Jin-ming Yu1, Qun-yu Kong2, Paul Schoenhagen3, Tian Shen2, Yu-song He4, Ji-wei Wang2, Yan-ping Zhao5, Dan-ni Shi4, Bao-liang Zhong6. 1. Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China. Electronic address: jmyfudan@163.com. 2. Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China. 3. Cleveland Clinic, Imaging Institute and Heart & Vascular Institute, Cleveland, OH, USA. 4. Medical Affairs of Great China Region of Novartis, Beijing, China. 5. Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China. 6. Department of Science and Education, Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Abstract
BACKGROUND: The prognostic significance of long-term visit-to-visit blood pressure variability (BPV) has not yet been validated in "real world" hypertensive patients. The aim of the current study is to explore the prognostic value of BPV on stroke in hypertensive patients. METHODS: This was a dynamic prospective cohort study based on electronic medical records in Shanghai, China. Hypertensive patients (N=122,636) without history of stroke at baseline, were followed up from 2005 to 2011. The cohort comprised of 4522 stroke patients and 118,114 non-stroke patients during a mean follow-up duration of 48 months. BPV was measured by standard deviation (SD) and the coefficient of variation (CV) of blood pressure. RESULTS: The visit-to-visit variability of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was independently associated with the occurrence of stroke [SD: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.042 (1.021 to 1.064) and 1.052 (1.040 to 1.065); CV: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.183 (1.010 to 1.356) and 1.151 (1.005 to 1.317), respectively]. The hazard ratio values increased along with an increase of the BPV levels of SBP and DBP. The increment effect remained significant after controlling the blood pressure control status of subjects. CONCLUSIONS: Increased BPV of both SBP and DBP, independent of the average blood pressure, is a predictor of stroke among community hypertensive patients in real-world clinical practice. The risk of stroke increased along with increased BPV. Stabilizing BPV might be a therapeutic target in hypertension.
RCT Entities:
BACKGROUND: The prognostic significance of long-term visit-to-visit blood pressure variability (BPV) has not yet been validated in "real world" hypertensivepatients. The aim of the current study is to explore the prognostic value of BPV on stroke in hypertensivepatients. METHODS: This was a dynamic prospective cohort study based on electronic medical records in Shanghai, China. Hypertensivepatients (N=122,636) without history of stroke at baseline, were followed up from 2005 to 2011. The cohort comprised of 4522 strokepatients and 118,114 non-strokepatients during a mean follow-up duration of 48 months. BPV was measured by standard deviation (SD) and the coefficient of variation (CV) of blood pressure. RESULTS: The visit-to-visit variability of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was independently associated with the occurrence of stroke [SD: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.042 (1.021 to 1.064) and 1.052 (1.040 to 1.065); CV: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.183 (1.010 to 1.356) and 1.151 (1.005 to 1.317), respectively]. The hazard ratio values increased along with an increase of the BPV levels of SBP and DBP. The increment effect remained significant after controlling the blood pressure control status of subjects. CONCLUSIONS: Increased BPV of both SBP and DBP, independent of the average blood pressure, is a predictor of stroke among community hypertensivepatients in real-world clinical practice. The risk of stroke increased along with increased BPV. Stabilizing BPV might be a therapeutic target in hypertension.
Authors: Sarah L Stevens; Sally Wood; Constantinos Koshiaris; Kathryn Law; Paul Glasziou; Richard J Stevens; Richard J McManus Journal: BMJ Date: 2016-08-09