An apparent paradox in visit-to-visit blood pressure variability and adverse outcomes in malignant hypertension patients : the West Birmingham malignant hypertension registry
Argyris, Antonios A Shantsila, Alena Beevers, D Gareth Shantsila, Eduard Lip, Gregory Υ Η
Argyris, Antonios A
Shantsila, Alena
Beevers, D Gareth
Shantsila, Eduard
Lip, Gregory Υ Η
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University of Liverpool; Sandwell and West Birmingham NHS Trust; Medical University of Bialystok
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Publication date
2025-10-10
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Abstract
Background: Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given that such high BP variability has been associated with poorer outcomes in the general hypertensive population, our aim was to examine the prognostic role of visit-to-visit BP variability with cardiovascular disease and mortality in this high risk MHT population. Methods: Data from the West Birmingham MHT Registry were analyzed. We calculated quartiles of visit-to-visit BP variability and used Kaplan-Meier curves and Cox proportional hazard models to examine the association of BP variability with incidence of outcomes. Results: A total of 339 patients (age 48 ± 13 years, 65 % male) were included, with a median follow-up 11 years (IQR 3-18). On Kaplan-Meier analyses, subjects in the highest variability quartiles had significantly lower risk of cardiovascular disease, all-cause mortality and all-cause mortality/dialysis than patients in the lower quartiles (log rank p < 0.001). In Cox proportional hazard models, higher systolic BP variability was associated with lower incidence of all outcomes [HR (95 % CI): 0.266 (0.128-0.552) for higher vs lower quartile for all-cause mortality]. Higher diastolic BP variability was associated with lower risk of mortality outcomes [HR (95 % CI): 0.236 (0.107-0.519)]. This effect was attenuated in the subgroup with better BP control at follow-up. Conclusions: Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.
Citation
Argyris AA, Shantsila A, Beevers DG, Shantsila E, Lip GΥΗ. An apparent paradox in visit-to-visit blood pressure variability and adverse outcomes in malignant hypertension patients: The West Birmingham malignant hypertension registry. Curr Probl Cardiol. 2025 Oct 10;50(12):103192. doi: 10.1016/j.cpcardiol.2025.103192. Epub ahead of print
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Article