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Citation
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HERO ID
6740310
Reference Type
Journal Article
Title
Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women's Health Initiative
Author(s)
Shimbo, D; Newman, JD; Aragaki, AK; Lamonte, MJ; Bavry, AA; Allison, M; Manson, JE; Wassertheil-Smoller, S
Year
2012
Is Peer Reviewed?
Yes
Journal
Hypertension
ISSN:
0194-911X
EISSN:
1524-4563
Volume
60
Issue
3
Page Numbers
625-630
Language
English
PMID
22753206
DOI
10.1161/HYPERTENSIONAHA.112.193094
Web of Science Id
WOS:000307951900018
Abstract
Accumulating evidence suggests that increased visit-to-visit variability (VVV) of blood pressure is associated with stroke. No study has examined the association between VVV of blood pressure and stroke in postmenopausal women, and scarce data exist as to whether this relation is independent of the temporal trend of blood pressure. We examined the association of VVV of blood pressure with stroke in 58,228 postmenopausal women enrolled in the Women's Health Initiative. Duplicate blood pressure readings, which were averaged, were taken at baseline and at each annual visit. VVV was defined as the SD for the participant's mean systolic blood pressure (SBP) across visits (SD) and about the participant's regression line with SBP regressed across visits (SDreg). Over a median follow-up of 5.4 years, 997 strokes occurred. In an adjusted model including mean SBP over time, the hazard ratios (95% CI) of stroke for higher quartiles of SD of SBP compared with the lowest quartile (referent) were 1.39 (1.03-1.89) for quartile 2, 1.52 (1.13-2.03) for quartile 3, and 1.72 (1.28-2.32) for quartile 4 (P trend <0.001). The relation was similar for SDreg of SBP quartiles in a model that additionally adjusted for the temporal trend in SBP (P trend <0.001). The associations did not differ by stroke type (ischemic versus hemorrhagic). There was a significant interaction between mean SBP and SDreg on stroke with the strongest association seen below 120 mmHg. In postmenopausal women, greater VVV of SBP was associated with increased risk of stroke, particularly in the lowest range of mean SBP.
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