Variable Blood Pressure Associated With Cardiovascular Risk
Blood pressure variability is linked with heart attacks, stroke, narrowing of the arteries and other cardiovascular events, according to a new study by Cedars-Sinai investigators. The findings, published in eClinicalMedicine, suggest clinicians should take patients' blood pressure fluctuations into account when considering their cardiovascular risk.
"It's not just elevated blood pressure itself that should be cause for concern," said Joseph Ebinger, MD, first author of the study, clinical cardiologist and director of Clinical Analytics in the Smidt Heart Institute at Cedars-Sinai. "This study shows that fluctuations in blood pressure over the course of months or years also can lead to poor health outcomes."
Blood pressure is measured by two numbers: The systolic higher number, which reflects pressure in the arteries when the heart beats, and the diastolic lower number, which reflects arterial pressure between beats. The more force a person's heart has to use to pump blood through the arteries, the higher the person's risk for heart attack, stroke and other cardiovascular issues.
Joseph E. Ebinger, MD
The investigators reviewed the electronic medical records of 42,482 patients whose blood pressure readings were taken at medical appointments occurring between 2013 and 2019. After calculating the variability of the patients' blood pressure readings, the investigators examined the associations between this variability and the patients' health outcomes. They found the greater the degree of fluctuation for a patient's blood pressure—regardless of the patient's average blood pressure level—the more likely it was that the patient would experience a cardiovascular event. This was true even after the investigators accounted for differences in age, sex and other medical problems the patients may have had.
Electronic health records could be programmed to automatically calculate blood pressure variability for individual patients, which could serve as an important tool to help doctors advise patients in real time, according to the authors.
"This study highlights a great example of how doctors could leverage electronic health record data to understand new information about a patient's cardiovascular risks while in the clinic," said senior author Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science and director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute.
The authors next plan to study what noncardiovascular conditions may be linked with blood pressure variability and whether reducing blood pressure variability can decrease risk for adverse health events.
Other Cedars-Sinai investigators who worked on this study are Matthew Driver, MPH; David Ouyang, MD; Patrick Botting, MSHS; Mohamad Rashid, MBChB; Ciantel Blyler, PharmD; Natalie Bello, MD, MPH; Florian Rader, MD; and Christine Albert, MD, MPH.
Funding: This study was funded by the National Institutes of Health (award numbers R01-HL134168, R01-HL131532, R01-HL143227, R01-HL142983, U54-AG065141, R01-HL153382, K23-HL136853, K23-HL153888 and K99-HL157421), the China Scholarship Council grant (award number 201806260086), the Academy of Finland (award number 321351), the Emil Aaltonen Foundation and the Finnish Foundation for Cardiovascular Research.