Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus
Abstract Background High blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among pati...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-021-01280-z |
| _version_ | 1818676326305890304 |
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| author | Yuen-Kwun Wong Yap-Hang Chan JoJo S. H. Hai Kui-Kai Lau Hung-Fat Tse |
| author_facet | Yuen-Kwun Wong Yap-Hang Chan JoJo S. H. Hai Kui-Kai Lau Hung-Fat Tse |
| author_sort | Yuen-Kwun Wong |
| collection | DOAJ |
| description | Abstract Background High blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among patients with coronary artery disease (CAD), with and without type 2 diabetes mellitus (T2DM). Methods Patients with stable CAD were enrolled and monitored for new MACE. Visit-to-visit BPV was defined as the coefficient of variation (CV) of systolic and diastolic BP across clinic visits. Multivariable logistic regression analysis was performed to evaluate the association of BPV with MACE. Area under the receiver operating characteristic curve (AUC) was used to assess its predictive ability. Results Among 1140 Chinese patients with stable CAD, 192 (17%) experienced a new MACE. In multivariable analyses, the risk of MACE was significantly associated with CV of systolic BP (odds ratio [OR] for highest versus lowest quartile, 3.30; 95% CI 1.97–5.54), and diastolic BP (OR for highest versus lowest quartile, 2.39; 95% CI 1.39–4.11), after adjustment for variables of the risk factor model (age, gender, T2DM, hypertension, antihypertensive agents, number of BP measurements) and mean BP. The risk factor model had an AUC of 0.70 for prediction of MACE. Adding systolic/diastolic CV into the risk factor model with mean BP significantly increased the AUC to 0.73/0.72 (P = 0.002/0.007). In subgroup analyses, higher CV of systolic BP remained significantly associated with an increased risk for MACE in patients with and without T2DM, whereas the association of CV of diastolic BP with MACE was observed only in those without T2DM. Conclusions Visit-to-visit variability of systolic BP and of diastolic BP was an independent predictor of new MACE and provided incremental prognostic value beyond mean BP and conventional risk factors in patients with stable CAD. The association of BPV in CAD patients without T2DM with subsequent risk for MACE was stronger than in those with T2DM. |
| first_indexed | 2024-12-17T08:41:42Z |
| format | Article |
| id | doaj.art-068e61373b934263bf9971b312e7b2b3 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-17T08:41:42Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-068e61373b934263bf9971b312e7b2b32022-12-21T21:56:19ZengBMCCardiovascular Diabetology1475-28402021-04-012011910.1186/s12933-021-01280-zPredictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitusYuen-Kwun Wong0Yap-Hang Chan1JoJo S. H. Hai2Kui-Kai Lau3Hung-Fat Tse4Department of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalAbstract Background High blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among patients with coronary artery disease (CAD), with and without type 2 diabetes mellitus (T2DM). Methods Patients with stable CAD were enrolled and monitored for new MACE. Visit-to-visit BPV was defined as the coefficient of variation (CV) of systolic and diastolic BP across clinic visits. Multivariable logistic regression analysis was performed to evaluate the association of BPV with MACE. Area under the receiver operating characteristic curve (AUC) was used to assess its predictive ability. Results Among 1140 Chinese patients with stable CAD, 192 (17%) experienced a new MACE. In multivariable analyses, the risk of MACE was significantly associated with CV of systolic BP (odds ratio [OR] for highest versus lowest quartile, 3.30; 95% CI 1.97–5.54), and diastolic BP (OR for highest versus lowest quartile, 2.39; 95% CI 1.39–4.11), after adjustment for variables of the risk factor model (age, gender, T2DM, hypertension, antihypertensive agents, number of BP measurements) and mean BP. The risk factor model had an AUC of 0.70 for prediction of MACE. Adding systolic/diastolic CV into the risk factor model with mean BP significantly increased the AUC to 0.73/0.72 (P = 0.002/0.007). In subgroup analyses, higher CV of systolic BP remained significantly associated with an increased risk for MACE in patients with and without T2DM, whereas the association of CV of diastolic BP with MACE was observed only in those without T2DM. Conclusions Visit-to-visit variability of systolic BP and of diastolic BP was an independent predictor of new MACE and provided incremental prognostic value beyond mean BP and conventional risk factors in patients with stable CAD. The association of BPV in CAD patients without T2DM with subsequent risk for MACE was stronger than in those with T2DM.https://doi.org/10.1186/s12933-021-01280-zBlood pressure variabilityCoronary artery diseaseRisk predictionType 2 diabetes mellitus |
| spellingShingle | Yuen-Kwun Wong Yap-Hang Chan JoJo S. H. Hai Kui-Kai Lau Hung-Fat Tse Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus Cardiovascular Diabetology Blood pressure variability Coronary artery disease Risk prediction Type 2 diabetes mellitus |
| title | Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_full | Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_fullStr | Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_full_unstemmed | Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_short | Predictive value of visit-to-visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_sort | predictive value of visit to visit blood pressure variability for cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| topic | Blood pressure variability Coronary artery disease Risk prediction Type 2 diabetes mellitus |
| url | https://doi.org/10.1186/s12933-021-01280-z |
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