Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the intermap study

ABSTRACT Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about

factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40–59 years from four countries (Japan, the People’s Republic of China [PRC], the

United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined

visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were

analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value

in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar

results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme

inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible

confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and

mechanisms of these findings remain to be elucidated. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS

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institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS COMBINED EFFECT OF VISIT-TO-VISIT VARIATIONS IN HEART RATE AND SYSTOLIC BLOOD

PRESSURE ON ALL-CAUSE MORTALITY IN HYPERTENSIVE PATIENTS Article 20 July 2021 WHAT DID WE LEARN FROM THE INTERNATIONAL DATABASES ON AMBULATORY AND HOME BLOOD PRESSURE IN RELATION TO

CARDIOVASCULAR OUTCOME? Article Open access 03 February 2023 VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND MORTALITY AND CARDIOVASCULAR OUTCOMES AFTER ACUTE MYOCARDIAL INFARCTION Article 13

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2-RO1-HL50490-06 from the US National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; by the Chicago Health Research Foundation; and by national agencies in

PRC, Japan (the Ministry of Education, Science, Sports, and Culture, Grant-in-Aid for Scientific Research A090357003), and in the UK. PE is Director of the Medical Research Council-Public

Health England (MRC-PHE) Center for Environment and Health and acknowledges support from the Medical Research Council and Public Health England (MR/L01341X/1). PE acknowledges support from

the National Institute for Health Research (NIHR) Biomedical Research Center at Imperial College Healthcare NHS Trust and Imperial College London, and the NIHR Health Protection Research

Unit in Health Impact of Environmental Hazards (HPRU-2012-10141). PE is a UK Dementia Research Institute (DRI) Professor, UK DRI at Imperial College London, funded by the MRC, Alzheimer’s

Society and Alzheimer’s Research UK. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Public Health, Shiga University of Medical Science, Otsu, Japan Naoyuki Takashima, Katsuyuki

Miura, Naoko Miyagawa & Hirotsugu Ueshima * Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan Takayoshi Ohkubo * Center for Epidemiologic

Research in Asia, Shiga University of Medical Science, Otsu, Japan Katsuyuki Miura & Hirotsugu Ueshima * Research Institute of Strategy for Prevention, Tokyo, Japan Akira Okayama *

Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan Nagako Okuda * Department of Public Health, Kanazawa Medical University, Kanazawa, Japan Hideaki

Nakagawa * School of Health Sciences, Sapporo Medical University, Sapporo, Japan Shigeyuki Saito * Department of Hygiene and Public Health, Iwate Medical University, Yahaba, Japan Kiyomi

Sakata * National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh Sohel Reza Choudhury * MRC-PHE Centre for Environment and Health, Department of Epidemiology and

Biostatistics, School of Public Health, Imperial College London, London, UK Queenie Chan & Paul Elliott * Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute,

Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Liancheng Zhao * Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Jeremiah Stamler Authors *

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search for this author inPubMed Google Scholar CONSORTIA INTERMAP STUDY GROUP CORRESPONDING AUTHOR Correspondence to Naoyuki Takashima. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors

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Takashima, N., Ohkubo, T., Miura, K. _et al._ Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the INTERMAP study. _J Hum Hypertens_

33, 229–236 (2019). https://doi.org/10.1038/s41371-018-0129-z Download citation * Received: 09 May 2018 * Revised: 02 September 2018 * Accepted: 14 September 2018 * Published: 12 November

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