Increased visit-to-visit variability (VVV) of blood pressure, which is calculated based on several readings, has been suggested to be a significant predictor of cardiovascular events and mortality, independent of mean blood pressure. This study examined associations between the VVV of systolic blood pressure (SBP) measured annually and cardiovascular disease (CVD) events among 72,617 Japanese subjects. Data were obtained from the Japan Epidemiology Collaboration on Occupational Health Study, which is an ongoing epidemiological survey of workers in Japan. VVV was calculated as the coefficient of variation of SBP readings from 2008 to 2011; information on fatal and nonfatal CVD events was collected from registries of specific outcomes between April 2012 and March 2019. A Cox proportional hazards model was applied to investigate associations after adjusting for mean SBP between 2008 and 2011 and covariates. During the 7-year follow-up period, there were 63 CVD fatalities and 314 CVD events (combining fatal and nonfatal events). The results showed that a one-standard deviation increase in VVV was associated with a significant increase in the risk of CVD mortality (hazard ratio [HR] = 1.42; 95% confidence interval [CI] = 1.32–1.54); those in the highest tertile had a 3.20 times (95% CI = 1.26–8.17) higher risk of CVD mortality than those in the lowest tertile. We found less pronounced associations regarding CVD events (HR = 1.08, 95% CI = 1.02–1.15). In conclusion, VVV was significantly associated with CVD mortality in our Japanese working population.
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The authors thank Toshiteru Okubo (Chairperson of Industrial Health Foundation, Director of Radiation Effects Research Foundation) for scientific advice on the conduct of the J-ECOH Study and Nobumi Katayama, Rika Osawa, Mika Shichishima, Haruka Miyake (National Center for Global Health and Medicine) for administrative support.
This study was financially supported by the Industrial Health Foundation (140202-01, 150903-01, 170301-01), the Japan Society for the Promotion of Science (JSPS KAKENHI JP16H05251) and the National Center for Global Health and Medicine (28-Shi-1206).
The J-ECOH study group
Seitaro Dohi5, Hiroko Okazaki5, Isamu Kabe14, Tohru Nakagawa3, Shuichiro Yamamoto3, Toru Honda3, Toshiaki Miyamoto6, Takeshi Kochi4, Masafumi Eguchi4, Taiki Shirasaka4, Isagi Mizuta10, Makoto Yamamoto10, Naoko Sasaki8, Takayuki Ogasawara8, Makiko Shimizu7, Naoki Gonmori7, Akihiko Uehara9, Kayo Kitahara15, Toshitaka Yokoya15, Ai Hori12, Chihiro Nishiura16, Teppei Imai17, Akiko Nishihara18, Kenji Fukasawa19, Kenya Yamamoto20, Reiko Kuroda20, Noritada Kato21, Masatoshi Kawashima22, Kentaro Tomita11, Chihiro Kinugawa23, Takafumi Totsuzaki24, Masashi Masuda25, Nobuaki Sakamoto26, Yohei Ohsaki26, Aki Tomizawa26, Satsue Nagahama27, Mayumi Ohtsu28, Motoki Endo29, Hiroshi Nakashima30, Masauyki Tatemichi31, Kota Fukai31, Megumi Kawashima32, Naoki Kunugita33, Tomofumi Sone34, Toshiteru Ohkubo35, Tetsuya Mizoue31, Yosuke Inoue1, Takako Miki1, Ami Fukunaga1, Shohei Yamamoto1, Maki Konishi1, Nobumi Katayama1, Rika Osawa1, Keisuke Kuwahara1,2
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Inoue, Y., Kuwahara, K., Hu, H. et al. Visit-to-visit variability of blood pressure and cardiovascular events among the working-age population in Japan: findings from the Japan Epidemiology Collaboration on Occupational Health Study. Hypertens Res 44, 1017–1025 (2021). https://doi.org/10.1038/s41440-021-00654-w
- Cardiovascular diseases
- Longitudinal studies
- Occupational health