Association between visit-to-visit blood pressure variability and adverse events in coronary artery disease patients after coronary intervention

Tsung Ying Tsai, Hsin Bang Leu, Pai Feng Hsu, Ya Ling Yang, Su Chan Chen, Shao Sung Huang, Wan Leong Chan, Shing Jong Lin, Jaw Wen Chen, Ju Pin Pan, Min Ji Charng, Ying Hwa Chen, Tao Cheng Wu, Tse Min Lu, Po Hsun Huang, Hao Min Cheng, Chin Chou Huang, Shih Hsien Sung, Yenn Jiang Lin, Cheng Hsueh Wu

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Blood pressure variability (BPV) is independently associated with higher cardiovascular risks. However, whether BPV is associated with poor outcomes for coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) remained undetermined. We aimed to investigate the relationship between BPV and the outcomes of CAD patients undergoing PCI. Two thousand seven hundred and sixty-two CAD patients (1938 males, mean age 69.6 ± 12.9) who received PCI at Taipei Veterans General Hospital from 2006 to 2015 with multiple blood pressure measurements before and after the index PCI were enrolled. We calculated the standard deviation of systolic blood pressure, diastolic blood pressure, and pulse pressure as parameters of BPV. The primary endpoint was the composite of major adverse cardiovascular events [MACE comprising of cardiovascular death, nonfatal myocardial infarction (MI), and non-fatal stroke] and heart failure hospitalization (HHF). The key secondary endpoint was MACE. Both pre-PCI and post-PCI BPV were associated with CV events even after adjusting for co-morbidities and mean blood pressure. In Cox analysis, for every 1 mmHg increase in systolic BPV, the hazard ratio for the MACE + HHF, MACE, HHF, and cardiovascular death was 1.04 (95%CI: 1.03–1.05), 1.04 (95%CI: 1.02–1.05), 1.05 (95%CI: 1.04–1.06), and 1.06 (95%CI: 1.03–1.09), respectively. The association between BPV and cardiovascular risk is independent of blood pressure control status. The prognostic value of BPV was superior to mean blood pressure in both pre-PCI and post-PCI period. BPV is independently associated with cardiovascular events after PCI and has a better prognostic value than mean blood pressure suggesting the importance of maintaining stable blood pressure for CAD patients.

Original languageEnglish
Pages (from-to)1327-1338
Number of pages12
JournalJournal of Clinical Hypertension
Volume24
Issue number10
DOIs
Publication statusPublished - Oct 2022
Externally publishedYes

Keywords

  • blood pressure variability
  • coronary artery disease
  • outcome
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

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