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Visit-to-visit blood pressure variability and mortality and cardiovascular outcomes after acute myocardial infarction

Journal of Human Hypertension volume 36, pages 960–967 (2022)Cite this article

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Abstract

The relationship between visit-to-visit blood pressure variability (BPV) and cardiovascular outcomes remains unclear. Our study assessed the prognostic implications of visit-to-visit BPV in patients after acute myocardial infarction (AMI). The present study enrolled 7,375 patients who underwent percutaneous coronary intervention for AMI and at least five measurements of blood pressure after hospital discharge. Visit-to-visit BPV was estimated as variability independent of mean. The primary endpoint was all-cause mortality. The secondary endpoints were major cardiovascular events (the composite of cardiovascular death, myocardial infarction, and ischemic stroke) and hospitalization for heart failure. During a median follow-up of 5.8 years, adjusted risks of all-cause mortality, major cardiovascular events, and hospitalization for heart failure continuously increased as systolic BPV and diastolic BPV increased. Patients in the highest quartile of systolic BPV (versus lowest) had increased risk of all-cause mortality (adjusted hazard ratio (aHR) 1.51 [95% confidence interval (CI) 1.23–1.85]), major cardiovascular events (aHR 1.31 [95% CI 1.1–1.55]), and hospitalization for heart failure (aHR 2.15 [95% CI 1.49–3.1]). Patients in the highest quartile of diastolic BPV was also associated with all-cause mortality (aHR 1.39 [95% CI 1.14–1.7]), major cardiovascular events (aHR 1.29 [95% CI 1.08–1.53]), and hospitalization for heart failure (aHR 2.01[95% CI 1.4–2.87]). Both systolic and diastolic BPV improved the predictive ability of the GRACE (Global Registry of Acute Coronary Events) risk score for both all-cause mortality and major cardiovascular events. Higher visit-to-visit BPV was associated with increased risks of mortality and cardiovascular events in patients after AMI.

Current guidelines recommend using the mean of multiple blood pressure (BP) measurements across separate visits to identify and treat hypertension [1, 2]. BP has been shown to vary from visit to visit, with this visit-to-visit BP variability had been reported to be an important risk factor for poor cardiovascular outcomes [3,4,5]. Higher BP variability has been shown to be an independent predictor of all-cause and cardiovascular mortality, stroke, and cardiac disease from high-risk patients to general populations [3,4,5,6,7,8,9].

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Fig. 1: Cumulative incidence of clinical outcomes by visit-to-visit systolic blood pressure variability.

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Acknowledgements

The authors thank Jinseob Kim, MD, MPH, and Misun Park, MS, for their excellent statistical support and analyses. The authors also thank the clinical research coordinators and members of the cardiac catheterization laboratories at the participating centers.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Eun Ho Choo, Ji-Su Mok, Woo Baek Chung, Byung-Hee Hwang, Ho Joong Youn, Wook Sung Chung & Kiyuk Chang

  2. Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Sungmin Lim, Chan Joon Kim & Jong-Min Lee

  3. Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Ik Jun Choi, Kwan Yong Lee & Doo Soo Jeon

  4. Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea

    Mahn-Won Park

  5. Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Chul Soo Park

  6. Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hee-Yeol Kim

  7. Division of Cardiology, Department of Internal Medicine, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea

    Ki-Dong Yoo

  8. Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea

    Min Chul Kim, Myung Ho Jeong & Youngkeun Ahn

  9. Department of Preventive Medicine, Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hyeon-Woo Yim

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  1. Eun Ho Choo
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Contributions

Conception and design: KC. Acquisition of data: KC, YA, SL, IJC, KYL, B-HH, CJK, M-WP, JML, DBK, SHH, CSP, HYK, KDY, DSJ, HJY, WSC, MCK, MHJ. Analysis and interpretation of data: SL, IJC, EHC. Drafting of the manuscript or revising it critically for important intellectual content: EHC, J-S Mok, WBC, KC. Final approval of the manuscript submitted: KC.

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Correspondence to Kiyuk Chang.

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Choo, E.H., Mok, JS., Chung, W.B. et al. Visit-to-visit blood pressure variability and mortality and cardiovascular outcomes after acute myocardial infarction. J Hum Hypertens 36, 960–967 (2022). https://doi.org/10.1038/s41371-021-00594-5

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