Pulse lineResearch With Heart Logo

Estimating the association between blood pressure variability and cardiovascular disease: An application using the ARIC Study.

TitleEstimating the association between blood pressure variability and cardiovascular disease: An application using the ARIC Study.
Publication TypeJournal Article
Year of Publication2019
AuthorsBarrett JK, Huille R, Parker R, Yano Y
Secondary AuthorsGriswold M
JournalStat Med
Volume38
Issue10
Pagination1855-1868
Date Published2019 05 10
ISSN1097-0258
KeywordsBlood Pressure, Cardiovascular Diseases, Computer Simulation, Datasets as Topic, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Prognosis, Risk Factors, Systole, United States
Abstract

The association between visit-to-visit systolic blood pressure variability and cardiovascular events has recently received a lot of attention in the cardiovascular literature. But, blood pressure variability is usually estimated on a person-by-person basis and is therefore subject to considerable measurement error. We demonstrate that hazard ratios estimated using this approach are subject to bias due to regression dilution, and we propose alternative methods to reduce this bias: a two-stage method and a joint model. For the two-stage method, in stage one, repeated measurements are modelled using a mixed effects model with a random component on the residual standard deviation (SD). The mixed effects model is used to estimate the blood pressure SD for each individual, which, in stage two, is used as a covariate in a time-to-event model. For the joint model, the mixed effects submodel and time-to-event submodel are fitted simultaneously using shared random effects. We illustrate the methods using data from the Atherosclerosis Risk in Communities study.

DOI10.1002/sim.8074
Alternate JournalStat Med
PubMed ID30575102
PubMed Central IDPMC6445736
Grant ListMR/L003120/1 / MRC_ / Medical Research Council / United Kingdom
RG/13/13/30194 / BHF_ / British Heart Foundation / United Kingdom
MR/K014811/1 / MRC_ / Medical Research Council / United Kingdom
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201000021C / HL / NHLBI NIH HHS / United States
MR/L501566/1 / MRC_ / Medical Research Council / United Kingdom
HHSN2682017000021 / / National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services / International
HHSN268201700001I / HL / NHLBI NIH HHS / United States
MC_UU_00002/5 / MRC_ / Medical Research Council / United Kingdom
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
G0902100 / MRC_ / Medical Research Council / United Kingdom
MR/N027485/1 / MRC_ / Medical Research Council / United Kingdom