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Ten-second central SBP variability predicts first and recurrent cardiovascular events

Sluyter, John D.a; Camargo, Carlos A. Jrb; Scragg, Robert K.R.a

doi: 10.1097/HJH.0000000000001930

Objective: Long-term (day-to-day or visit-to-visit) blood pressure variability (BPV) predicts elevated risk of cardiovascular events but represents just one BPV type. We examined whether 10-s BPV predicts cardiovascular events.

Methods: In 4999 adults (58% men; aged 50–84 years; 670 with a prior cardiovascular event), we performed suprasystolic brachial pressure measurements over ∼10 s, yielding aortic pressure waveforms. BPV was calculated by average real variability (ARV), root mean square of successive differences, standard deviation (SD), coefficient of variation and relative range. Participants were followed up for 4.6 years (median), accruing 310 first and 187 recurrent cardiovascular events, respectively.

Results: In multivariable-adjusted analyses, all central SBPV parameters were associated with first cardiovascular events: the standardized hazard ratio for each ranged from 1.25 to 1.29. The hazard ratio between the lowest and highest sextile ranged from 1.92 [95% confidence interval (CI) 1.31–2.80] for coefficient of variation to 2.19 (95% CI 1.38–3.46) for ARV. All central SBPV parameters also were associated with higher risk of recurrent cardiovascular events: adjusted standardized hazard ratio ranged from 1.16 to 1.21. Because of fewer recurrent events, these low-versus-high comparisons were based on tertiles; hazard ratios between the lowest and highest tertiles ranged from 1.50 (95% CI 1.02–2.23) for ARV to 1.76 (95% CI 1.20–2.60) for SD. The highest categorical net reclassification improvement for 5-year risk of first cardiovascular events was 13% (95% CI 7–18%) and substantially higher among those with intermediate (10–20%) risk: 39% (95% CI 26–52%).

Conclusion: Ten-second central SBPV parameters predict first and recurrent cardiovascular events.

aSchool of Population Health, University of Auckland, Auckland, New Zealand

bDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Dr John D. Sluyter, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64 9 9236702; fax: +64 9 3737503; e-mail:

Abbreviations: ARV, average real variability; BPV, blood pressure variability; CVD, cardiovascular disease; NRI, net reclassification improvement; RMSSD, root mean square of successive differences; SD, standard deviation

Received 3 May, 2018

Accepted 2 August, 2018

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