The Association between Long- and Intra-Dialytic Blood Pressure Variability with All-Cause Mortality in Hemodialysis Patients

2019 ◽  
Vol 48 (1) ◽  
pp. 43-50
Author(s):  
Ruoxi Liao ◽  
Jiameng Li ◽  
Liping Lin ◽  
Si Sun ◽  
Liya Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Baseline Blood Pressure ◽  
Mortality Hazard ◽  
All Cause Mortality ◽  
Average Real Variability ◽  
Mortality Hazard Ratio

Background: Blood pressure variability (BPV) is a potential prognostic predictor for all-cause mortality. Objectives: We conducted a retrospective cohort study to compare the prognostic value of long-term BPV with intra-dialytic BPV in hemodialysis (HD) patients. Materials and Methods: We included 611 HD patients and collected their baseline blood pressure (BP) measurements for 1 year and monitored them for 40 months. Long-term BPV was assessed by pre-dialysis BP SD and pre-dialysis absolute BP residual metric. Intra-dialytic BPV was assessed by intra-dialytic BP average real variability and intra-dialytic absolute BP residual. Results: Long-term systolic BPV showed a weak correlation with mean BP, but a stronger correlation with intra-dialytic BPV. High long-term systolic blood pressure (SBP) SD and long-term SBP residual metrics were associated with high all-cause mortality (p = 0.0084 and 0.0056, respectively), while no such association was found for intra-dialytic BPV or diastolic BPV. According to receiver operating characteristic curve with mortality as dependent variable, long-term SBP residual metric showed the strongest prognostic ability (area under curve [AUC] 0.679, p = 0.0006), which was even stronger in patients with BP ≥140/90 mm Hg (AUC 0.713, p = 0.0004). After completely adjusting for confounders, long-term SBP residual metric remained significantly associated with all-cause mortality (hazard ratio 1.628 per quartile; 95% CI 1.086–2.441). Conclusions: Our results suggest long-term SBP residual metric to be a better predictor of all-cause mortality in HD patients, which could be used as an additional target for BP management.

Long term habitual vigorous physical activity is associated with lower visit-to-visit systolic blood pressure variability

2020 ◽  
Author(s):  
Xiaoyong Xu ◽  
Xianghong Meng ◽  
Shin-ichi Oka
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Standard Deviation ◽  
Systolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Vigorous Physical Activity ◽  
Systolic Blood Pressure Variability ◽  
Average Real Variability ◽  
Post Hoc

Abstract Objective Our work aimed to investigate the association between vigorous physical activity and visit-to-visit systolic blood pressure variability (BPV). Methods We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mmHg) or standard (<140 mmHg) SBP targets. We assessed whether patients with hypertension who habitually engage in vigorous physical activity would have lower visit-to-visit systolic BPV compared with those who do not engage in vigorous physical activity. Visit-to-visit systolic BPV was calculated by standard deviation (SD), average real variability (ARV), and standard deviation independent of the mean (SDIM) using measurements taken during the 1-, 2-, 3-, 6-, 9- and 12-month study visits. A medical history questionnaire assessed vigorous physical activity, which was divided into three categories according to the frequency of vigorous physical activity. Results A total of 7571 participants were eligible for analysis (34.8% female, mean age 67.9±9.3 years). During a follow-up of 1-year, vigorous physical activity could significantly reduce SD, ARV, and SDIM across increasing frequency of vigorous physical activity. There were negative linear trends between frequency of vigorous physical activity and visit-to-visit systolic BPV. Conclusions Long-term engagement in vigorous physical activity was associated with lower visit-to-visit systolic BPV.

