Dataset Information

China Stroke Primary Prevention Trial: Visit-to-Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients.

ABSTRACT: The optimal range of blood pressure variability remains unclear. We aimed to stratify the degree of risk of stroke based on visit-to-visit systolic blood pressure (SBP) variability in a large Chinese hypertensive population in 32 communities. We retrospectively analyzed the data of 20 702 hypertensive patients from the China Stroke Primary Prevention Trial. The participants were randomized into 2 treatment groups to receive either enalapril or enalapril plus folic acid. Their blood pressures were measured every 3 months. The outcome was the first stroke. Three parameters of SBP variability were calculated: standard deviation, coefficient of variation, and average real variability. The records of first 4, 6, 8, 10 and 12 visits at which SBP was measured were used to calculate SBP variability and to predict subsequent stroke risk in adjusted Cox regression models. After median follow-up of 4.5 years, 597 patients had experienced stroke. Visit-to-visit SBP variability was an independent predictor of subsequent stroke (eg, the hazard ratio for the highest quintile of average real variability [22.67-61.07 mm Hg] over 6 visits was 1.55, 95% CI 1.07-2.25, P=0.021), independent of mean SBP over the follow-up period. Its value was more predictive when more blood pressure records were used. Visit-to-visit SBP variability is an independent predictor of primary stroke in Chinese hypertensive patients. This predictive value depends on the number of blood pressure measurements used to calculate variability but is independent of mean SBP. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.

SUBMITTER: Men X

PROVIDER: S-EPMC5523997 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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China Stroke Primary Prevention Trial: Visit-to-Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients.

Men Xi X Sun Wei W Fan Fangfang F Zhao Min M Huang Xiao X Wang Yu Y Liu Lishun L Liu Ran R Sun Weiping W Peng Qing Q Qin Xianhui X Tang Genfu G Li Jianping J Zhang Yan Y Cai Yefeng Y Hou Fan Fan FF Wang Binyan B Xu Xiping X Cheng Xiaoshu X Sun Ningling N Huang Yining Y Huo Yong Y

Journal of the American Heart Association 20170313 3

<h4>Background</h4>The optimal range of blood pressure variability remains unclear. We aimed to stratify the degree of risk of stroke based on visit-to-visit systolic blood pressure (SBP) variability in a large Chinese hypertensive population in 32 communities.<h4>Methods and results</h4>We retrospectively analyzed the data of 20 702 hypertensive patients from the China Stroke Primary Prevention Trial. The participants were randomized into 2 treatment groups to receive either enalapril or enalap ...[more]

PMID: 28288974

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Project description:BackgroundHigh visit-to-visit blood pressure variability (BPV) and hypertension are risk factors for mild cognitive impairment (MCI) and probable dementia (PD). Few articles assessed the effect of BPV on the MCI and PD in intensive blood pressure treatment and the different functions of three types of visit-to-visit BPV: systolic blood pressure variability (SBPV), diastolic blood pressure variability (DBPV) and pulse pressure variability (PPV).MethodsWe performed a post hoc analysis of the SPRINT MIND trial. The primary outcomes were MCI and PD. BPV was measured by average real variability (ARV). The Kaplan-Meier curves were used to clarify the difference in tertiles of BPV. We fit Cox proportional hazards models to our outcome. We also did an interaction analysis between the intensive and standard groups.ResultsWe enrolled 8,346 patients in the SPRINT MIND trial. The incidence of MCI and PD in the intensive group was lower than that in the standard group. 353 patients had MCI and 101 patients had PD in the standard group while 285 patients had MCI and 75 patients had PD in the intensive group. Tertiles with higher SBPV, DBPV and PPV in the standard group had a higher risk of MCI and PD (all p < 0.05). Meanwhile, higher SBPV and PPV in the intensive group were associated with an increased risk of PD (SBPV: HR(95%) = 2.1 (1.1-3.9), p = 0.026; PPV: HR(95%) = 2.0 (1.1-3.8), p = 0.025 in model 3) and higher SBPV in the intensive group was associated with an increased risk of MCI(HR(95%) = 1.4 (1.2-1.8), p < 0.001 in model 3). The difference between intensive and standard blood pressure treatment was not statistically significant when we considered the effect of the higher BPV on the risk of MCI and PD (all p for interaction >0.05).ConclusionIn this post hoc analysis of the SPRINT MIND trial, we found that higher SBPV and PPV were associated with an increased risk of PD in the intensive group, and higher SBPV was associated with an increased risk of MCI in the intensive group. The effect of higher BPV on the risk of MCI and PD was not significantly different in intensive and standard blood pressure treatment. These findings emphasized the need for clinical work to monitor BPV in intensive blood pressure treatment.

Dataset Information

China Stroke Primary Prevention Trial: Visit-to-Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients.

Publications

China Stroke Primary Prevention Trial: Visit-to-Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients.

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