Is Blood Pressure Variability a Better Predictor of Disease Than Mean Blood Pressure?

Aayush Visaria1, MPH, Louis F. Amorosa2, MD

1Rutgers New Jersey Medical School; 2Rutgers Robert Wood Johnson Medical School; 3North American Disease Intervention

BACKGROUND METHODS RESULTS

Study Methodology
Hypertension is a Global, Worsening Issue Odds of Having Been Diagnosed with Stroke
• A secondary analysis of the National Health and Nutrition Examination Survey III (NHANES III)
• Worldwide, an estimated 1.4 billion adults have 1988-1994, a CDC-based U.S. nationally representative survey, was conducted. A complex, cluster-
Predictor Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI)
Systolic Blood Pressure Variability 1.08 (1.05,1.11)* 0.99 (0.95,1.03)
hypertension. Nearly 1 in 3 have hypertension and sampling method was used to collect data. Diastolic Blood Pressure Variability 1.02 (0.96,1.08) 1.00 (0.94,1.06)
another 1 in 3 are pre-hypertensive Systolic Blood Pressure 1.04 (1.03,1.05)* 1.00 (0.99,1.01)
Statistical Analysis Diastolic Blood Pressure 1.00 (0.98,1.01) 0.99 (0.97,1.00)
• A total of 14,342 adult (>18 years), non-pregnant subjects were included in the study. Those
taking antihypertensive medications and/or with incomplete data on study variables were
excluded from the analysis.
Odds of Having Been Diagnosed with Heart failure
Predictor Variables Measurement
Blood Pressure Variability Standard Deviation (in mmHg) of 3 to 9 Predictor Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI)
(Systolic & Diastolic) consecutive blood pressure readings Systolic Blood Pressure Variability 1.12 (1.09,1.15)* 1.04 (1.01,1.07)*
The Diagnostic Criteria is Fairly Arbitrary Mean Blood Pressure Average (in mmHg) of 3 to 9 consecutive Diastolic Blood Pressure Variability 1.02 (0.98,1.05) 1.00 (0.96,1.03)
(Systolic & Diastolic) blood pressure readings Systolic Blood Pressure 1.04 (1.03,1.05)* 1.00 (0.99,1.02)
• Blood pressure works on a continuous scale, not Outcome Variables Measurement (Survey Questions – Yes/No)
Diastolic Blood Pressure 0.98 (0.96,1.00) 0.98 (0.95,1.00)
dichotomous as suggested by criteria. The higher the
blood pressure, the higher the risk of disease. Myocardial Infarction (MI) "Has a doctor ever told you that you had a heart attack?" Every 1 mmHg in Systolic BPV and mean SBP
Congestive Heart Failure (CHF) "Has a doctor ever told you that you had CHF?" constituted a significant 12% and 4%
Stroke "Has a doctor ever told you that you had a stroke?" increase in odds of having congestive heart
• Multivariate logistic regression models were run adjusting for confounders (age, sex, mean blood
failure.
pressure, LDL, HDL, BMI, fasting blood sugar) and accounting for the complex survey design.
Blood Pressure Fluctuates Constantly Odds of Having Been Diagnosed with Heart Attack
• Blood pressure constantly fluctuates as the body tries RESULTS Predictor Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI)
to adapt to external and internal stimuli. One-time Systolic Blood Pressure Variability 1.10 (1.07, 1.12)* 1.01 (0.99, 1.04)
measurements may not capture these fluctuations. Diastolic Blood Pressure Variability 1.02 (0.99, 1.05) 1.00 (0.97, 1.03)
Positive linear Systolic Blood Pressure 1.04 (1.03, 1.05)* 1.00 (0.99, 1.01)
Diastolic Blood Pressure 0.99 (0.97, 1.00) 0.97 (0.96, 0.99)*
association between
systolic blood pressure
variability and age.
Blood pressure
DISCUSSION
variability patterns
mimic those of mean • There is a clear changing distribution of systolic blood pressure variability
blood pressure. and mean blood pressure with increasing age. Because variability and
averages increase with age at a similar rate, there may be a possible
physiological, general mechanism of aging.
• Increased Systolic BPV was associated with Congestive Heart Failure (CHF)
RESEARCH QUESTIONS even after adjustment for potential confounders (e.g. age, gender),
whereas mean SBP did not increase odds of CHF. This may suggest that BPV,
1. Is Blood Pressure Variability particularly systolic BPV, offers pathophysiological knowledge not captured
by simple mean blood pressure. Calculating variability may be useful
(both systolic and diastolic) a diagnostically, therapeutically and for understanding blood pressure
fluctuations as a function of age.
significant predictor of stroke, • One may speculate that increased fluctuations confer greater stress on the
congestive heart failure, or body to maintain homeostasis, while mean blood pressure values, even if
high, represent a stable, adapted state to the body’s condition.
myocardial infarction? • Limitations include cross-sectional nature of data and lack of environmental,
behavioral, and clinical measures to assess effect of diet and metabolite
levels on distribution of hypertension types.

2. Is Blood Pressure Variability a

better predictor of stroke,
congestive heart failure, and/or
myocardial infarction than From “35-55” to “55-75” there is a large increase in both systolic blood Contact information:
Aayush Visaria, MPH
pressure variability and mean systolic blood pressure, unexplainable by current
mean blood pressure? known physiological mechanisms.
Aayush.visaria@rutgers.edu