Physical Fitness and Long-term Blood Pressure Variability in Young Male Military Personnel

2020 ◽  
Vol 16 (2) ◽  
pp. 156-160 ◽  
Author(s):  
Gen-Min Lin ◽  
Kun-Zhe Tsai ◽  
Chin-Sheng Lin ◽  
Chih-Lu Han
Keyword(s):  
Blood Pressure ◽  
Physical Fitness ◽  
Military Personnel ◽  
Blood Pressure Variability ◽  
Young Male ◽  
The Elderly ◽  
Average Real Variability ◽  
The Right ◽  
Run Test

Aims: The aim of this study is to investigate the association of physical fitness with longterm Blood Pressure Variability (BPV) in young male adults. Methods: 1,112 healthy military males, aged 18-40 years (mean age, 32 years), in Taiwan were included for the current analysis. Resting blood pressures were measured over the right upper arm in a sitting position every two years from 2012 to 2018 (2012-14, 2014-15, 2015-16, 2016-18). Long-term BPV by Standard Deviation (SDSBP and SDDBP) and Average Real Variability (ARVSBP and ARVDBP) were assessed across 4 visits during the study period. Aerobic fitness was evaluated by the time taken for a 3000-meter run test, and anaerobic fitness was evaluated by the number of 2-minute sit-ups and 2-minute push-ups. Results: After adjusting the systolic and diastolic blood pressure, the time for a 3000-meter run was associated with ARVSBP, SDSBP, and SDDBP (β [SE]: 0.007 [0.002], 0.004 [0.002], and 0.005 [0.002], respectively, all p <0.05) but not with ARVDBP. In addition, the number of 2-minute sit-ups was inversely associated with ARVSBP (β [SE]: -0.041 [0.017], p =0.01) but not with ARVDBP, SDSBP, and SDDBP. There was no association of the number of 2-minute push-ups with the BPV indexes. After additionally adjusting the age, body mass index, and other covariates, all the associations were found to be not significant. Conclusion: It was found that there was no association of physical fitness with long-term BPV in young male military personnel. Previous studies have shown no association with cardiorespiratory fitness in the elderly. This study further increased the knowledge of a null association between anaerobic fitness and long-term BPV.

scholarly journals Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease

Hypertension ◽  
2016 ◽  
Vol 67 (2) ◽  
pp. 387-396 ◽  
Author(s):  
George Thomas ◽  
Dawei Xie ◽  
Hsiang-Yu Chen ◽  
Amanda H. Anderson ◽  
Lawrence J. Appel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Disease ◽  
Treatment Resistant ◽  
Mortality Hazard ◽  
All Cause Mortality ◽  
Peripheral Arterial ◽  
Mortality Hazard Ratio

The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure ≥140/90 mm Hg on ≥3 antihypertensives, or use of ≥4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRH—composite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22–1.56]); renal events (1.28 [1.11–1.46]); CHF (1.66 [1.38–2.00]); and all-cause mortality (1.24 [1.06–1.45]). The subset of participants with ATRH and blood pressure at goal on ≥4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12–1.51]) and CHF (1.59 [1.28–1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate ≥30 mL/min per 1.73 m 2 . Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

scholarly journals Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

2016 ◽  
Vol 26 (2) ◽  
pp. 189-198 ◽  
Author(s):  
J. Damián ◽  
R. Pastor-Barriuso ◽  
E. Valderrama-Gama ◽  
J. de Pedro-Cuesta
Keyword(s):  
Depressive Symptoms ◽  
Nursing Homes ◽  
Life Expectancy ◽  
Hazard Ratio ◽  
Mortality Hazard ◽  
All Cause Mortality ◽  
Mortality Hazard Ratio ◽  
Long Term Mortality

Background.Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status.Methods.We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998–1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models.Results.The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70–1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46–0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98–1.86). The median life expectancy increased by 1.8 years (95% CI: −3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6–10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms.Conclusions.The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.

scholarly journals Prestroke Physical Activity and Adverse Health Outcomes After Stroke in the Atherosclerosis Risk in Communities Study

Stroke ◽  
2021 ◽  
Author(s):  
Mauro F. F. Mediano ◽  
Yejin Mok ◽  
Josef Coresh ◽  
Anna Kucharska-Newton ◽  
Priya Palta ◽  
...  
Keyword(s):  
Lower Risk ◽  
Hazard Ratio ◽  
Atherosclerosis Risk In Communities ◽  
Adverse Health Outcomes ◽  
Mortality Hazard ◽  
Atherosclerosis Risk ◽  
All Cause Mortality ◽  
Mortality Hazard Ratio

Background and Purpose: The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). Methods: We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. Results: During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63–0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62–0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29–0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58–0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. Conclusions: Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.

