Association of Variability and Hypertensive Loads in 24-h Blood Pressure with Mortality and Cardiovascular Risk

Authors

Jesus D. Melgarejo, The University of Texas Rio Grande ValleyFollow
Dhrumil Patil, Katholieke Universiteit Leuven
Luis J. Mena, Polytechnic University of Sinaloa
Kristina P. Vatcheva, The University of Texas Rio Grande ValleyFollow
Jose A. Garcia, The University of Texas Rio Grande Valley
Claudia Satizabal, University of Texas Health Science Center at San Antonio
Carlos A. Chavez, Universidad del Zulia
Rosa V. Pirela, The University of Texas Rio Grande ValleyFollow
Sudha Seshadri, University of Texas Health Science Center at San Antonio
Gladys E. Maestre, The University of Texas Rio Grande ValleyFollow

Document Type

Article

Publication Date

1-31-2024

Abstract

Background: Evidence shows that high 24-h blood pressure (BP) variability increases cardiovascular risk. We investigated whether 24-h BP variability relates to mortality and cardiovascular risk due to inherent variability and/or hypertensive loads in 24-h BP.

Methods: A total of 1050 participants from the Maracaibo Aging Study (mean age, 66y; women, 67.2%) underwent 24-h ambulatory BP monitoring and were followed between 2001-2016. To evaluate inherent BP variability, we used average real variability (ARV) as it captures variability among consecutive BP readings. 24-h systolic BP load was the proportion (%) of systolic BP readings ≥130 mmHg during the daytime and ≥110 during the nighttime. Our primary endpoint was total mortality and major adverse cardiovascular endpoints (MACE). Statistics included Cox proportional models.

Results: During a median follow-up of 8.3 years, 299 participants died and 210 experienced MACE. Each +2 mmHg (corresponding to 1-standard deviation) higher 24-h systolic ARV (mean value, 9.0±2.0 mmHg) was associated with higher hazard ratios (HR) for mortality by 1.28-fold (95% confidence interval [CI], 1.14-1.43) and for MACE by 1.24-fold (95% CI, 1.081.42). Each 30% higher 24-h systolic BP loads (median value, 63%) was associated with mortality and MACE with HRs of 1.29 (95% CI, 1.15-1.46) and 1.28 (95% CI, 1.101.48); respectively. After models were additionally adjusted by BP level, only ARV was associated with mortality (HR, 1.17; 95% CI, 1.04-1.33) and MACE (HR, 1.16; 95% CI, 1.00-1.34).

Conclusions: High ARV and hypertensive loads in 24-h systolic BP were associated with mortality and cardiovascular risk, however only ARV is associated independently of the BP level.

Comments

Original published version available at https://doi.org/10.1093/ajh/hpae011

Recommended Citation

Melgarejo, J. D., Patil, D., Mena, L. J., Vatcheva, K. P., Garcia, J. A., Satizabal, C. L., Chavez, C. A., Pirela, R. V., Silva, E., Calmon, G., Lee, J. H., Terwilliger, J. D., Seshadri, S., & Maestre, G. E. (2024). Association of Variability and Hypertensive Loads in 24-h Blood Pressure With Mortality and Cardiovascular Risk. American journal of hypertension, 37(5), 323–333. https://doi.org/10.1093/ajh/hpae011

Publication Title

American Journal of Hypertension

DOI

10.1093/ajh/hpae011

Academic Level

faculty

Mentor/PI Department

Neuroscience