Visit-to-Visit Variability of Blood Pressure and @entity301 , XXXX , @entity712 , and Mortality: A Cohort Study.

@entity1 @entity64 @entity712 @entity301 @entity299 @entity583 @entity65
Background: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a @entity1 's underlying BP. Objective: To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with @entity65 ( @entity65 ) and mortality outcomes. Design: Prospective cohort study. Setting: Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent @entity299 Trial). @entity1 : 25  814 ALLHAT @entity1 . Measurements: The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. @entity1 without @entity65 events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal @entity301 ( @entity301 ) or nonfatal @entity583 , all-cause mortality, @entity64 , and @entity712 . Results: During follow-up, 1194 fatal @entity301 or nonfatal MI events, 1948 deaths, 606 @entity64 , and 921 @entity712 events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing @entity1 in the highest versus lowest quintile of SD of SBP (>= 14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal @entity301 or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for @entity64 , and 1.25 (CI, 0.97 to 1.61) for @entity712 . Higher VVV of diastolic BP was also associated with @entity65 events and mortality. Limitation: Long-term outcomes were not available. Conclusion: Higher VVV of SBP is associated with an increased risk for @entity65 and mortality. Future studies should examine whether reducing VVV of BP lowers this risk. Primary Funding Source: National Institutes of Health.
