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Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality

BACKGROUND: Information is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long‐te...

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Autores principales: Chowdhury, Enayet K., Nelson, Mark R., Wing, Lindon M. H., Jennings, Garry L. R., Beilin, Lawrence J., Reid, Christopher M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898807/
https://www.ncbi.nlm.nih.gov/pubmed/31679444
http://dx.doi.org/10.1161/JAHA.119.012630
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author Chowdhury, Enayet K.
Nelson, Mark R.
Wing, Lindon M. H.
Jennings, Garry L. R.
Beilin, Lawrence J.
Reid, Christopher M.
author_facet Chowdhury, Enayet K.
Nelson, Mark R.
Wing, Lindon M. H.
Jennings, Garry L. R.
Beilin, Lawrence J.
Reid, Christopher M.
author_sort Chowdhury, Enayet K.
collection PubMed
description BACKGROUND: Information is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long‐term mortality in an elderly hypertensive population. METHODS AND RESULTS: We used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24‐hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow‐up). Weighted day‐night systolic BPV was calculated for both baseline and follow‐up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day‐night systolic BPV between baseline and follow‐up. Having constant stable: high BPV was associated with an increase in all‐cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow‐up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group. CONCLUSIONS: Our results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow‐up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long‐term mortality.
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spelling pubmed-68988072019-12-16 Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality Chowdhury, Enayet K. Nelson, Mark R. Wing, Lindon M. H. Jennings, Garry L. R. Beilin, Lawrence J. Reid, Christopher M. J Am Heart Assoc Original Research BACKGROUND: Information is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long‐term mortality in an elderly hypertensive population. METHODS AND RESULTS: We used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24‐hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow‐up). Weighted day‐night systolic BPV was calculated for both baseline and follow‐up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day‐night systolic BPV between baseline and follow‐up. Having constant stable: high BPV was associated with an increase in all‐cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow‐up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group. CONCLUSIONS: Our results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow‐up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long‐term mortality. John Wiley and Sons Inc. 2019-11-04 /pmc/articles/PMC6898807/ /pubmed/31679444 http://dx.doi.org/10.1161/JAHA.119.012630 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Chowdhury, Enayet K.
Nelson, Mark R.
Wing, Lindon M. H.
Jennings, Garry L. R.
Beilin, Lawrence J.
Reid, Christopher M.
Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality
title Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality
title_full Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality
title_fullStr Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality
title_full_unstemmed Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality
title_short Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality
title_sort change in blood pressure variability among treated elderly hypertensive patients and its association with mortality
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898807/
https://www.ncbi.nlm.nih.gov/pubmed/31679444
http://dx.doi.org/10.1161/JAHA.119.012630
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