Outcome-Driven Thresholds for Increased Home Blood Pressure Variability

Eeva P Juhanoja; Teemu J Niiranen; Jouni K Johansson; Pauli J Puukka; Lutgarde Thijs; Kei Asayama; Ville L Langén; Atsushi Hozawa; Lucas S Aparicio; Takayoshi Ohkubo; Ichiro Tsuji; Yutaka Imai; George S Stergiou; Antti M Jula; Jan A Staessen; International Database on Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO) Investigators

doi:10.1161/HYPERTENSIONAHA.116.08603

Outcome-Driven Thresholds for Increased Home Blood Pressure Variability

Hypertension. 2017 Apr;69(4):599-607. doi: 10.1161/HYPERTENSIONAHA.116.08603. Epub 2017 Feb 13.

Authors

Eeva P Juhanoja¹, Teemu J Niiranen², Jouni K Johansson², Pauli J Puukka², Lutgarde Thijs², Kei Asayama², Ville L Langén², Atsushi Hozawa², Lucas S Aparicio², Takayoshi Ohkubo², Ichiro Tsuji², Yutaka Imai², George S Stergiou², Antti M Jula², Jan A Staessen²; International Database on Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO) Investigators

Affiliations

¹ From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.). eeva.juhanoja@utu.fi.
² From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.).

PMID: 28193705
DOI: 10.1161/HYPERTENSIONAHA.116.08603

Abstract

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.

Keywords: blood pressure; epidemiology; hypertension; risk factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Pressure / physiology*
Blood Pressure Monitoring, Ambulatory
Cardiovascular Diseases / diagnosis
Cardiovascular Diseases / epidemiology
Cardiovascular Diseases / physiopathology
Circadian Rhythm / physiology*
Female
Finland / epidemiology
Follow-Up Studies
Greece / epidemiology
Humans
Incidence
Japan / epidemiology
Male
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Surveys and Questionnaires
Time Factors