Abstract
1 min readObjective: Evaluating the risk for cardiovascular mortality within 5 years in middle-age and older subjects, who displayed 24-hour diastolic BP variability (DBPV) greater than the systolic BP variability (SBPV).Design and method: Study population was a subgroup of Dublin Outcome Study that included 3,815 participants older than 50 years (age 65 ± 9, males 47%, hypertension 72%, diabetes 12%) not on antihypertensive medications at referral, who underwent 24-hour ambulatory BP monitoring and followed up for 5 years, of whom 315 died from cardiovascular cause (CV), including 195 from cardiac illness (CARD), and 88 from stroke (STRK). Variability was expressed by standard deviation of the BP readings. We marked the groups of participants with DBPV>SBPV and DBPV<=SBPV by the variable Index equals to 1 and 0, respectively, Odd ratio (OR) was determined using multiple logistic regression, in which the outcome was 1 for death from a specific cause, and 0 otherwise. The independent variables were Index, age, sex, body mass index (BMI), current smoking status, presence of diabetes mellitus, past cardiovascular diseases, 24-hour mean arterial pressure (MAP) and heart rate, and MAP nocturnal dipping. Results: Both groups displayed similar characteristics, but %mortality for the DBPV>SBPV group (N=165) was much higher than for the DBPV<=SBPV group (N = 3650): CV (27.9% vs 11.9%); CARD (18.2% vs 4.5%), and STRK (8.5% vs 2.0%). The odd ratios for DBPV>SBPV (see table) demonstrated high clinical and statistical significance for the tested mortality causes, and insensitivity to adjustment. For age<=50 did not display comparable association with CV death, but the small sample number did not permit a fair evaluation. Conclusions: Greater ambulatory diastolic BP variability than the systolic one for age>50 years is associated with high risk for CV death within 5 years.
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