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. 2022 Dec;31(1):228-235.
doi: 10.1080/08037051.2022.2118662.

Blood pressure control measures and cardiovascular outcomes: a prospective hypertensive cohort

Konstantinos Sideris  1 , Ioannis Andrikou  1 , Costas Thomopoulos  2 , Fotis Tatakis  1 , Maria Kariori  1 , Eleni Manta  1 , Theodoros Kalos  1 , Stergios Soulaidopoulos  1 , Sotirios Drogkaris  1 , Dimitris Konstantinidis  1 , Konstantinos Tsioufis  1
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Free article

Blood pressure control measures and cardiovascular outcomes: a prospective hypertensive cohort

Konstantinos Sideris et al. Blood Press. 2022 Dec.
Free article

Abstract

Purpose: We investigated whether blood pressure (BP) control measures, visit-to-visit BP variability, and time in therapeutic range (TTR) are associated with future cardiovascular outcomes in hypertensive patients.

Materials and methods: Among 1,408 hypertensive patients without cardiovascular disease, we prospectively evaluated the incident major cardiovascular events over 6 years. In newly diagnosed patients, antihypertensive drug treatment was initiated. We estimated two markers of on-treatment BP control, (1) visit-to-visit BPV as the coefficient of variation of office systolic BP (BP-CV), and (2) TTR calculated as the percentage of office systolic BP measurements within 120-140mmHg across visits.

Results: The hypertensive cohort (672 males, mean age 60 years, 31% newly diagnosed) had a mean systolic/diastolic BP of 142/87 mmHg. The mean number of visits was 4.9 ± 2.6, while the mean attained systolic/diastolic BP during follow-up was 137/79 mmHg using 2.7 ± 1.1 antihypertensive drugs. The BP-CV and TTR were 9.1 ± 4.1% and 45 ± 29%, respectively, and the incidence of the composite outcome was 8.3% (n = 117). After adjustment for relevant confounders and standardization to z-scores, BP-CV and TTR were associated with a 43% (95% CI, 27-62%) increase and a 33% (95% CI, 15-47%) reduction in the outcome. However, the joint evaluation of TTR and BP-CV in a common multivariable model indicated that a standardized change of TTR was associated with the outcome to a greater extent than BP-CV (mean hazard ratios of 30% vs. 24%, respectively). When combined with the higher BP standardized-CV quartile, the lower TTR quartile predicted the outcome by 2.3 times (95% CI, 1.1-5.4) compared to the inverse TTR and BP-CV quartile pattern.

Conclusion: High BP-CV or low TTR was associated with future cardiovascular events in a cohort of treated hypertensive patients. As a determinant, the extent of TTR value appears greater than BP-CV when these measures are considered in the same multivariable model.

Keywords: Blood pressure variability; blood pressure time in therapeutic range; cardiovascular risk; hypertension; primary prevention; prognosis.

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