Abstract 16912: Visit-to-visit Variability of Blood Pressure Predicts Cardiovascular Outcome in Patients With Coronary Artery Disease From the Stability Trial
Introduction: Although elevated blood pressure (BP) is a well-established risk factor for cardiovascular events, recent studies have also highlighted the higher cardiovascular risk associated with an elevated BP variability, as assessed by visit-to-visit variability, independently of mean BP level. However, the risk associated with BP variability in a population of patients with coronary artery disease (CAD) has never been evaluated.
Methods: In 15,828 patients from the STABILITY trial (darapladib versus placebo in patients with established CAD), BP variability was assessed by the standard deviation (SD) of systolic BP and diastolic BP from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomization. The primary endpoint was the composite of time to cardiovascular death, myocardial infarction, or stroke (major adverse cardiac event, MACE) occurring after the first 12 months after randomization. Patients lost to follow-up or with an event during the first year were excluded from all analyses.
Results: Subsequent to 1 year post randomization, the median follow-up time was 2.6 years in 13,794 patients. During this period, a total of 1010 patients experienced a MACE (among first MACE 410 were cardiovascular death, 423 non-fatal myocardial infarction, and 177 non-fatal stroke). Mean (SD) of the average systolic BP over first year of study was 131 (13.7) mmHg and the average diastolic BP was 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD in SBP was 9.8 (4.8) mmHg, and 6.3 (3.0) mmHg for SD in DBP. In Cox regression models adjusted for mean BP during first year of study, treatment allocation, baseline vascular disease, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP [hazard ratio per 5mmHg increase, 1.13, 95% confidence interval (95% CI) 1.06-1.21, P<0.001], and with SD of diastolic BP [hazard ratio 1.28, 95% CI 1.15-1.41, P<0.001].
Conclusions: In patients with CAD, higher visit-to-visit BP variability is a strong predictor of increased risk of cardiovascular events, independently of mean BP.
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- © 2016 by American Heart Association, Inc.