Li Hsin-Lun, Lin Hung-Ju, Muo Chih-Hsin, Lu Chung-Yen, Kuo Chin-Chi, Chen Pei-Chun
Department of Applied Mathematics National Sun Yet-sen University Kaohsiung Taiwan.
Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan.
J Am Heart Assoc. 2025 Jun 3;14(11):e037658. doi: 10.1161/JAHA.124.037658. Epub 2025 May 26.
The real-world applicability of long-term blood pressure (BP) variability measurements remains underexplored. We evaluated the association between visit-to-visit BP variability and the risk of cardiovascular events and all-cause mortality using electronic health records.
In this retrospective cohort study at a large academic medical center in Taiwan, we calculated the variability independent of the mean (VIM) and average real variability of BP using electronic health records of 16 945 adults with at least one outpatient BP measurement in any 3 consecutive years from 2012 to 2017. We used Cox proportional hazards models to assess associations between BP variability and cardiovascular events, including cardiovascular deaths, and all-cause mortality through 2020.
Over a median follow-up of 4 years, 317 patients experienced cardiovascular events, and 582 died. Adjusted hazard ratios (HRs) for cardiovascular events increased gradually across both VIM and average real variability quartiles of BP. The adjusted HRs (95% CIs) per interquartile range increase in systolic BP variability was 1.24 (1.09-1.41) for VIM and 1.11 (1.01-1.23) for average real variability. For diastolic BP, the HRs (95% CIs) were 1.22 (1.09-1.36) and 1.13 (1.02-1.24), respectively. Similar results were observed for all-cause mortality except a weaker association with average real variability of diastolic BP (HR, 1.08 [95% CI, 0.99-1.17]). The association between VIM of BP and risk of cardiovascular events was consistent across patient subgroups.
In the electronic health records analysis, visit-to-visit BP variability was independently associated with the risk of cardiovascular events and all-cause mortality. Our findings indicate the applicability of BP variability indices in real-world health care settings.
长期血压（BP）变异性测量在现实世界中的适用性仍未得到充分探索。我们使用电子健康记录评估了就诊间血压变异性与心血管事件风险及全因死亡率之间的关联。
在台湾一家大型学术医疗中心进行的这项回顾性队列研究中，我们利用2012年至2017年连续3年中至少有一次门诊血压测量记录的16945名成年人的电子健康记录，计算了独立于均值的变异性（VIM）和血压的平均实际变异性。我们使用Cox比例风险模型评估血压变异性与心血管事件（包括心血管死亡）以及截至2020年的全因死亡率之间的关联。
在中位随访4年期间，317名患者发生了心血管事件，582人死亡。在血压的VIM和平均实际变异性四分位数中，心血管事件的调整后风险比（HR）均逐渐增加。收缩压变异性每增加一个四分位数间距，VIM的调整后HR（95%CI）为1.24（1.09 - 1.41），平均实际变异性为1.11（1.01 - 1.23）。对于舒张压，HR（95%CI）分别为1.22（1.09 - 1.36）和1.13（1.02 - 1.24）。除了与舒张压平均实际变异性的关联较弱（HR，1.08 [95%CI，0.99 - 1.17]）外，全因死亡率也观察到类似结果。血压VIM与心血管事件风险之间的关联在各患者亚组中是一致的。
在电子健康记录分析中，就诊间血压变异性与心血管事件风险及全因死亡率独立相关。我们的研究结果表明血压变异性指数在现实世界的医疗环境中具有适用性。
