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. 2021 Jun 4:8:665117.
doi: 10.3389/fcvm.2021.665117. eCollection 2021.

Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Menghui Liu  1   2 , Xiaohong Chen  3 , Shaozhao Zhang  1   2 , Yifen Lin  1   2 , Zhenyu Xiong  1   2 , Xiangbin Zhong  1   2 , Yue Guo  1   2 , Xiuting Sun  1   2 , Huimin Zhou  1   2 , Xingfeng Xu  1   2 , Lichun Wang  1   2 , Xinxue Liao  1   2 , Xiaodong Zhuang  1   2
Affiliations

Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Menghui Liu et al. Front Cardiovasc Med. .

Abstract

Background: Systolic or diastolic blood pressure (BP) variability is associated with an increased risk of cardiovascular events. We assessed whether BP variability measured by mean arterial pressure (MAP) was associated with increased risk of heart failure (HF) and death in individuals with or without hypertension. Methods: We evaluated 9,305 Atherosclerosis Risk in Communities (ARIC) study participants with or without hypertension and calculated BP variability based on MAP values from visit 1 to 4 [expressed as standard deviation (SD), average real variability (ARV), coefficient of variation (CV), and variability independent of the mean (VIM)]. Multivariate-adjusted Cox regression model and restricted cubic spline curve were used to evaluate the associations of MAP variability with all-cause mortality and HF. Results: During a median follow-up of 16.8 years, 1,511 had an HF event and 2,903 died. Individuals in the highest quartile of VIM were both associated with a 21% higher risk of all-cause mortality [hazard ratio (HR), 1.21; 95% CI, 1.09-1.35] and HF (HR, 1.21; 95% CI, 1.04-1.39) compared with the lowest quartile of VIM. Cubic spline curves reveal that the risk of deaths and HF increased with MAP variability when it reached a higher level. Results were similar in individuals with normotension (all-cause mortality: HR, 1.30; 95% CI, 1.09-1.55; HF, HR, 1.49; 95% CI, 1.12-1.98). Conclusions: In individuals with or without hypertension, greater visit-to-visit MAP variability was associated with a higher risk of all-cause mortality and HF, indicating that the BP variability assessed by MAP might be a potential risk factor for HF and death.

Keywords: all-cause mortality; blood pressure variability; heart failure; mean arterial pressure; variability independent of the mean.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence estimates (Kaplan–Meier) for the (A) all-cause mortality and (B) heart failure in four groups by quartile value of MAP variability (VIM). MAP, mean arterial pressure; VIM, variability independent of the mean.
Figure 2
Figure 2
Adjusted hazard ratios (95% CI) for the association of MAP variability measured by VIM with incident (A) all-cause mortality and (B) heart failure. Hazard ratios (indicated by a red solid line) and 95% CIs (red dotted lines) are derived from Cox proportional hazard regression models adjusted for age, sex, race, BMI, education level, smoking status, drinking status, total cholesterol, LDL-C, HDL-C, triglyceride, fasting glucose, eGFR, prevalent hypertension, diabetes mellitus, coronary heart disease, myocardial infarction, stroke, antihypertensive medicine, aspirin, statin, SBP, DBP at visit 4, and mean of MAP from visit 1 to 4. The VIM of MAP was centered at the sample median and modeled using a restricted cubic spline with knots at the 5th, 50th, and 95th percentiles. The black dotted line is the reference line as hazard ratio = 1. Histograms represent the frequency distribution of MAP variability (VIM). MAP, mean arterial pressure; VIM, variability independent of the mean; BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure; DBP, diastolic blood pressure.
Figure 3
Figure 3
Association of the highest quartile of MAP variability group (VIM Q4) compared with the lower MAP variability group (VIM Q1 + Q2 + Q3) for all-cause mortality in key subgroups. Hazard ratios and 95% CIs were obtained after individually removing the original variable from the Cox Model 3 that adjusted for age, sex, race, BMI, education level, smoking status, drinking status, total cholesterol, LDL-C, HDL-C, triglyceride, fasting glucose, eGFR, prevalent hypertension, diabetes mellitus, coronary heart disease, myocardial infarction, stroke, antihypertensive medicine, aspirin, statin, SBP, DBP at visit 4, and mean of MAP from visit 1 to 4. MAP, mean arterial pressure; VIM, variability independent of the mean; BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure; DBP, diastolic blood pressure.
Figure 4
Figure 4
Association of the highest quartile of MAP variability group (VIM Q4) compared with the lower MAP variability group (VIM Q1 + Q2 + Q3) for heart failure in key subgroups. Hazard ratios and 95% CIs were obtained after individually removing the original variable from the Cox Model 3 that adjusted for age, sex, race, BMI, education level, smoking status, drinking status, total cholesterol, LDL-C, HDL-C, triglyceride, fasting glucose, eGFR, prevalent hypertension, diabetes mellitus, coronary heart disease, myocardial infarction, stroke, antihypertensive medicine, aspirin, statin, SBP, DBP at visit 4, and mean of MAP from visit 1 to 4. MAP, mean arterial pressure; VIM, variability independent of the mean; BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure; DBP, diastolic blood pressure.
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