BP variability tied to coronary atheroma progression and adverse clinical outcomes

  • Clark D & al.
  • JAMA Cardiol
  • 10 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • In patients with coronary artery disease (CAD) receiving stablished medical therapies, greater visit-to-visit blood pressure variability (BPV), particularly systolic BPV, is significantly associated with coronary atheroma progression and major adverse cardiovascular events (MACEs).

Why this matters

  • Findings suggests that maintaining stable blood pressure (BP) levels may improve cardiovascular outcomes in patients with CAD.

Study design

  • Post-hoc analysis of 7 randomised clinical trials involving 3912 patients with CAD who underwent serial intravascular ultrasonography between November 2017 and March 2019.
  • Visit-to-visit BPV was assessed across 3, 6, 12, 18 and 24 months.
  • Main outcomes: per cent atheroma volume (PAV) progression and MACEs (death, myocardial infarction, stroke, urgent revascularisation for acute coronary syndrome and hospitalisation for unstable angina).
  • Funding: None disclosed.

Key results

  • Systolic BPV (β, 0.096; P=.007) was significantly associated with PAV progression, but no significant association was observed between PAV progression and diastolic BPV (β, 0.003; P=.92) and pulse pressure variability (β, 0.072; P=.07) without a signal for differential effect greater or less than a mean BP of 140/90 mmHg.
  • Binary outcome of PAV progression with maximum follow-up BP was significantly associated with systolic BPV (OR, 1.09; P=.02) but not with diastolic BPV (OR, 1.04; P=.25) and pulse pressure variability (OR, 1.02; P=.54).
  • There was a significant stepwise association between cumulative MACEs and increasing quartiles of systolic BPV (Kaplan-Meier estimates for quartiles 1-4: 6.1% vs 8.5% vs 10.1% vs 12.0%, respectively; log-rank P<.001>
  • This association was not observed between MACEs and diastolic BPV and pulse pressure variability.


  • Results may not be applicable to those without atherosclerotic heart disease.
  • BP measurement methods were not consistent across studies.

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