Kidney Week

Abstract: FR-PO739

The Impact of Repeated SBP Measurements in a Single Visit on Cardiovascular Prediction

Session Information

• Hypertension and CVD: Clinical, Outcomes, Trials
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials

Authors

• Desbiens, Louis-Charles, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada

Louis-Charles Desbiens,

• Nadeau-Fredette, Annie-Claire, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada

Annie-Claire Nadeau-Fredette,

• Madore, Francois, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada

Francois Madore,

• Agharazii, Mohsen, Universite Laval Faculte de medecine, Quebec, Quebec, Canada

Mohsen Agharazii,

• Goupil, Remi, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada

Remi Goupil,

Background

Blood pressure (BP) is known for its intra-individual variability, even during a single clinic visit. Several guidelines recommend averaging BP measurements during a single office visit to monitor hypertension as it correlates more closely with ambulatory BP. However, whether these averages improve cardiovascular prediction has never been evaluated yet.

Methods

We studied individuals aged between 40 and 69 from the CARTaGENE cohort (Canada). Three SBP measurements (SBP₁,SBP₂,SBP₃) at two-minute intervals were taken with an Omron 907L device. These values were averaged to generate SBP_1-2 (mean of SBP₁ and SBP₂), SBP_2-3 (SBP₂ and SBP₃), and SBP_1-2-3 (SBP₁, SBP₂ and SBP₃). Major adverse atherosclerotic events (MACE: cardiovascular death, stroke, myocardial infarction) during a 10-year follow-up were obtained using medico-administrative databases. Associations of each SBP parameter with MACE were obtained using fully adjusted Cox models. Attributable risks were derived for each SBP parameter. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores (ASCVD; using pooled cohort equations) for each SBP parameter and associated C-statistics.

Results

From 17,966 included individuals, 2,378 had a MACE during the follow-up. SBP values at baseline were 126.5 mmHg (SBP₁), 123.2 (SBP₂) and 122.5 (SBP₃). After adjustment, SBP₃ had the strongest association with MACE incidence. This association was significantly greater than that observed for SBP₁, SBP_1-2, or SBP_1-2-3. In comparison to SBP_1, SBP₃ and SBP_2-3 increased the absolute risk attributable to SBP by up to two times. When included in ASCVD scores, SBP₃ yielded the highest C-statistic, which was significantly higher than all other SBP parameters except SBP_2-3.

Conclusion

Averaging repeated SBP measurements during a single office visit improves cardiovascular risk prediction compared to a single measurement. The first SBP value should nevertheless be discarded in order to maximize predictive performance.

Table

Funding

• Government Support – Non-U.S.