Patients with greater variations in blood pressure over multiple office visits have a greater risk of cardiovascular disease (CVD) and all-cause mortality, reports research in the Annals of Internal Medicine.

In the prospective cohort study, 25,814 participants aged ≥55 from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) had their blood pressure measured during seven clinical office visits that were conducted from six to 28 months following ALLHAT enrollment. Visit-to-visit variability (VVV) of systolic blood pressure (BP) and diastolic BP was compared to rates of cardiovascular disease (CVD) and mortality outcomes, including fatal coronary heart disease (CHD) or nonfatal myocardial infarction (MI), all-cause mortality, stroke, and heart failure.

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During follow-up (average 2.8 years), there were 1,194 fatal CHD or nonfatal MI events, 1,948 deaths, 606 strokes, and 921 heart failure events. After multivariable adjustment, the hazard ratio comparing participants in the highest vs. lowest quintile of SD of SBP (≥14.4mmHg vs. <6.5mmHg) was 1.30 (95% CI, 1.06– 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32– 1.90) for all-cause mortality, 1.46 (CI, 1.06– 2.01) for stroke, and 1.25 (CI, 0.97– 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality; long-term outcomes were not available.

Additional studies are needed to evaluate if reducing VVV of BP can lower the risk of CVD and all-cause mortality, the authors conclude.

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