22 Jan Blood Pressure Variability in Mid-Life Associated With Greater Cardiovascular Risk
MedicalResearch.com Interview with:
Yuichiro Yano MD
Assistant Professor in Family Medicine and Community Health
MedicalResearch.com: What is the background for this study?
Response: The blood pressure (BP) guideline in the US recommend using an “average” of multiple BP measurements over time for screening for and management of high BP in young adults. While it is well known that BP varies across visits, that “variability” (i.e., visit-to-visit blood pressure variability) is dismissed as a random fluctuation in the clinical setting.
Little is known regarding the clinical relevance of visit-to-visit blood pressure variability over time in young adults.
MedicalResearch.com: What are the main findings?
Response: This is a prospective cohort study of 3,394 African Americans and whites; the mean (±standard deviation) age of the participants was 35.1±3.6 years, 45.9% were African American, 55.7% were female, and 3% were taking antihypertensive medication. Higher long-term visit-to-visit systolic BP variability from young adulthood to midlife was associated with an increased risk for cardiovascular disease events (hazard ratio 1.23 per standard deviation higher level) and all-cause mortality (hazard ratio 1.26) by middle age. These associations were independently of average systolic BP levels during young adulthood and a single systolic blood pressure measure in midlife.
MedicalResearch.com: What should readers take away from your report?
Response: Our research was significant because the findings contribute to improved assessment of blood pressure-related risk in young adults by focusing not only on individual average BP level but also its variability over time.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: At least two different types of research are required. First, our results require further testing in an independent cohort to determine whether the assessment of visit-to-visit systolic BP variability in clinical practice improves detection and subsequent medical management of young adults at higher risk for cardiovascular disease events. In the clinical setting, electronic health record systems could be programmed to calculate a person’s visit-to-visit BP variability over time, which could help clinicians identify individuals at high risk for cardiovascular disease events. Second, from this study, it remains uncertain whether higher visit-to-visit BP variability is a causal driver for cardiovascular disease events or a marker of poor health. Some meta-analyses that included post hoc studies from randomized controlled trials have suggested that changes in visit-to-visit BP variability attributed to intensification of antihypertensive medication were associated with greater reduction in stroke risk, independently of changes in average BP levels.
Calcium channel blockers have a stronger effect in reducing visit-to-visit BP variability compared to other classes of antihypertensive medication (e.g., angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta blockers).Thus, persons with high visit-to-visit BP variability may benefit more when prescribed calcium channel blockers instead of other classes of antihypertensive medication.
Yano Y, Reis JP, Lewis CE, et al. Association of Blood Pressure Patterns in Young Adulthood With Cardiovascular Disease and Mortality in Middle Age. JAMA Cardiol. Published online January 22, 2020. doi:10.1001/jamacardio.2019.5682
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Last Updated on January 22, 2020 by Marie Benz MD FAAD