The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study

To determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease (CHD), heart failure (HF) and stroke risks

The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study

AIMS: To determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease (CHD), heart failure (HF) and stroke risks. METHODS AND RESULTS: 11,129 black and white participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study (mean age 53.9±5.7 (SD) years) were included. Each participant had 3 sitting, 5 supine, and 6 standing BP measures during one day. Main outcome measures were changes in estimated CHD, HF and stroke risk when using the different BP measures. Mean sitting, standing and supine SBP of the study population were 120.8±18.6, 124.9±20 and 124.7±19.6 mmHg respectively. The substitution of the second sitting SBP with the third sitting SBP (taken ~5 minutes later) in two separate CHD risk models reclassified 3.3% to 5.1% of study participants. Similar substitutions for HF and stroke risk prediction models led to reclassification of 1.9 and 2.7% of participants respectively. When mean sitting SBP was replaced with mean standing SBP 5.4% to 11.6% of the participants were reclassified. Maximum upward and downward change in an individual’s estimated risk was 31%, and 26% respectively. CONCLUSIONS: Estimated risks of CHD, HF and stroke for an individual can change significantly within a day due to changes in SBP. Given recommendations to use estimated risk for therapeutic decisions, our study has implications for the use of a single SBP in cardiovascular risk estimation