Factors associated with intra-individual visit-to-vist variability in blood pressure in four countries: The INTERMAP Study

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Title: Factors associated with intra-individual visit-to-vist variability in blood pressure in four countries: The INTERMAP Study
Authors: Takashima, N
Ohkubo, T
Miura, K
Okayama, A
Nagako, O
Nakagawa, H
Saito, S
Sakata, K
Choudhury, SR
Miyagawa, N
Chan, Q
Zhao, L
Elliott, P
Ueshima, H
Stamler, J
Item Type: Journal Article
Abstract: Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40–59 years from four countries (Japan, the People’s Republic of China [PRC], the United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and mechanisms of these findings remain to be elucidated.
Issue Date: 12-Nov-2018
Date of Acceptance: 14-Sep-2018
ISSN: 0950-9240
Publisher: Nature Publishing Group
Start Page: 229
End Page: 236
Journal / Book Title: Journal of Human Hypertension
Volume: 33
Copyright Statement: © Springer Nature Limited 2018
Sponsor/Funder: National Institutes of Health
National Institutes of Health
Medical Research Council (MRC)
Funder's Grant Number: IMTERMAP Subaward No. 60024563
60024563 ICL
Keywords: Science & Technology
Life Sciences & Biomedicine
Peripheral Vascular Disease
Cardiovascular System & Cardiology
INTERMAP Study Group
Cardiovascular System & Hematology
1103 Clinical Sciences
Publication Status: Published
Article Number: JHH-18-0177R
Online Publication Date: 2018-11-12
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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