Skip to main content
SpringerLink
Log in

Visit-to-visit Systolic Blood Pressure Variability and Stroke Risk: A Systematic Review and Meta-analysis

  • Published:
Current Medical Science Aims and scope Submit manuscript

Summary

Visit-to-visit variability in systolic blood pressure (SBP) may have an important additional role in increasing the risk of vascular complications, including stroke. We conducted a meta-analysis to assess the relationship between visit-to-visit SBP variability (SBPV) and stroke risk. PubMed, EMBASE, and the Cochrane library databases were searched for cohort studies with data on visit-to-visit SBPV and stroke risk. Studies that reported adjusted relative risks (RRs) with 95% CIs of stroke associated with SBPV were included. Fourteen cohort studies met the inclusion criteria and were included in our meta-analysis. After adjustment for age, sex, and existing vascular risk factors, the analysis showed that the risk of stroke in patients with SBPV was significantly increased compared with patients with a small baseline SBPV [SD (RR=1.20, 95% CI=(1.07–1.35), P=0.0005), CV (RR=1.12, 95% CI=(1.00-1.26), P=0.008)]. In addition, follow-up variations of more than 5 years were associated with a higher risk of stroke than those of less than 5 years [RR=1.08, 95% CI=(1.04–1.11)]. Visit-to-visit SBPV was associated with an increased risk of stroke, especially in terms of the time of variation. Taken together, SBPV data may be useful as a preventative diagnostic method in the management of stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012,380(9859):2095–2128

    Article  Google Scholar 

  2. Shimbo D, Newman JD, Aragaki AK, et al. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative. Hypertension, 2012,60(3):625–630

    Article  CAS  Google Scholar 

  3. Gunewardene HO. The stroke in high arterial pressure: A study of 150 cases. Br Med J, 1932,1(3708):180–182

    Article  CAS  Google Scholar 

  4. Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke, 2015,46(7):2032–2060

    Article  Google Scholar 

  5. Pringle E, Phillips C, Thijs L, et al. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens, 2003,21(12):2251–2257

    Article  CAS  Google Scholar 

  6. Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet, 2010,375(9718):895–905

    Article  Google Scholar 

  7. Yokota K, Sakurada T, Koitabashi K, et al. Association Between Residual Kidney Function and Visit-to-Visit Blood Pressure Variability in Peritoneal Dialysis Patients. Adv Perit Dial, 2015,31:49–53

    PubMed  Google Scholar 

  8. Nagai M, Hoshide S, Nishikawa M, et al. Visit-to-visit blood pressure variability in the elderly: associations with cognitive impairment and carotid artery remodeling. Atherosclerosis, 2014,233(1):19–26

    Article  CAS  Google Scholar 

  9. Gondo K, Miura S, Suematsu Y, et al. Association Between Visit-to-Visit Variability in Blood Pressure and Cardiovascular Events in Hypertensive Patients After Successful Percutaneous Coronary Intervention. J Clin Med Res, 2015,7(7):545–550

    Article  Google Scholar 

  10. Patel A, Macmahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med, 2008,358(24):2560–2572

    Article  CAS  Google Scholar 

  11. Tully P J, Debette S, Dartigues J F, et al. Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults: Three-City Cohort Study. Stroke, 2016,47(5):1194–1200

    Article  CAS  Google Scholar 

  12. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000,283(15):2008–2012

    Article  CAS  Google Scholar 

  13. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011 ([https://doi.org/www.cochrane-handbook.org]).

  14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 2010,8(5): 336–341

    Article  Google Scholar 

  15. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://doi.org/www.Ohri.Ca/Programs/Clinical_Epidemiology/Oxford.Asp. (https://doi.org/www.ohri.ca/programs/clinical_epidemiology/oxford.asp).

