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The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

TitleThe impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.
Publication TypeJournal Article
Year of Publication2016
AuthorsOgunwale AN, Morrison AC, Sun W, Dodge RC, Virani SS, Taylor A, Gottesman RF, Yang E, Wei P, McEvoy JW, Heiss G, Boerwinkle E, Ballantyne CM
Secondary AuthorsNambi V
JournalEur J Prev Cardiol
Volume23
Issue14
Pagination1529-36
Date Published2016 09
ISSN2047-4881
KeywordsAtherosclerosis, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Female, Humans, Incidence, Male, Middle Aged, Risk Assessment, Risk Factors, United States
Abstract

AIMS: The aim of this study was to determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease, heart failure and stroke risks.

METHODS AND RESULTS: Black and White participants, N = 11,129, enrolled in the Atherosclerosis Risk in Communities study (mean age 53.9 ± 5.7 (SD) years) were included. Each participant had three sitting, five supine, and six standing blood pressure measures during one day. Main outcome measures were changes in estimated coronary heart disease, heart failure and stroke risk when using the different blood pressure measures. Mean sitting, standing and supine systolic blood pressure values of the study population were 120.8 ± 18.6, 124.9 ± 20 and 124.7 ± 19.6 mmHg, respectively. The substitution of the second sitting systolic blood pressure with the third sitting systolic blood pressure (taken ∼5 min later) in two separate coronary heart disease risk models reclassified 3.3% to 5.1% of study participants. Similar substitutions for heart failure and stroke risk prediction models led to reclassification of 1.9% and 2.7% of participants respectively. When mean sitting systolic blood pressure was replaced with mean standing systolic blood pressure 5.4% to 11.6% of the participants were reclassified. Maximum upward and downward change in an individual's estimated risk was 31% and 26% respectively.

CONCLUSIONS: Estimated risks of coronary heart disease, heart failure, and stroke for an individual can change significantly within a day due to changes in systolic blood pressure. Given recommendations to use estimated risk for therapeutic decisions, our study has implications for the use of a single systolic blood pressure in cardiovascular risk estimation.

DOI10.1177/2047487316633549
Alternate JournalEur J Prev Cardiol
PubMed ID26869459
PubMed Central IDPMC4981557
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States