Study On The Correlation Between Blood Pressure Variability And Clinical Prognosis In Elderly Patients With Hypertensio

Background and Objective:Hypertension is a significant global public health concern that increases the risk of various cardiovascular diseases and mortality.Despite numerous guidelines recommending mean blood pressure as the fundamental clinical indicator for hypertension prevention and treatment,blood pressure variability(BPV)has received less attention.Visit-to-visit BPV is an indicator calculated by office blood pressure measurements during follow-up period.Previous clinical research on visit-to-visit BPV has failed to establish a consensus on its clinical value due to factors such as differences in cohort composition,evaluation methods,measurement tools,and evaluation indicators.However,recent studies(including the SPRINT and STEP trials)have introduced new approaches for treating hypertension,emphasizing that intensive blood pressure reduction could substantially reduce the incidence of adverse events associated with hypertension.As a result,many guidelines have suggested stricter blood pressure control targets,with a recommended target blood pressure of less than.130/80 mmHg for hypertensive patients.Consequently,the clinical value of blood pressure variability in populations receiving more stringent blood pressure treatment targets needs to be research.This study aims to investigate the predictive value of BPV in elderly hypertensive populations for cardiovascular events and to explore the factors that influence visit-to-visit BPV.Methods:This study is based on the STEP(Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients)trial,a multicenter,prospective,randomized controlled study on hypertension.Baseline information(including demographic characteristics,clinical features,comorbidities,and medication),blood pressure-lowering treatment strategy,follow-up information(including follow-up clinic blood pressure measurements,home blood pressure monitoring values,medication changes,etc.),and clinical endpoint events were collected from the STEP cohort of elderly hypertensive patients aged 60-80 years old to investigate the predictive value of visit-to-visit BPV for cardiovascular adverse events in this population and explore the influencing factors of blood pressure variability.In this study,visit-to-visit blood pressure variability was defined as the coefficient of variation(CV),standard deviation(SD),Delta,and variance-independent of mean(VIM)of blood pressure measurements(including systolic and diastolic blood pressure)during the 6th,9th,12th,15th,and 18th month follow-up periods after enrollment.The restricted cubic spline functions were used to fit the relationship between each BPV parameter and clinical endpoint events.Cox proportional hazard models were used to calculate the hazard ratios(HRs)and 95%confidence intervals(CIs)for the relative risk of 1-SD increase BPV indexes and clinical endpoint event occurrence in the two groups of patients receiving different antihypertension strategies.Multivariate regression models were used to explore the related influencing factors of clinic blood pressure variability in the overall population.Result:In analyzing the association between visit-to-visit BPV and clinical endpoints in elderly hypertensive patients,a total of 7678 patients from the STEP trial were included,with a mean age of 66.19±4.79 years and 53.5%being male.Visit-to-visit BPV showed a linear correlation with clinical event risk.In the overall population,after adjusting for various confounding factors such as patient demographic characteristics,clinical features,antihypertensive treatment strategies,and antihypertensive medication,the study found that visit-to-visit diastolic blood pressure variability(DBPV)was significantly associated with clinical endpoints(adjusted HR≥1.19;P≤0.009),while visit-to-visit systolic blood pressure variability(SBPV)had no clear association with cardiovascular events(P≥0.16).Sensitivity analysis validated these results.In the analysis of factors affecting blood pressure variability,a multivariable regression model for the total 7678 hypertensive patients showed that the use of beta-blockers may be associated with increased visit-to-visit DBPV,while standard antihypertensive treatment and aspirin use can reduce visit-to-visit DBPV.E levated visit-to-visit SBPV was significantly associated with female sex,history of hyperlipidemia,higher Framingham score(FRS),and the use of diuretics and beta-blockers,while standard antihypertensive treatment may reduce visit-to-visit SBPV.In the analysis of the prognostic value of visit-to-visit BPV in patients with different treatment strategies,the study included a total of 3875 patients who received intensive antihypertensive treatment(with a blood pressure target of 110-130 mmHg for systolic pressure)and 3803 patients who received standard antihypertensive treatment(with a blood pressure target of 130-150 mmHg for systolic pressure).In the standard treatment group,elevated visit-to-visit DBPV was significantly associated with cardiovascular events(adjusted HR≥1.21;P≤0.029),while visit-to-visit SBPV had no significant association with cardiovascular events.In the intensive treatment group,both visit-to-visit SBPV and visit-to-visit DBPV were not associated with clinical adverse events(P≥0.30)Conclusion:This study found that visit-to-visit DBPV was an independent risk factor for cardiovascular adverse events in elderly hypertensive patients aged 60-80 years.For elderly hypertensive patients,clinicians should pay more attention to the continuous monitoring of diastolic blood pressure.Stratified analysis of different antihypertensive strategy groups showed that in patients receiving standard antihypertensive therapy,visitto-visit DBPV can be used as an independent predictor of the risk of cardiovascular events and increased diastolic blood pressure variability means a higher risk of adverse cardiovascular events including coronary heart disease,heart failure,and stroke occurred.Factors affecting the