Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial

Emmanuelle Vidal-Petiot, Amanda Stebbins, Karen Chiswell, Diego Ardissino, Phil Aylward, Christopher P. Cannon, Marco A. Ramos Corrales, Claes Held, Jose Luis López-Sendón, Ralph A.H. Stewart, Lars Wallentin, Harvey D. White, Philippe Gabriel Steg

Research output: Contribution to journalArticle

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Abstract

Aims To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. Methods and results In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0)mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. Conclusion In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP.

LanguageEnglish
Pages2813-2822
Number of pages10
JournalEuropean Heart Journal
Volume38
Issue number37
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

  • Coronary heart disease
  • STABILITY trial
  • Visit-to-visit variability of blood pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vidal-Petiot, Emmanuelle ; Stebbins, Amanda ; Chiswell, Karen ; Ardissino, Diego ; Aylward, Phil ; Cannon, Christopher P. ; Ramos Corrales, Marco A. ; Held, Claes ; López-Sendón, Jose Luis ; Stewart, Ralph A.H. ; Wallentin, Lars ; White, Harvey D. ; Steg, Philippe Gabriel. / Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial. In: European Heart Journal. 2017 ; Vol. 38, No. 37. pp. 2813-2822.
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title = "Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial",
abstract = "Aims To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. Methods and results In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0)mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95{\%} CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95{\%} CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. Conclusion In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP.",
keywords = "Coronary heart disease, STABILITY trial, Visit-to-visit variability of blood pressure",
author = "Emmanuelle Vidal-Petiot and Amanda Stebbins and Karen Chiswell and Diego Ardissino and Phil Aylward and Cannon, {Christopher P.} and {Ramos Corrales}, {Marco A.} and Claes Held and L{\'o}pez-Send{\'o}n, {Jose Luis} and Stewart, {Ralph A.H.} and Lars Wallentin and White, {Harvey D.} and Steg, {Philippe Gabriel}",
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Vidal-Petiot, E, Stebbins, A, Chiswell, K, Ardissino, D, Aylward, P, Cannon, CP, Ramos Corrales, MA, Held, C, López-Sendón, JL, Stewart, RAH, Wallentin, L, White, HD & Steg, PG 2017, 'Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial', European Heart Journal, vol. 38, no. 37, pp. 2813-2822. https://doi.org/10.1093/eurheartj/ehx250

Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial. / Vidal-Petiot, Emmanuelle; Stebbins, Amanda; Chiswell, Karen; Ardissino, Diego; Aylward, Phil; Cannon, Christopher P.; Ramos Corrales, Marco A.; Held, Claes; López-Sendón, Jose Luis; Stewart, Ralph A.H.; Wallentin, Lars; White, Harvey D.; Steg, Philippe Gabriel.

In: European Heart Journal, Vol. 38, No. 37, 01.10.2017, p. 2813-2822.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial

AU - Vidal-Petiot, Emmanuelle

AU - Stebbins, Amanda

AU - Chiswell, Karen

AU - Ardissino, Diego

AU - Aylward, Phil

AU - Cannon, Christopher P.

AU - Ramos Corrales, Marco A.

AU - Held, Claes

AU - López-Sendón, Jose Luis

AU - Stewart, Ralph A.H.

AU - Wallentin, Lars

AU - White, Harvey D.

AU - Steg, Philippe Gabriel

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Aims To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. Methods and results In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0)mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. Conclusion In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP.

AB - Aims To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. Methods and results In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0)mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. Conclusion In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP.

KW - Coronary heart disease

KW - STABILITY trial

KW - Visit-to-visit variability of blood pressure

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U2 - 10.1093/eurheartj/ehx250

DO - 10.1093/eurheartj/ehx250

M3 - Article

VL - 38

SP - 2813

EP - 2822

JO - European heart journal

T2 - European heart journal

JF - European heart journal

SN - 0195-668X

IS - 37

ER -