.74]; event rates 0.28 vs. 0.92 per 100 patient-years) after a median follow-up of 3.26 years. In the non-statin group, the risk of all-cause mortality (aHR 1.07 [0.69–1.66]; event rates 2.01 vs. 1.94 per 100 patient-years) and CV mortality (aHR 1.42 [0.56–3.59]; event rates 0.52 vs. 0.41 per 100 patient-years) were not significantly different in both SBP goal arms. Conclusion: The combination of statin therapy and intensive SBP management leads to improved survival in hypertensive patients with CKD.

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HUBUNGAN INDEKSMASSA TUBUH DAN LINGKAR PINGGANG DENGAN TEKANAN DARAH LAKI-LAKI DEWASA

JURNAL MEDIA KESEHATAN ◽

10.33088/jmk.v9i2.314 ◽

2018 ◽

Vol 9 (2) ◽

pp. 193-199

Author(s):

Tamariani Manullang

Keyword(s):

Blood Pressure ◽

Waist Circumference ◽

Systolic Blood Pressure ◽

Study Design ◽

Computer Software ◽

Adult Males ◽

Cross Sectional ◽

Relationship Of ◽

The Relationship

Prevalence of hypertension in adult males was highest in PuskesmasBasuki Rahmat (16.2%) as many as 648 cases of hypertension patients which hasincreased compared to 2012 by 12% in cases of hypertension totaled 482 patients((Dinkes Kota, 2013). This study aims to determine the relationship of body massindex (BMI) and waist circumference (WC) with systolic blood pressure (BP) in adultmales in Puskesmas Basuki Rahmat Bengkulu City in 2015. The study design wasdescriptive analytic with cross sectional approach. Study location was in PuskesmasBasuki Rahmat City of Bengkulu. Samples were selected using purposive samplingtotalling 68 people. Criterias sample were being adult males who occupied inPuskesmas Basuki Rahmat City of Bengkulu, aged ≥ 18 years, agreed to beinterviewed,and able to communicate actively. Data were obtained include BMI, WCand systolic BP adult males and processed using computer software with pearsoncorrelation analysis.The results showed that there was relationship between BMI andsystolic BP (p = 0.0005; r = 0.395); between WC and systolic BP (p = 0.004 and r =0.347) in adult males. This study concluded that there was relationship between BMIand WC with systolic BP in adult males in Puskesmas Basuki Rahmat Bengkulu Cityin 2015.

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