Journal
HYPERTENSION
Volume 69, Issue 4, Pages 599-607Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.116.08603
Keywords
blood pressure; epidemiology; hypertension; risk factors
Categories
Funding
- Hospital District of Southwest Finland
- Urmas Pekkala Foundation
- Turku University Foundation
- Finnish Cultural Foundation
- Ministry of Education, Culture, Sports, Science, and Technology, Japan [23249036, 23390171, 24390084, 24591060, 24790654, 25253059, 25461083, 25461205, 25860156, 26282200, 26860093, 16H05243, 16K09472, 16K11850, 16K15359]
- Japan Society for the Promotion of Science (JSPS) [25*7756, 25*9328, 26*857, 27*656]
- Japan Arteriosclerosis Prevention Fund an Intramural Research Fund
- Cardiovascular Diseases of National Cerebral and Cardiovascular Center [22-4-5]
- Health Labor Sciences Research Grant from the Ministry of Health, Labor, and Welfare [H26-Junkankitou [Seisaku]-Ippan-001]
- European Union [HEALTH-FP7-278249-EUMASCARA, HEALTH-F7-305507 HOMAGE]
- European Research Council [2011-294713-EPLORE, 713601-uPROPHET]
- Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium [G.0881.13, G.088013, 11Z0916N]
- Grants-in-Aid for Scientific Research [16K15359, 16K09472, 16K11850] Funding Source: KAKEN
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Increased blood pressure (BP) variability predicts cardiovascular disease, but lack of operational thresholds limits its use in clinical practice. Our aim was to define outcome-driven thresholds for increased day-to-day home BP variability. We studied a population-based sample of 6238 individuals (mean age 60.0 +/- 12.9, 56.4% women) from Japan, Greece, and Finland. All participants self-measured their home BP on 3 days. We defined home BP variability as the coefficient of variation of the first morning BPs on 3 to 7 days. We assessed the association between systolic/diastolic BP variability (as a continuous variable and in deciles of coefficient of variation) and cardiovascular outcomes using Cox regression models adjusted for cohort and classical cardiovascular risk factors, including BP. During a follow-up of 9.3 +/- 3.6 years, 304 cardiovascular deaths and 715 cardiovascular events occurred. A 1 SD increase in systolic/diastolic home BP variability was associated with increased risk of cardiovascular mortality (hazard ratio, 1.17/1.22; 95% confidence interval, 1.06-1.30/1.11-1.34; P=0.003/<0.0001) and cardiovascular events (hazard ratio, 1.13/1.14; 95% confidence interval, 1.05-1.21/1.07-1.23; P=0.0007/0.0002). Compared with the average risk in the whole population, risk of cardiovascular deaths (hazard ratio, 1.66/1.84; 95% confidence interval, 1.27-2.17/1.42-2.37; P=0.0002/<0.0001) and events (hazard ratio, 1.46/1.42; 95% confidence interval, 1.21-1.76/1.17-1.71; P<0.0001/0.0004) was increased in the highest decile of systolic/diastolic BP variability (coefficient of variation>11.0/12.8). Increased home BP variability predicts cardiovascular outcomes in the general population. Individuals with a systolic/diastolic coefficient of variation of day-to-day home BP >11.0/12.8 may have an increased risk of cardiovascular disease. These findings could help physicians identify individuals who are at an increased cardiovascular disease risk.
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