level of visit-to-visit BPV in the clinic included:gender,hyperlipidemia,Framingham score,receiving intensive antihypertensive therapy,using diuretics and β-blockers,and using aspirin.Receiving intensive antihypertensive treatment may increase blood pressure fluctuations in patients,but studies on the antihypertensive treatment group found that increased blood pressure variability(including diastolic and systolic blood pressure variability)is not associated with increased cardiovascular risk.Clinicians should therefore continue to focus on office BP control rather than management of BPV in populations already receiving intensive antihypertensive therapy unless a clear benefit of reducing BP variability is shown in prospective trials.In addition,we found that BPV based on home blood pressure measurements was not associated with cardiovascular event risk in the elderly population.Background and Purpose: Long-term Blood Pressure Variability(BPV)is an indicator that assesses an individual’s blood pressure fluctuations over weeks,months,or even years.It’s influenced by physiological factors,behavior factors,environmental factors,antihypertensive treatment.The clinical value of long-term BPV is still controversial.Post-hoc analyses of previous large clinical trials and multiple meta-analyses have demonstrated that elevated long-term BPV is an independent risk factor for cardiovascular events and other adverse events.However,some studies have suggested that long-term BPV is not associated with clinical adverse events and that its predictive value for cardiovascular events is not superior to average blood pressure.Most previous studies on long-term BPV are based on office blood pressure measurement(OBPM)and overlook the role of home blood pressure measurement(HBPM)in assessing blood pressure variability.With the development of home blood pressure monitoring devices,HBPM is increasingly being used in clinical blood pressure management and is widely recommended in hypertension management guidelines in many countries.Compared to OBPM,HBPM has the advantages of high convenience and cost-effectiveness.Additionally,HBPM is closer to flie real-life environment of the measured individual and avoids the effect of white coat hypertension.Therefore,BPV based on HBPM has the potential to reflect the blood pressure fluctuation in a patient’s daily life.However,HBPM also has some drawbacks,including non-standardized measurements,unstable measurement frequency,and a significant impact of patient compliance.Currently,research on home blood pressure variability(HBPV)is mostly small-sample,short-term studies,and studies on HBPV based on home blood pressure measurements have focused on short-term blood pressure variability studies(such as 24-hour blood pressure variability and day-to-day blood pressure variability) or small-sample cohorts and lack large-scale clinical studies on long-term blood pressxire variability based on long-term home blood pressure monitoring.Additionally,some studies have suggested that visit-to-visit blood pressure variability(OBPV)and HBPV may represent different mechanisms,reflecting different characteristics of blood pressure fluctuation,and providing different information about cardiovascular homeostatic regxilation.Therefore,the clinical value of long-term HBPV and its association and difference with OBPV are worth further exploration.To explore die prognostic value of HBPV in elderly hypertensive patients receiving antihypertensive treatment by analyzing the association between HBPV and cardiovascular events in the elderly hypertensive population aged 60-80 years.This research will help for optimizing blood pressure monitoring and management in elderly hypertensive patients.Method: Based on the research backgroxmd mentioned above,this study will conduct a post-hoc analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertension Patients(STEP)study,which aimed to investigate the different antihypertension strategies in elderly hypertension patients in China.The STEP study was a large,multicenter,prospective,randomized controlled trial comparing the cardiovascular benefits of standard antihypertension treatment versus intensive treatment in randomly assigned patients.This study first collected clinical characteristics,home blood pressure monitoring values,and outcome event information from 6,832 elderly hypertensive patients included in the STEP study.HBPV was defined as the standard deviation(SD),coefficient of variation(CV),and average real variability(ARV)of self-measured blood pressure values from the 6th to the 18 th month after enrollment.Cox proportional hazard regression models were used to investigate the association between HBPV and major outcome events,major adverse cardiac events(MACE),and acute coronary syndrome(ACS).Multiple regression models were used to explore the factors influencing HBPV,and Pearson correlation analysis was used to investigate the correlation between HBPV and OBPV.Results: In the Cox proportional hazards regression model,we found that after adjusting for covariates,there was no association between home blood pressure variability and the risk of primary outcome events,MACE,and ACS(P≥0.059).Additionally,we separately analyzed the association between home blood pressure measurements and clinical events in different antihypertensive treatment groups,and the results were consistent with the above findings.Factors such as gender,BMI, smoking,and average blood pressure were associated with the level of HBPV,and factors such as female gender and smoking may lead to an elevated HBPV.The correlation analysis between OBPV and HBPV suggested that the correlation between them was weak(|r|<0.2).Conclusion: Based on the above findings,HBPV calculated using home blood pressure monitoring values was not associated with primary outcome events,MACE and ACS among elderly hypertensive patients.Thus,in the patients receiving antihypertensive treatment,clinicians should pay more attention to the average home blood pressure level and antihypertensive achievement rate rather than HBPV.