Emmanuelle Vidal-Petiot1,2,3, Amanda Stebbins4, Karen Chiswell4, Diego Ardissino5, Philip E Aylward6, Christopher P Cannon7, Marco A Ramos Corrales8, Claes Held9, José Luis López-Sendón10, Ralph A H Stewart11, Lars Wallentin9, Harvey D White11, Philippe Gabriel Steg1,2,12. 1. Cardiology and Physiology Departments, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France. 2. Paris Diderot University, Sorbonne Paris Cité, Paris, France. 3. INSERM U1149, Paris, France. 4. Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA. 5. Azienda Ospedaliero, Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy. 6. South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia. 7. Cardiovascular Division, Brigham and Women's Hospital, 70 Francis street, Boston, MA 02115, USA and former employee at Harvard Clinical Research Institute, Boston, MA, USA. 8. San Jose Satelite Hospital, Naucalpan, Circunvalacion Poniente 53, 53100 Naucalpan de Juárez, Mexico. 9. Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 14B, SE-752 37 Uppsala, Sweden. 10. Hospital Universitario La Paz, IdiPaz, Paseo de la Castellana 261, Planta 1, 28046 Madrid, Spain. 11. Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New Zealand. 12. NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK, FACT (French Alliance for Cardiovascular Trials), F-CRIN network, INSERM U1148, Paris, France.
Abstract
AIMS: To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. METHODS AND RESULTS: In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. CONCLUSION: In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. METHODS AND RESULTS: In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. CONCLUSION: In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP. Published on behalf of the European Society of Cardiology. All rights reserved.
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