How many measurements are needed to estimate blood pressure variability without loss of prognostic information?
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Mena Luis J, Maestre Gladys E, Hansen Tine W, Thijs Lutgarde, Liu Yanping, Boggia José, Li Yan, Kikuya Masahiro, Björklund-Bodegård Kristina, Ohkubo Takayoshi, Jeppesen Jørgen, Torp-Pedersen Christian, Dolan Eamon, Kuznetsova Tatiana, Stolarz-Skrzypek Katarzyna, Tikhonoff Valérie, Malyutina Sofia, Casiglia Edoardo, Nikitin Yuri, Lind Lars, Sandoya Edgardo, Kawecka-Jaszcz Kalina, Filipovsky Jan, Lmai Yutaka, Wang Jiguang, O'Brien Eoin, Staessen Jan A, International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators
Аннотация
METHODS: ARV was calculated from a discovery dataset that included 24-hour ambulatory BP measurements for 1,254 residents (mean age = 56.6 years; 43.5% women) of Copenhagen, Denmark. Concordance between ARV from full (≥80 BP readings) and randomly reduced 24-hour BP recordings was examined, as was prognostic accuracy. A test dataset that included 5,353 subjects (mean age = 54.0 years; 45.6% women) with at least 48 BP measurements from 11 randomly recruited population cohorts was used to validate the results.
RESULTS: In the discovery dataset, a minimum of 48 BP readings allowed an accurate assessment of the association between cardiovascular risk and ARV. In the test dataset, over 10.2 years (median), 806 participants died (335 cardiovascular deaths, 206 cardiac deaths) and 696 experienced a major fatal or nonfatal cardiovascular event. Standardized multivariable-adjusted hazard ratios (HRs) were computed for associations between outcome and BP variability. Higher diastolic ARV in 24-hour ambulatory BP recordings predicted (P < 0.01) total (HR = 1.12), cardiovascular (HR = 1.19), and cardiac (HR = 1.19) mortality and fatal combined with nonfatal cerebrovascular events (HR = 1.16). Higher systolic ARV in 24-hour ambulatory BP recordings predicted (P < 0.01) total (HR = 1.12), cardiovascular (HR = 1.17), and cardiac (HR = 1.24) mortality.
CONCLUSIONS: Forty-eight BP readings over 24 hours were observed to be adequate to compute ARV without meaningful loss of prognostic information.