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Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study.

ABSTRACT: OBJECTIVE:This study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs). DESIGN:Prospective cohort study. SETTING:The average real variability of systolic blood pressure (ARVSBP) was the indicator for visit-to-visit BPV. The participants were divided into three groups: normal weight, overweight and obesity. We further divided these groups into four subgroups based on the ARVSBP. A Cox regression model was used to calculate the HRs of the ARVSBP on CVEs in the same and different BMI groups. Additionally, a competitive risk model was used to calculate the HRs of the ARVSBP on CVEs in the same BMI group. PARTICIPANTS:In total, 41?043 individuals met the inclusion criteria (no historical CVEs or tumours, no incidence of CVEs or tumours and no death during the four examinations) and had complete systolic blood pressure and BMI data. RESULTS:A total of 868 CVEs occurred. The cumulative incidence of CVEs increased as ARVSBP rose in both the normal weight and overweight groups. In same BMI groups, the risk of CVEs significantly increased as ARVSBP increased only in the normal weight group (highest quartiles of ARVSBP: HR (95%?CI) 2.20 (1.46-3.31)). In the different BMI groups, the risk of CVEs in the ARVSBP subgroup in each BMI group was higher than that the least quintile of ARVSBP in the normal weight group (highest quartiles of ARVSBP in obesity: HR (95%?CI) 2.28 (1.47-3.55)). The result of the competitive risk model did not change. CONCLUSIONS:As BMI and ARVSBP increase, the risk of CVEs increases. However, the risk of visit-to-visit BPV on CVEs varies in different BMI groups, especially in people of normal weight. TRIAL REGISTRATION NUMBER:CHiCTR-TNC1100 1489.

SUBMITTER: Chen H

PROVIDER: S-EPMC7511611 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study.

Chen Haojia H Chen Youren Y Wu Weiqiang W Huang Jianhuan J Chen Zekai Z Chen Zhichao Z Yan Xiuzhu X Wu Shouling S

BMJ open 20200918 9

<h4>Objective</h4>This study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs).<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>The average real variability of systolic blood pressure (ARV<sub>SBP</sub>) was the indicator for visit-to-visit BPV. The participants were divided into three groups: normal weight, overweight and obesity. We further divided these groups into four ...[more]

PMID: 32948548

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Project description:BackgroundHigh blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among patients with coronary artery disease (CAD), with and without type 2 diabetes mellitus (T2DM).MethodsPatients with stable CAD were enrolled and monitored for new MACE. Visit-to-visit BPV was defined as the coefficient of variation (CV) of systolic and diastolic BP across clinic visits. Multivariable logistic regression analysis was performed to evaluate the association of BPV with MACE. Area under the receiver operating characteristic curve (AUC) was used to assess its predictive ability.ResultsAmong 1140 Chinese patients with stable CAD, 192 (17%) experienced a new MACE. In multivariable analyses, the risk of MACE was significantly associated with CV of systolic BP (odds ratio [OR] for highest versus lowest quartile, 3.30; 95% CI 1.97-5.54), and diastolic BP (OR for highest versus lowest quartile, 2.39; 95% CI 1.39-4.11), after adjustment for variables of the risk factor model (age, gender, T2DM, hypertension, antihypertensive agents, number of BP measurements) and mean BP. The risk factor model had an AUC of 0.70 for prediction of MACE. Adding systolic/diastolic CV into the risk factor model with mean BP significantly increased the AUC to 0.73/0.72 (P = 0.002/0.007). In subgroup analyses, higher CV of systolic BP remained significantly associated with an increased risk for MACE in patients with and without T2DM, whereas the association of CV of diastolic BP with MACE was observed only in those without T2DM.ConclusionsVisit-to-visit variability of systolic BP and of diastolic BP was an independent predictor of new MACE and provided incremental prognostic value beyond mean BP and conventional risk factors in patients with stable CAD. The association of BPV in CAD patients without T2DM with subsequent risk for MACE was stronger than in those with T2DM.

Dataset Information

Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study.

Publications

Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study.

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