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Visit-to-visit variability of systolic blood pressure predicts all-cause mortality in patients received percutaneous coronary intervention with drug-eluting stents

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Abstract

Blood pressure (BP) and its variability are associated with atherosclerotic disease and cardiovascular events. The prognostic implications of outpatient clinic visit-to-visit blood pressure variability (BPV) are unknown in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 1,463 patients undergoing PCI with DES were consecutively enrolled from January 2009 to December 2013. We analyzed the 1,234 patients, who measured clinic BP more than three times during the first year after PCI. The BPV is determined by standard deviation of systolic and diastolic BP, and coefficient of variation. Median follow-up duration was 905 days (interquartile range 529–1,310 days). All patients were divided into two groups according to the coefficient of variation of systolic BP (CVSBP); high CVSBP group (> 8.78, n = 617) and low CVSBP group (≤ 8.78, n = 617). High CVSBP group had significantly higher all-cause mortality (7.9% versus 3.1%, p < 0.001) and composite of all-cause mortality, myocardial infarction, and stroke (13.1% versus 6.2%, p < 0.001). In multivariate logistic regression analysis for prediction of all-cause mortality, and composite of all-cause mortality, myocardial infarction, and stroke after PCI with DES, hazard ratios of high CVSBP group were 2.441 (95% of confidence interval 1.042–5.718, p = 0.040), and 1.980 (95% of confidence interval 1.125–3.485, p = 0.018). The higher visit-to-visit BPV is associated higher mortality in patients undergoing PCI with DES. The clinic measured visit-to-visit BPV may serve as a predictor of all-cause mortality after PCI with DES.

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References

  1. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE, Investigators SIRIUS (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323

    Article  CAS  PubMed  Google Scholar 

  2. Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME, Investigators TAXUS-IV (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231

    Article  CAS  PubMed  Google Scholar 

  3. Katritsis DG, Karvouni E, Ioannidis JPA (2005) Meta-analysis comparing drug-eluting stents with bare metal stents. Am J Cardiol 95:640–643

    Article  CAS  PubMed  Google Scholar 

  4. Thune JJ, Signorovitch J, Kober L, Velazquez EJ, McMurray JJ, Califf RM, Maggioni AP, Rouleau JL, Howlett J, Zelenkofske S, Pfeffer MA, Solomon SD (2008) Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction. Hypertension 51:48–54

    Article  CAS  PubMed  Google Scholar 

  5. Bangalore S, Messerli FH, Wun CC, Zuckerman AL, DeMicco D, Kostis JB, LaRosa JC (2010) J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J 31:2897–2908

    Article  CAS  PubMed  Google Scholar 

  6. Bangalore S, Qin J, Sloan S, Murphy SA, Cannon CP (2010) What is the optimal blood pressure in patients after acute coronary syndromes?: relationship of blood pressure and cardiovascular events in the PRavastatin OR atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation 122:2142–2151

    Article  CAS  PubMed  Google Scholar 

  7. Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR (2010) Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 375:895–905

    Article  PubMed  Google Scholar 

  8. Poortvliet RK, Ford I, Lloyd SM, Sattar N, Mooijaart SP, de Craen AJ, Westendorp RG, Jukema JW, Packard CJ, Gussekloo J, de Ruijter W, Stott DJ (2012) Blood pressure variability and cardiovascular risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). PLoS ONE 7:e52438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Suchy-Dicey AM, Wallace ER, Mitchell SV, Aguilar M, Gottesman RF, Rice K, Kronmal R, Psaty BM, Longstreth WT Jr (2013) Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study. Am J Hypertens 26:1210–1217

    Article  PubMed  PubMed Central  Google Scholar 

  10. Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S (2011) The relationship between visit-to-visit variability in systolic blood pressure and allcause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 57:160–166

    Article  CAS  PubMed  Google Scholar 

  11. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW, Academic Research Consortium (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351

    Article  PubMed  Google Scholar 

  12. Park S, Yan P, Cerezo C, Jeffers BW (2016) Effect of visit-to-visit blood pressure variability on cardiovascular events in patients with coronary artery disease and well-controlled blood pressure. J Am Soc Hypertens 10:799–810

    Article  PubMed  Google Scholar 

  13. Lau KK, Wong YK, Chan YH, Teo KC, Chan KH, Wai Li LS, Cheung RT, Siu CW, Ho SL, Tse HF (2014) Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases—relationships and comparisons with vascular markers of atherosclerosis. Atherosclerosis 235:230–235

    Article  CAS  PubMed  Google Scholar 

  14. Lau KK, Wong YK, Chang RS, Teo KC, Hon SF, Chan KH, Wat KL, Cheung RT, Li LS, Siu CW, Ho SL, Tse HF (2014) Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct. Eur J Neurol 21:319–325

    Article  CAS  PubMed  Google Scholar 

  15. Rossignol P, Cridlig J, Lehert P, Kessler M, Zannad F (2012) Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSIDIAL. Hypertension 60:339–346

