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Atherosclerosis. 2014 Jul;235(1):230-5. doi: 10.1016/j.atherosclerosis.2014.04.015. Epub 2014 May 9.

Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases--relationships and comparisons with vascular markers of atherosclerosis.

Author information

  • 1Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong.
  • 2Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong.
  • 3Division of Rehabilitation Medicine, Department of Medicine, The University of Hong Kong, Hong Kong.
  • 4Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong. Electronic address: slho@hku.hk.
  • 5Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong. Electronic address: hftse@hkucc.hku.hk.

Abstract

BACKGROUND:

Visit-to-visit blood pressure variability (BPV) is a simple surrogate marker for the development of atherosclerotic diseases, cardiovascular and all-cause mortality. Nevertheless, the relative prognostic value of BPV in comparison with other established vascular assessments remain uncertain.

METHODS:

We prospectively followed-up 656 high-risk patients with diabetes or established cardiovascular or cerebrovascular diseases for the occurrence of major adverse cardiovascular events (MACEs). Baseline brachial endothelial function, carotid intima-media thickness (IMT) and plaque burden, ankle-brachial index and arterial stiffness were determined. Visit-to-visit BPV were recorded during a mean 18 ± 9 outpatient clinic visits.

RESULTS:

After a mean 81 ± 12 month's follow-up, 123 patients (19%) developed MACEs. Patients who developed a MACE had significantly higher systolic BPV, more severe endothelial function, arterial stiffness and systemic atherosclerotic burden compared to patients who did not develop a MACE (all P<0.01). BPV significantly correlated with all of the vascular assessments (P<0.01). A high carotid IMT had the greatest prognostic value in predicting development of a MACE (area under receiver operating characteristic curve (AUC) 0.69 ± 0.03, P<0.01). A high BPV also had moderate prognostic value in prediction of MACE (AUC 0.65 ± 0.03, P<0.01). After adjustment of confounding factors, a high BPV remained a significant independent predictor of MACE (hazards ratio 1.67, 95% confidence interval 1.14-2.43, P<0.01).

CONCLUSIONS:

Compared with established surrogate markers of atherosclerosis, visit-to-visit BPV provides similar prognostic information and may represent a new and simple marker for adverse outcomes in patients with vascular diseases.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Blood pressure variability; Cardiovascular and cerebrovascular diseases; Vascular markers

PMID:
24861726
[PubMed - in process]
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