Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial)

Tara I Chang, David M Reboussin, Glenn M Chertow, Alfred K Cheung, William C Cushman, William J Kostis, Gianfranco Parati, Dominic Raj, Erik Riessen, Brian Shapiro, George S Stergiou, Raymond R Townsend, Konstantinos Tsioufis, Paul K Whelton, Jeffrey Whittle, Jackson T Wright, Vasilios Papademetriou, SPRINT Research Group*

Research output: Contribution to journalArticlepeer-review

Abstract

Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP targets. We defined OBPV as the coefficient of variation of the systolic BP using measurements taken during the 3-,6-, 9-, and 12-month study visits. In our cohort of 7879 participants, older age, female sex, black race, current smoking, chronic kidney disease, and coronary disease were independent determinants of higher OBPV. Use of thiazide-type diuretics or dihydropyridine calcium channel blockers was associated with lower OBPV whereas angiotensin-converting enzyme inhibitors or angiotensin receptor blocker use was associated with higher OBPV. There was no difference in OBPV in participants randomized to standard or intensive treatment groups. We found that OBPV had no significant associations with the composite end point of fatal and nonfatal cardiovascular events (n=324 primary end points; adjusted hazard ratio, 1.20; 95% confidence interval, 0.85-1.69, highest versus lowest quintile) nor with heart failure or stroke. The highest quintile of OBPV (versus lowest) was associated with all-cause mortality (adjusted hazard ratio, 1.92; confidence interval, 1.22-3.03) although the association of OBPV overall with all-cause mortality was marginal (P=0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.

Original languageEnglish
Pages (from-to)751-758
Number of pages8
JournalHypertension
Volume70
Issue number4
DOIs
Publication statusPublished - Oct 2017

Keywords

  • Aged
  • Antihypertensive Agents
  • Blood Pressure
  • Blood Pressure Determination
  • Cardiovascular Diseases
  • Heart Failure
  • Humans
  • Hypertension
  • Male
  • Middle Aged
  • Office Visits
  • Outcome and Process Assessment (Health Care)
  • Patient Care Planning
  • Renal Insufficiency, Chronic
  • Risk Assessment
  • Risk Factors
  • United States
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

Fingerprint

Dive into the research topics of 'Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial)'. Together they form a unique fingerprint.

Cite this