Association of Variability and Hypertensive Loads in 24-h Blood Pressure with Mortality and Cardiovascular Risk

Jesus D. Melgarejo, Dhrumil Patil, Luis J. Mena, Kristina P. Vatcheva, Jose A. Garcia, Claudia L. Satizabal, Carlos A. Chavez, Rosa V. Pirela, Egle Silva, Gustavo Calmon, Joseph H. Lee, Joseph D. Terwilliger, Sudha Seshadri, Gladys E. Maestre

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Evidence shows that high 24-h blood pressure (BP) variability increases cardiovascular risk. We investigated whether 24-h BP variability relates to mortality and cardiovascular risk due to inherent variability and/or hypertensive loads in 24-h BP. METHODS: A total of 1,050 participants from the Maracaibo Aging Study (mean age, 66 years; women, 67.2%) underwent 24-h ambulatory BP monitoring and were followed between 2001 and 2016. To evaluate inherent BP variability, we used average real variability (ARV) as it captures variability among consecutive BP readings. 24-h systolic BP load was the proportion (%) of systolic BP readings ≥130 mm Hg during the daytime and ≥110 during the nighttime. Our primary endpoint was total mortality and major adverse cardiovascular endpoints (MACE). Statistics included Cox proportional models. RESULTS: During a median follow-up of 8.3 years, 299 participants died and 210 experienced MACE. Each +2 mm Hg (corresponding to 1-standard deviation) higher 24-h systolic ARV (mean value, 9.0 ± 2.0 mm Hg) was associated with higher hazard ratios (HRs) for mortality by 1.28-fold (95% confidence interval [CI], 1.14-1.43) and for MACE by 1.24-fold (95% CI, 1.08-1.42). Each 30% higher 24-h systolic BP load (median value, 63%) was associated with mortality and MACE with HRs of 1.29 (95% CI, 1.15-1.46) and 1.28 (95% CI, 1.10-1.48); respectively. After models were additionally adjusted by BP level, only ARV was associated with mortality (HR, 1.17; 95% CI, 1.04-1.33) and MACE (HR, 1.16; 95% CI, 1.00-1.34). CONCLUSIONS: High ARV and hypertensive loads in 24-h systolic BP were associated with mortality and cardiovascular risk, however, only ARV is associated independently of the BP level.

Original languageEnglish (US)
Pages (from-to)323-333
Number of pages11
JournalAmerican Journal of Hypertension
Volume37
Issue number5
DOIs
StatePublished - May 2024

Keywords

  • ambulatory blood pressure monitoring
  • blood pressure
  • blood pressure loads
  • blood pressure variability
  • cardiovascular risk
  • hypertension
  • population-based science

ASJC Scopus subject areas

  • Internal Medicine

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