BP variability in young adults may predict midlife CVD, all-cause mortality
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Measurements of visit-to-visit BP variability may be used to identify young adults who are at increased risk for CVD and all-cause mortality at midlife, according to findings published in JAMA Cardiology.
Using BP measurements from baseline and 2, 5, 7 and 10 years after baseline adjusted for a single BP measure at the year 10 examination, researchers found that for CVD events, the HRs for each 1-standard deviation (SD) increase in BP measures were:
- 1.25 for mean BP; 95% CI, 0.9-1.74;
- 1.23 for variability independent of the mean BP; 95% CI, 1.07-1.43; and
- 0.99 for annual change of BP; 95% CI, 0.81-1.26.
Moreover, variability independent of the mean for BP was the only BP pattern associated with all-cause mortality (HR = 1.24; 95% CI, 1.09-1.41), according to the study.
“Our research was significant because the findings contribute to improved assessment of BP-related risk in young adults by focusing not only on individual ‘average’ BP level but also its ‘variability’ over time,” Yuichiro Yano, MD, PhD, assistant professor of family medicine and community health at Duke University, told Healio. “The BP guideline in the U.S. recommends using an ‘average’ of multiple BP measurements over time for screening for and management of high BP in young adults. While it is well known that BP varies across visits, that ‘variability’ (ie, visit-to-visit BP variability) is dismissed as a random fluctuation in the clinical setting. Little is known regarding the clinical relevance of visit-to-visit BP variability over time in young adults.”
CARDIA analysis
In this prospective analysis of the CARDIA study, researchers assessed a sample of young adults (n = 3,394; mean age at 10-year examination, 35 years; 46% black; 56% women; 3% taking antihypertensive medication) enrolled from March 1985 to June 1986 for a median follow-up of 20 years with the aim of using BP variability to identify individuals at risk for CVD and all-cause mortality at middle age.
Unresolved questions
“There are at least two unresolved questions. First, our results require further testing in an independent cohort to determine whether the assessment of visit-to-visit systolic BP variability in clinical practice improves detection and subsequent medical management of young adults at higher risk for cardiovascular disease events. In the clinical setting, electronic health record systems could be programmed to calculate a person’s visit-to-visit BP variability over time, which could help clinicians identify individuals at high risk for cardiovascular disease events,” Yano said in an interview. “Second, from this study, it remains uncertain whether higher visit-to-visit BP variability is a causal driver for cardiovascular disease events or a marker of poor health. Some meta-analyses that included post hoc studies from randomized controlled trials have suggested that changes in visit-to-visit BP variability attributed to intensification of antihypertensive medication were associated with greater reduction in stroke risk, independently of changes in average BP levels. Calcium channel blockers have a stronger effect in reducing visit-to-visit BP variability compared to other classes of antihypertensive medication (eg, ACE inhibitors, angiotensin receptor blockers and beta-blockers).Thus, persons with high visit-to-visit BP variability may benefit more when prescribed calcium channel blockers instead of other classes of antihypertensive medication.” – by Scott Buzby
For more information:
Yuichiro Yano, MD, PhD, can be reached at yuichiro.yano@duke.edu.
Disclosures: Yano reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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