Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial)
Open accessAbstract
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
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In the SPRINT trial, all-cause mortality was independently associated with visit-to-visit systolic BP variability quantified using variability independent of the mean or maximum minus minimum BP levels, but not with systolic BP variability quantified using the coefficient of variation.
“In an analysis of the SPRINT trial77,78, which enrolled patients with hypertension and high cardiovascular risk, all-cause mortality was independently associated with visit-to-visit systolic BPV quantified using VIM or maximum minus minimum BP levels, but was not associated with systolic BPV quantified using the coefficient of variation.”
From Blood pressure and its variability: classic and novel measurement techniques (2022) · cites this paper as [77]
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Experimental — accuracy not yet measuredCalcium-channel blockers and diuretics reduce BP variability compared with other antihypertensive agents.
“Other studies have also confirmed a beneficial effect of calcium-channel blockers and diuretics in reducing BPV compared with other antihypertensive agents77,91–94.”
From Blood pressure and its variability: classic and novel measurement techniques (2022) · cites this paper as [77]
The Results (Correlates of OBPV) associate thiazide-type diuretics and dihydropyridine calcium-channel blockers with lower visit-to-visit office BP variability. The Discussion also reports lower variability in comparator treatment groups from other trials, but says it is only possible that these drugs lower variability; the SPRINT associations do not establish the causal effect implied by “reduce.” (LLM, conf=0.84)
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Blood pressure and its variability: classic and novel measurement techniques
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- Authors
- Chang, T. I., Reboussin, D. M., Chertow, G. M., Cheung, A. K., Cushman, W. C., Kostis, W. J., Parati, G., Raj, D., Riessen, E., Shapiro, B., Stergiou, G. S., Townsend, R. R., Tsioufis, K., Whelton, P. K., Whittle, J., Wright, J. T., & Papademetriou, V.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- 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...
- ORCID
- Venue
- Hypertension
- Published
- 2017-10
- Volume
- 70
- Issue
- 4
- Pages
- 751-758
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC6209591
- OpenAlex
- W2740027835
- Cited by
- 104
- References
- 24
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 12 · 2023: 14 · 2022: 14 · 2021: 14 · 2020: 11 · 2019: 7 · 2018: 14 · 2017: 2
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000093, UL1TR000050, UL1TR000073, UL1TR001064, UL1TR000075, UL1TR000005, UL1TR000433, UL1TR000445, UL1TR002003, UL1TR000439)
- National Institute of General Medical Sciences (P30GM103337)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK095914)
- National Institute of Neurological Disorders and Stroke
- National Center for Research Resources (UL1RR025755, UL1RR024134, UL1RR025752, UL1RR025771)
- National Center for Advancing Translational Sciences (9U54TR000017‐06)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- systolic blood pressure, cardiovascular outcomes, intensive blood pressure control, SPRINT trial, all-cause mortality, heart failure, stroke, antihypertensive drugs, thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Heart Failure, Humans, Hypertension, Male, Middle Aged, Office Visits, Outcome and Process Assessment, Health Care, Patient Care Planning, Risk Factors, United States, Risk Assessment, Renal Insufficiency, Chronic
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