From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.).
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Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP targets. We defined OBPV as the coefficient of variation of the systolic BP using measurements taken during the 3-,6-, 9-, and 12-month study visits. In our cohort of 7879 participants, older age, female sex, black race, current smoking, chronic kidney disease, and coronary disease were independent determinants of higher OBPV. Use of thiazide-type diuretics or dihydropyridine calcium channel blockers was associated with lower OBPV whereas angiotensin-converting enzyme inhibitors or angiotensin receptor blocker use was associated with higher OBPV. There was no difference in OBPV in participants randomized to standard or intensive treatment groups. We found that OBPV had no significant associations with the composite end point of fatal and nonfatal cardiovascular events (n=324 primary end points; adjusted hazard ratio, 1.20; 95% confidence interval, 0.85–1.69, highest versus lowest quintile) nor with heart failure or stroke. The highest quintile of OBPV (versus lowest) was associated with all-cause mortality (adjusted hazard ratio, 1.92; confidence interval, 1.22–3.03) although the association of OBPV overall with all-cause mortality was marginal (P=0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062