  16. Yinon L, Chen Y, Parvez F, et al. A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort. Prev Med, 2013,57(6):807–812

    Article  Google Scholar 

  17. Mcmullan CJ, Lambers Heerspink HJ, et al. Visit-to-Visit Variability in Blood Pressure and Kidney and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Nephropathy: A Post Hoc Analysis From the RENAAL Study and the Irbesartan Diabetic Nephropathy Trial. Am J Kidney Dis, 2014,64(5):714–722

    Article  Google Scholar 

  18. Lau KK, Wong YK, Chan YH, et al. Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases-relationships and comparisons with vascular markers of atherosclerosis. Atherosclerosis, 2014,235(1):230–235

    Article  CAS  Google Scholar 

  19. Gao S, Hendrie HC, Wang C, et al. Redefined Blood Pressure Variability Measure and Its Association With Mortality in Elderly Primary Care Patients. Hypertension, 2014,64(1):45–52

    Article  CAS  Google Scholar 

  20. Muntner P, Whittle J, Lynch AI, et al. Visit-to-Visit Variability of Blood Pressure and Coronary Heart Disease, Stroke, Heart Failure, and Mortality: A Cohort Study. Ann Intern Med, 2015,163(5):329–338

    Article  Google Scholar 

  21. Men X, Sun W, Fan F, et al. China Stroke Primary Prevention Trial: Visit-to-Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients. J Am Heart Assoc, 2017,6(3):e4350

    Article  Google Scholar 

  22. Chang TI, Tabada GH, Yang J, et al. Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease. J Hypertens, 2016,34(2):244–252

    Article  CAS  Google Scholar 

  23. Dai H, Lu Y, Song L, et al. Visit-to-visit Variability of Blood Pressure and Risk of Stroke: Results of the Kailuan Cohort Study. Sci Rep, 2017,7(1):285–286

    Article  Google Scholar 

  24. Poortvliet RK, Ford I, Lloyd SM, et al. Blood pressure variability and cardiovascular risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). PLoS One, 2012,7(12):e52438

    Article  CAS  Google Scholar 

  25. Schutte R, Thijs L, Liu YP, et al. Within-subject blood pressure level—not variability—predicts fatal and nonfatal outcomes in a general population. Hypertension, 2012,60(5):1138–1147

    Article  CAS  Google Scholar 

  26. Hata J, Arima H, Rothwell PM, et al. Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patients With Type 2 Diabetes Mellitus: The ADVANCE Trial. Circulation, 2013,128(12):1325–1334

    Article  Google Scholar 

  27. Suchy-Dicey AM, Wallace ER, Mitchell SV, et al. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens, 2013,26(10):1210–1217

    Article  Google Scholar 

  28. Wang J, Shi X, Ma C, et al. Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease. J Hypertens, 2017,35(1):10–17

    Article  CAS  Google Scholar 

  29. Ko Y, Park JH, Yang MH, et al. The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke. Stroke, 2010,41(11):2512–2518

    Article  Google Scholar 

  30. Sheng YC, Wang K, Xu L, et al. A cyclic fluctuation model for 24-h ambulatory blood pressure monitoring in Chinese patients with mild to moderate hypertension. Acta Pharmacol Sin, 2013,8(34):1043–1051

    Article  Google Scholar 

Download references

Acknowledgments

We acknowledge The First Affiliated Hospital of Nanchang University, The Affiliated Hospital of Jiujiang University and The Second Affiliated Hospital of Nanchang University for support in preparation of this report. We thank LetPub (https://doi.org/www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Outpatient, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China

    Han Wang

  2. Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China

    Min Li, Shu-hua Xie, Ye-tong Oyang & Min Yin

  3. Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, 332000, China

    Han Wang, Bing Bao, Zhi-ying Chen & Xiao-ping Yin

Authors
  1. Han Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shu-hua Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ye-tong Oyang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Min Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bing Bao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhi-ying Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiao-ping Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Zhi-ying Chen or Xiao-ping Yin.

Additional information

Conflict of Interest Statement

The authors declare that there is no conflict of interest with any financial organization or corporation or individual that can inappropriately influence this work.

The study was supported by grants from the National Natural Science Foundation of China (No. 81760221 and No. 81660209), National Science & Technology Foundational Resource Investigation Program of China (No. 2018FY100900), the Major Program of the Natural Science Foundation of Jiangxi Province (No. 2016ACB20015).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, H., Li, M., Xie, Sh. et al. Visit-to-visit Systolic Blood Pressure Variability and Stroke Risk: A Systematic Review and Meta-analysis. CURR MED SCI 39, 741–747 (2019). https://doi.org/10.1007/s11596-019-2100-9

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-019-2100-9

Key words

Search

Navigation