Visit-to-visit blood pressure variability and clinical events in older patients receiving home medical care: the ohcare study

Abstract Background In recent years, the management of blood pressure (BP) variability and mean BP levels have become more important for hypertensive patients. We investigated the association of visit-to-visit variability (VVV) of BP with clinical events in older patients (about 85 years old) receiving home medical care. Methods We included patients who were followed up as part of the Osaka Home CAre Registry (OHCARE) study. OHCARE was a prospective cohort study that targeted older patients receiving home medical care in Japan. We included patients (n = 103) that fulfilled the following inclusion criteria: aged 65 years or older; BP measurements performed on at least three occasions before the baseline date (median 4.78 occasions); BP measurement interval of 16 ± 13 days (median ± 1 standard deviation [SD]). We used SD and coefficient of variation (CV) of systolic blood pressure (SBP) measured at baseline as the VVV of BP. Main outcomes were clinical events including hospitalizations, falling, and death during follow-up. Results Regarding the relationship between VVV and clinical events, the rate of hospitalization was significantly higher in the group with the largest SD of SBP than in the group with the smallest. Furthermore, multivariate analysis showed that SD and CV of SBP had independent positive associations with hospitalization. Conclusions In older patients requiring home medical care, a higher VVV in SBP may be related to the occurrence of events leading to hospitalizations; thus, our findings suggest that it could be used as a predictive marker.