Within-subject diastolic blood pressure variability: implications for risk assessment and screening.
J Clin Epidemiol
; 45(9): 985-98, 1992 Sep.
Article
en En
| MEDLINE
| ID: mdl-1432027
ABSTRACT
Because of variability in diastolic blood pressure within an individual, repeated measurements increase precision in assessing an individual's underlying mean pressure and so also aid risk classification. Data from a cohort of 11,299 middle-aged men is used to model the variability in diastolic pressure between annual measurements. A simple model with pressure normally distributed about an underlying mean with standard deviation increasing with level fits the data very well. In modelling risk of cardiovascular mortality, a strong association is found with observed diastolic pressure level but not to trends in or variability between observed values. The effect of regression dilution is clear with the risk relationship appearing greater as one uses the mean of an increasing number of measurements. A method of adjusting for this regression dilution is described so giving an estimate of the relationship with underlying mean diastolic pressure. Using this survival model and the model for blood pressure variability, a method is presented for estimating both underlying mean pressure and absolute risk of cardiovascular disease given a sequence of blood pressure measurements from screening. This allows a sequential strategy for determining whether (a) antihypertensive intervention is desirable, (b) no further screening is necessary, or (c) further screening would aid the assessment, and emphasizes the need to consider blood pressure in the context of multiple risk factors.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Presión Sanguínea
/
Enfermedades Cardiovasculares
/
Clofibrato
/
Hipercolesterolemia
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Límite:
Adult
/
Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Epidemiol
Asunto de la revista:
EPIDEMIOLOGIA
Año:
1992
Tipo del documento:
Article
País de afiliación:
Reino Unido