Dataset Information

The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

ABSTRACT: AIMS:The aim of this study was to determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease, heart failure and stroke risks. METHODS AND RESULTS:Black and White participants, N?=?11,129, enrolled in the Atherosclerosis Risk in Communities study (mean age 53.9?±?5.7 (SD) years) were included. Each participant had three sitting, five supine, and six standing blood pressure measures during one day. Main outcome measures were changes in estimated coronary heart disease, heart failure and stroke risk when using the different blood pressure measures. Mean sitting, standing and supine systolic blood pressure values of the study population were 120.8?±?18.6, 124.9?±?20 and 124.7?±?19.6?mmHg, respectively. The substitution of the second sitting systolic blood pressure with the third sitting systolic blood pressure (taken ?5?min later) in two separate coronary heart disease risk models reclassified 3.3% to 5.1% of study participants. Similar substitutions for heart failure and stroke risk prediction models led to reclassification of 1.9% and 2.7% of participants respectively. When mean sitting systolic blood pressure was replaced with mean standing systolic blood pressure 5.4% to 11.6% of the participants were reclassified. Maximum upward and downward change in an individual's estimated risk was 31% and 26% respectively. CONCLUSIONS:Estimated risks of coronary heart disease, heart failure, and stroke for an individual can change significantly within a day due to changes in systolic blood pressure. Given recommendations to use estimated risk for therapeutic decisions, our study has implications for the use of a single systolic blood pressure in cardiovascular risk estimation.

SUBMITTER: Ogunwale AN

PROVIDER: S-EPMC4981557 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

Ogunwale Abayomi N AN Morrison Alanna C AC Sun Wensheng W Dodge Rhiannon C RC Virani Salim S SS Taylor Addison A Gottesman Rebecca F RF Yang Eric E Wei Peng P McEvoy John W JW Heiss Gerardo G Boerwinkle Eric E Ballantyne Christie M CM Nambi Vijay V

European journal of preventive cardiology 20160211 14

<h4>Aims</h4>The aim of this study was to determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease, heart failure and stroke risks.<h4>Methods and results</h4>Black and White participants, N = 11,129, enrolled in the Atherosclerosis Risk in Communities study (mean age 53.9 ± 5.7 (SD) years) were included. Each participant had three sitting, five supine, and six standing blood pressu ...[more]

PMID: 26869459

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Project description:IMPORTANCE:Studies document a progressive increase in heart disease risk as systolic blood pressure (SBP) rises above 115 mm Hg, but it is unknown whether an SBP lower than 120 mm Hg among adults with hypertension (HTN) lowers heart failure, stroke, and myocardial infarction risk. OBJECTIVE:To examine the risk of incident cardiovascular (CV) events among adults with HTN according to 3 SBP levels: 140 mm Hg or higher; 120 to 139 mm Hg; and a reference level of lower than 120 mm Hg. DESIGN, SETTING, AND PARTICIPANTS:A total of 4480 participants with HTN but without prevalent CV disease at baseline (years 1987-1989) from the Atherosclerosis Risk in Communities Study were included. Measurements of SBP were taken at baseline and at 3 triennial visits; SBP was treated as a time-dependent variable and categorized as elevated (?140 mm Hg), standard (120-139 mm Hg), and low (<120 mm Hg). Multivariable Cox regression models included baseline age, sex, diabetes status, BMI, high cholesterol level, smoking status, and alcohol intake. MAIN OUTCOMES AND MEASURES:Incident composite CV events (heart failure, ischemic stroke, myocardial infarction, or death related to coronary heart disease). RESULTS:After a median follow-up of 21.8 years, a total of 1622 incident CV events had occurred. Participants with elevated SBP developed incident CV events at a significantly higher rate than those in the low BP group (adjusted hazard ratio [HR], 1.46; 95% CI, 1.26-1.69). However, there was no difference in incident CV event-free survival among those in the standard vs low SBP group (adjusted HR, 1.00; 95% CI, 0.85-1.17). Further adjustment for BP medication use or diastolic BP did not significantly affect the results. CONCLUSIONS AND RELEVANCE:Among patients with HTN, having an elevated SBP carries the highest risk for cardiovascular events, but in this categorical analysis, once SBP was below 140 mm Hg, an SBP lower than 120 mm Hg did not appear to lessen the risk of incident CV events.

Project description:BackgroundAccurate blood pressure (BP) measurement is essential for the diagnosis and management of hypertension. In clinical practice, BP is estimated using noninvasive methods with significant variability of application of guidelines in clinical practice, impacting the accuracy and certainty of BP measurements.ObjectiveWe sought to assess how BP is measured in clinical practice.MethodsA survey was administered through professional societies that included predominantly cardiologists. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to the level of confidence in clinic BP measurement.ResultsThere were 571 surveys completed. The majority of respondents were cardiologists (61.1%), with 47 preventive cardiologists. BP was routinely checked in both arms by 53% at the initial visit, 48% check BP once each visit, and 64% wait 5 min before initial BP assessment. Automated BP assessment is used by 58% respondents. The majority (83%) trust their BP readings, and those who trust their BP readings are more likely to perform the initial BP assessment themselves, compared to those who do not trust the clinic BP readings (30.2% vs. 13.6%, P = 0.009). Accurate BP measurement is performed by 23% of cardiologists, and more likely performed accurately by a preventive cardiologist (38.3%) compared with other cardiologists (20.0%, P = 0.007). Accurate BP measurement is more likely for those who perform the initial BP themselves rather than any other staff (36.8% vs. 17.9%; P<0.001); and for those who repeat BP manually (80% vs. 54%; P<0.001), compared to those who do not measure BP accurately. Despite the inaccuracy of BP measurement, there is a high level of confidence in the BP readings.ConclusionsAccurate BP assessment continues to remain suboptimal in clinical practice. Reliability of BP assessment requires education, identifying barriers to implementation of recommendations and engagement of the entire team to improve BP assessment.

Dataset Information

The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

Publications

The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

Similar Datasets

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