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Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the INTERMAP study

Journal of Human Hypertension volume 33, pages 229–236 (2019)Cite this article

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Abstract

Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40–59 years from four countries (Japan, the People’s Republic of China [PRC], the United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and mechanisms of these findings remain to be elucidated.

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Acknowledgements

This research was supported by Grant 2-RO1-HL50490-06 from the US National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; by the Chicago Health Research Foundation; and by national agencies in PRC, Japan (the Ministry of Education, Science, Sports, and Culture, Grant-in-Aid for Scientific Research A090357003), and in the UK. PE is Director of the Medical Research Council-Public Health England (MRC-PHE) Center for Environment and Health and acknowledges support from the Medical Research Council and Public Health England (MR/L01341X/1). PE acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Center at Imperial College Healthcare NHS Trust and Imperial College London, and the NIHR Health Protection Research Unit in Health Impact of Environmental Hazards (HPRU-2012-10141). PE is a UK Dementia Research Institute (DRI) Professor, UK DRI at Imperial College London, funded by the MRC, Alzheimer’s Society and Alzheimer’s Research UK.

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Authors and Affiliations

  1. Department of Public Health, Shiga University of Medical Science, Otsu, Japan

    Naoyuki Takashima, Katsuyuki Miura, Naoko Miyagawa & Hirotsugu Ueshima

  2. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

    Takayoshi Ohkubo

  3. Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan

    Katsuyuki Miura & Hirotsugu Ueshima

  4. Research Institute of Strategy for Prevention, Tokyo, Japan

    Akira Okayama

  5. Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan

    Nagako Okuda

  6. Department of Public Health, Kanazawa Medical University, Kanazawa, Japan

    Hideaki Nakagawa

  7. School of Health Sciences, Sapporo Medical University, Sapporo, Japan

    Shigeyuki Saito

  8. Department of Hygiene and Public Health, Iwate Medical University, Yahaba, Japan

    Kiyomi Sakata

  9. National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh

    Sohel Reza Choudhury

  10. MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Queenie Chan & Paul Elliott

  11. Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

    Liancheng Zhao

  12. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jeremiah Stamler

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  1. Naoyuki Takashima
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  2. Takayoshi Ohkubo
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  3. Katsuyuki Miura
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  13. Paul Elliott
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  14. Hirotsugu Ueshima
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  15. Jeremiah Stamler
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INTERMAP Study Group

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Correspondence to Naoyuki Takashima.

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Takashima, N., Ohkubo, T., Miura, K. et al. Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the INTERMAP study. J Hum Hypertens 33, 229–236 (2019). https://doi.org/10.1038/s41371-018-0129-z

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