Kui Kai Lau1, Yuen Kwun Wong1, Yap Hang Chan2, Kay Cheong Teo1, Koon Ho Chan1, Leonard Sheung Wai Li3, Raymond Tak Fai Cheung1, Chung Wah Siu2, Shu Leong Ho4, Hung Fat Tse5. 1. Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong. 2. Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong. 3. Division of Rehabilitation Medicine, Department of Medicine, The University of Hong Kong, Hong Kong. 4. Neurology Division, Department of Medicine, The University of Hong Kong, Hong Kong. Electronic address: slho@hku.hk. 5. Cardiology 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.
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.
Authors: Edouard L Fu; Marco Trevisan; Catherine M Clase; Marie Evans; Bengt Lindholm; Joris I Rotmans; Merel van Diepen; Friedo W Dekker; Juan-Jesus Carrero Journal: Clin J Am Soc Nephrol Date: 2019-08-08 Impact factor: 8.237
Authors: Sarah L Stevens; Sally Wood; Constantinos Koshiaris; Kathryn Law; Paul Glasziou; Richard J Stevens; Richard J McManus Journal: BMJ Date: 2016-08-09