BP variability at midlife tied to long-term all-cause, CHD, stroke mortality

Blood pressure variability (BPV) over 5 years in a cohort of tenured male workers appears to increase the risk of 18-year all-cause, coronary heart disease (CHD), and stroke mortality, suggests a recent study.

“Elevated BP is associated with cardiovascular mortality,” the authors said. “BPV is also associated with cardiovascular mortality, [but] most studies evaluated hypertensive patients with a relatively short follow-up.”

This study included 10,059 men, aged 40–65 years, tenured civil servants, and municipal employees in Israel, among whom 9,398 who were examined in 1963, 1965, and 1968 had assessment of diabetic and coronary morbidity status and systolic (S)BP levels. Participants underwent clinical and biochemical assessments and had their BP measured in the recumbent position on the right arm.

The authors carried out analysis for standard deviation (SD)-SBP across study visits. They also calculated hazard ratios (HRs) for 18-year all-cause mortality, CHD, and stroke mortality associated with quintile of SD-SBP, with the lowest quintile serving as a reference.

In multivariate analysis, SD-SBP significantly correlated with all-cause, CHD, and stroke mortality. Age- and SBP-adjusted HRs of all-cause mortality for quintile 2–5 were as follows: 1.02 (95 percent confidence interval [CI], 0.90–1.17), 1.06 (95 percent CI, 0.94–1.20), 1.20 (95 percent CI, 1.06–1.35), and 1.36 (95 percent CI, 1.21–1.53), respectively.

Likewise, age-adjusted risk for CHD and stroke mortality elevated with increasing SD-SBP. Further adjustment for smoking, body mass index, diabetes mellitus, and CHD yielded similar results, according to the authors.