Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review

Toby O. Smith, Julia Ann Sillito, Choon-Hian Goh, Abdel-Rahman Abdel-Fattah, Alice Einarsson, Roy L. Soiza, Mamas A. Mamas, Maw Pin Tan, John F. Potter, Yoon K. Loke, Phyo K. Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality.
METHODS: Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised.
RESULTS: 61 studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, ‘day-by-day’ and ‘week-to-week’ variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed).
CONCLUSIONS: An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes was not possible.
Original languageEnglish
JournalAge and Ageing
Publication statusAccepted/In press - 5 Nov 2019

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Cardiovascular Diseases
Blood Pressure
Mortality
Observational Studies
Uncertainty
Databases
Population

Keywords

  • blood pressure
  • hypertension
  • hypotension
  • measurement
  • variability
  • review

Cite this

Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality : a systematic review. / Smith, Toby O.; Sillito, Julia Ann; Goh, Choon-Hian; Abdel-Fattah, Abdel-Rahman; Einarsson, Alice; Soiza, Roy L.; Mamas, Mamas A.; Tan, Maw Pin; Potter, John F.; Loke, Yoon K.; Myint, Phyo K. (Corresponding Author).

In: Age and Ageing, 05.11.2019.

Research output: Contribution to journalArticle

Smith, Toby O. ; Sillito, Julia Ann ; Goh, Choon-Hian ; Abdel-Fattah, Abdel-Rahman ; Einarsson, Alice ; Soiza, Roy L. ; Mamas, Mamas A. ; Tan, Maw Pin ; Potter, John F. ; Loke, Yoon K. ; Myint, Phyo K. / Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality : a systematic review. In: Age and Ageing. 2019.
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abstract = "BACKGROUND: Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality.METHODS: Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised.RESULTS: 61 studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, ‘day-by-day’ and ‘week-to-week’ variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed).CONCLUSIONS: An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes was not possible.",
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author = "Smith, {Toby O.} and Sillito, {Julia Ann} and Choon-Hian Goh and Abdel-Rahman Abdel-Fattah and Alice Einarsson and Soiza, {Roy L.} and Mamas, {Mamas A.} and Tan, {Maw Pin} and Potter, {John F.} and Loke, {Yoon K.} and Myint, {Phyo K.}",
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T1 - Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality

T2 - a systematic review

AU - Smith, Toby O.

AU - Sillito, Julia Ann

AU - Goh, Choon-Hian

AU - Abdel-Fattah, Abdel-Rahman

AU - Einarsson, Alice

AU - Soiza, Roy L.

AU - Mamas, Mamas A.

AU - Tan, Maw Pin

AU - Potter, John F.

AU - Loke, Yoon K.

AU - Myint, Phyo K.

PY - 2019/11/5

Y1 - 2019/11/5

N2 - BACKGROUND: Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality.METHODS: Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised.RESULTS: 61 studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, ‘day-by-day’ and ‘week-to-week’ variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed).CONCLUSIONS: An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes was not possible.

AB - BACKGROUND: Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality.METHODS: Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised.RESULTS: 61 studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, ‘day-by-day’ and ‘week-to-week’ variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed).CONCLUSIONS: An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes was not possible.

KW - blood pressure

KW - hypertension

KW - hypotension

KW - measurement

KW - variability

KW - review

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JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

ER -