Abstract P189: Long-term Blood Pressure Variability And Risk Of Cardiovascular Disease Events Among Community-dwelling Elderly

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Michael E Ernst ◽  
Enayet K Chowdhury ◽  
Lawrie Beilin ◽  
Karen L Margolis ◽  
Mark R Nelson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Blood Pressure Variability ◽  
The United States ◽  
Community Dwelling ◽  
Main Trial ◽  
All Cause Mortality ◽  
The Impact

Greater blood pressure variability (BPV) in midlife increases risk of future cardiovascular disease (CVD) events, but the impact of BPV in adults who have reached older ages while remaining free of CVD is unknown. We examined risk of overall incident CVD, ischemic stroke subgroup, and all-cause mortality associated with long-term, visit-to-visit BPV in participants of the ASPirin in Reducing Events in the Elderly study, a randomized primary prevention trial of daily low-dose aspirin in community-dwelling adults in Australia and the United States (US) aged 70 and older (65 if US minority) without evidence of CVD. The mean of three blood pressures (BP) using an automated cuff was recorded at baseline and annually. CVD was a prespecified composite secondary endpoint of ASPREE, and included fatal coronary heart disease, nonfatal MI, fatal or nonfatal stroke, or hospitalization for heart failure. All CVD events were adjudicated as part of the main trial. This analysis included participants who survived without CVD to the second annual visit and had BP recorded at baseline, years 1 and 2 (n=16,482). BPV was defined as within-individual standard deviation of mean systolic BP across these visits. Cox proportional hazards regression adjusting for confounders was used to calculate hazard ratios (HR) according to tertile of estimated BPV, with year 2 as time zero to minimize immortal time bias. Our results (Table) show that higher visit-to-visit BPV in older adults without previous CVD is associated with increased risk of future CVD events, ischemic stroke, and all-cause mortality, suggesting that BPV in older ages should be considered a potential therapeutic target for CVD risk-lowering.

scholarly journals Association of Circulating Osteoprotegerin Level with Blood Pressure Variability in Patients with Chronic Kidney Disease

2021 ◽  
Vol 11 (1) ◽  
pp. 178
Author(s):  
Sang Suh ◽  
Tae Oh ◽  
Hong Choi ◽  
Chang Kim ◽  
Kook-Hwan Oh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Pressure Variability ◽  
Cardiovascular Complications ◽  
History Of ◽  
Comorbidity Index ◽  
Average Real Variability ◽  
Stage 1

Circulating osteoprotegerin (OPG) is a biomarker for cardiovascular complications that are closely related to chronic kidney disease (CKD). To investigate the association between circulating OPG level with long-term visit-to-visit blood pressure variability (BPV) in patients with pre-dialysis CKD, a total of 1855 subjects with CKD from stage 1 to pre-dialysis stage 5 from a prospective cohort were analyzed. Long-term visit-to-visit BPV was determined by average real variability (ARV), standard deviation (SD), and coefficient of variation (CoV) of systolic and diastolic blood pressure (SBP and DBP). ARV of SBP (Adjusted β coefficient 0.143, 95% confidence interval 0.021 to 0.264) was significantly associated with serum OPG level. Although SD and CoV of SBP were not significantly associated with serum OPG level in multivariate linear regression analyses, restricted cubic spline visualized the linear correlation of serum OPG level with all of ARV, SD, and CoV. The association between serum OPG level and DBP variability was not significant. Subgroup analyses revealed that the association of serum OPG with BPV is more prominent in the subjects with Charlson comorbidity index ≤3 and in the subjects without history of diabetes mellitus. In conclusion, circulating OPG level is potentially associated with long-term visit-to-visit BPV in patients with pre-dialysis CKD.

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: &lt;120mmHg, ≥120mmHg and &lt;130mmHg, ≥130mmHg and &lt;140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of &lt;120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of &lt;120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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