Association between variability in systolic blood pressure and cardiovascular events in hypertensive patients: does gender metter?

Objective: To investigate the association between variability in systolic blood pressure (SBPV) and development of cardiovascular events (CVE): angina pectoris, myocardial infarction, cerebrovascular accident in hypertensive patients (pts) according to gender, and to estimate whether SBPV could be a predictor of CVE. Design and method: 300 hypertensive pts (148 men and 152 women) were studied. The study comprised 3 visits during a follow-up period of 30 months. Blood pressure values were defined by the arithmetic mean of three measurements at each visit. SBPV for each patient was defined using the standard deviation from 3 values of systolic BP (SBP-SD). In order to estimate distribution SBPV, quartiles of SBP-SD were introduced. High SBPV were defined as SBP-SD above the 4th and 3th quartile. Results: During 30 months follow up the incidence of CVE was higher in men than in women (22.3% vs 17.7%). The first quartile included SBPV values < 6.00 mmHg, the second quartile 6.01-10.00 mmHg, the third quartile 10.01-17.00 mmHg, and the fourth quartile >17.00 mmHg. The highest SBPV was recorded in 3rd and 4th quartile in men as well in women who had CVE, and SBPV was higher in men than in women (p<0.01 for both quartile). Logistic regression analysis showed that there was a significant relationship between SBPV and CVE in men (OR = 1.141; 95% CI 1.107-1.183, p<0.001), as well as in women (OR = 1.103; 95% CI 1.071-1.139, p<0.001). A cut-off value of SBPV = 12.48 mmHg predicted the CVE with a sensitivity of 68% and specificity of 64% in men (p<0.01), while cut-off value of SBPV = 12.03 mmHg predicted the CVE in women with a sensitivity of 65% and specificity of 67% (p<0.001). Conclusions: Our results showed a significant relationship between SBPV and CVE in hypertensive pts regardless of gender. Higher SBPV was recorded in men than in women. Lower value of SBPV in women >12.03 mmHg than in men >12.48 mmHg predicted future CVE.