DOI: 10.1097/01.hjh.0000522998.60193.42
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Issn Print: 0263-6352
Publication Date: 2017/09/01
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Abstract
Objective:Increased home blood pressure variability, and especially morning day-to-day variability, has been recognized as an independent predictor of cardiovascular morbidity and mortality. However, the optimal measurement protocol for assessment of home blood pressure variability is unknown. Our aim was to study how many days of measurement are needed to reliably assess day-to-day morning home blood pressure variability.
Design and method:We studied a population sample of 1736 Finnish adults (mean age: 56 ± 8.6 years; 54% women). The participants underwent a clinical examination and self-measured their blood pressure at home twice in the morning during seven consecutive days in 2000–2001. Day-to-day variability of morning home blood pressure was calculated based on the mean of the two morning measurements of each day. We used standard deviation as the variability index. We calculated the standard deviation of home morning blood pressure based on two through seven measurement days. We studied the association between systolic/diastolic blood pressure variability and adverse cardiovascular events using Cox regression models. The primary endpoint was a combination of stroke, hospitalization for heart failure, and major coronary heart disease event, whichever occurred first. Follow-up ended on December 31, 2007. The models were adjusted for age, sex, smoking status, diabetes status, use of antihypertensive treatment, presence of hypercholesterolemia, history of cardiovascular disease, and systolic/diastolic home blood pressure level.
Results:169 adverse cardiovascular events occurred during follow-up. Systolic and diastolic home blood pressure variability became significantly associated with cardiovascular events after the third measurement day (Table). Hazard ratios for three-day systolic/diastolic blood pressure variability were 1.04/1.06 (confidence interval 1.02–1.07; p = 0.0005/1.01–1.11; p = 0.01) and hazard ratios for seven-day variability were 1.04/1.06 (confidence interval 1.01–1.08; p = 0.01/1.004–1.12; p = 0.03), respectively. The use of more than three measurement days did not markedly alter the results (Table).
Conclusions:Our results suggest that three measurement days are sufficient for the reliable assessment of morning day-to-day home blood pressure variability.