    Article  CAS  PubMed  Google Scholar 

  16. Muntner P, Joyce C, Levitan EB, Holt E, Shimbo D, Webber LS, Oparil S, Re R, Krousel-Wood M (2011) Reproducibility of visit to visit variability of blood pressure measured as part of routine clinical care. J Hypertens 29:2332–2338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Levitan EB, Kaciroti N, Oparil S, Julius S, Muntner P (2012) Blood pressure measurement device, number and timing of visits, and intra-individual visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich) 14:744–750

    Article  Google Scholar 

  18. Mancia G, Facchetti R, Parati G, Zanchetti A (2012) Visit-to-visit blood pressure variability in the European Lacidipine Study on Atherosclerosis: methodological aspects and effects of antihypertensive treatment. J Hypertens 30:1241–1251

    Article  CAS  PubMed  Google Scholar 

  19. Sega R, Cesana G, Bombelli M, Grassi G, Stella ML, Zanchetti A, Mancia G (1998) Seasonal variations in home and ambulatory blood pressure in the PAMELA population. Pressione Arteriose Monitorate ELoro Associazioni. J Hypertens 16:1585–1592

    Article  CAS  PubMed  Google Scholar 

  20. Okada H, Fukui M, Tanaka M, Inada S, Mineoka Y, Nakanishi N, Senmaru T, Sakabe K, Ushigome E, Asano M, Yamazaki M, Hasegawa G, Nakamura N (2012) Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes. Atherosclerosis 220:155–159

    Article  CAS  PubMed  Google Scholar 

  21. Eguchi K, Hoshide S, Schwartz JE, Shimada K, Kario K (2012) Visit-to-visit and ambulatory blood pressure variability as predictors of incident cardiovascular events in patients with hypertension. Am J Hypertens 25:962–968

    Article  PubMed  Google Scholar 

  22. Arashi H, Ogawa H, Yamaguchi J, Kawada-Watanabe E, Hagiwara N (2015) Impact of visit-to-visit variability and systolic blood pressure control on subsequent outcomes in hypertensive patients with coronary artery disease (from the HIJ-CREATE substudy). Am J Cardiol 116:236–242

    Article  PubMed  Google Scholar 

  23. Webb AJ, Fischer U, Rothwell PM (2011) Effects of beta-blocker selectivity on blood pressure variability and stroke: a systematic review. Neurology 77:731–737

    Article  CAS  PubMed  Google Scholar 

  24. Smith TR, Drozda JP Jr, Vanslette JA, Hoeffken AS, Nicholson RA (2013) Medication class effects on visit-to-visit variability of blood pressure measurements: analysis of electronic health record data in the “real world”. J Clin Hypertens (Greenwich) 15:655–662

    Article  CAS  Google Scholar 

  25. Tocci G, Barbato E, Coluccia R, Modestino A, Paqliaro B, Mastromarino V, Giovannelli F, Berni A, Volpe M (2016) Medication class effects on visit-to-visit variability of blood pressure measurements: analysis of electronic health record data in the “real world”. Am J Hypertens 29:509–518

    Article  CAS  PubMed  Google Scholar 

  26. Kario K (2016) Evidence and perspectives on the 24-h management of hypertension: hemodynamic biomarker-initiated ‘anticipation medicine’ for zero cardiovascular event. Prog Cardiovasc Dis 59:262–281

    Article  PubMed  Google Scholar 

  27. Zakopoulos NA, Tsivgoulis G, Barlas G, Papamichael C, Spengos K, Manios E, Ikonomidis I Kotsis V, Spiliopoulou I, Vemmos K, Mavrikakis M, Moulopoulos SD (2005) Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness. Hypertension 45:505–512

    Article  CAS  PubMed  Google Scholar 

  28. Masugata H, Senda S, Murao K, Inukai M, Hosomi N, Iwado Y, Noma T, Kohno M, Himoto T, Goda F (2011) Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients. Hypertens Res 34:846–850

    Article  PubMed  Google Scholar 

  29. Nagai M, Hoshide S, Ishikawa J, Shimada K, Kario K (2011) Visit-to-visit blood pressure variations: new independent determinants for carotid artery measures in the elderly at high risk of cardiovascular disease. J Am Soc Hypertens 5:184–192

    Article  PubMed  Google Scholar 

  30. Kawai T, Ohishi M, Kamide K, Onishi M, Takeya Y, Tatara Y, Oguro R, Yamamoto K, Sugimoto K, Rakugi H (2012) The impact of visit-to-visit variability in blood pressure on renal function. Hypertens Res 35:239–243

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Suk Min Seo, Woo-Baek Chung, Yoon-Seok Koh, Pum-Jun Kim, Wook Sung Chung & Ki-Bae Seung

  2. Cardiovascular Center and Cardiology Division, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea

    Ik Jun Choi

  3. Cardiovascular Center and Cardiology Division, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Republic of Korea

    Sang-Hyun Ihm

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  1. Suk Min Seo
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Correspondence to Woo-Baek Chung.

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Seo, S.M., Chung, WB., Choi, I.J. et al. Visit-to-visit variability of systolic blood pressure predicts all-cause mortality in patients received percutaneous coronary intervention with drug-eluting stents. Heart Vessels 33, 489–497 (2018). https://doi.org/10.1007/s00380-017-1085-1

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