Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension

Abstract

Purpose

Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population.

Materials and methods

This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of ‘high blood pressure’, an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint.

Result

During follow-up, ‘high blood pressure’ developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of ‘high blood pressure’. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of ‘high blood pressure’.

Conclusion

Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.

PLAIN LANGUAGE SUMMARY

What is the context

• A relatively high blood pressure level recorded by chance is not usually examined further, especially in cases where the blood pressure values recorded in different opportunities were within normal levels.

• However, high blood pressure observed by chance may be a result of increased blood pressure variability.

• Increased blood pressure variability predicts incident hypertension in patients with diabetes, but clinical significance of increased blood pressure variability in the general population with normal blood pressure has not been studied.

What is new

• The impact of blood pressure variability on the development of hypertension in the normotensive general population was investigated.

• The present study demonstrated that increased blood pressure variability was the significant predictor of the development of hypertension in the general population.

What is the impact

• Increased year-to-year blood pressure variability as well as the highest blood pressure observed by chance in the preceding years is a strong predictor of the development of hypertension in the general normotensive population.

Keywords:

• Average real variability
• blood pressure
• blood pressure variability
• hypertension
• prediction

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Enshu Hospital (approval number; #2017-09-02).

Data availability statement

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

No financial assistance was received in support of the study.