Factors Associated with Visit-to-Visit Blood Pressure Variability in Hypertensive Patients at Primary Health Care Service
Author : G. A. R. Pertiwi, A. A. N. Aryawangsa, N.W.S. Ratni
Upload Date : 19-04-2018
Background: Increasing number of valid, well designed trials have demonstrated positive correlation between visit-to-visit variability (VVV) in SBP and increased risk of stroke and coronary heart disease. Some mechanisms were proposed to explain this, as high VVV of SBP was associated with endothelial damage, progression of artery calcification and diastolic dysfunction. Specific intervention to factors promoting high VVV of BP ultimately will improve cardiovascular outcomes in hypertensive patients. This study would assess VVV of BP in hypertensive patients and its associated factors.
Method: This was a cross sectional study, performed in 74 subjects who visited outpatient clinic at PKM Tabanan III, on April – Mei 2017. BP recorded over this year were retrospectively retrieved from subject‘s medical record. VVV of BP was classified into low and high variability based on standard deviation (SD) of SBP. Antihypertensive medical adherence expressed as percentage of PDC and salt intake was measured using 24 hour food recall. Bivariate analysis was performed continued by multivariate analysis for significant variables.
Results: Subjects were 67.6% female, mean age 62.70 ± 10.00 years. BP was measure for 4.82 ± 0.78 during this year, and mean SBP was 139.65 ± 10.57. Non-adherence and salt intake were significantly higher in high variability group compared to low variability (low vs. high variability: non-adherence: 13.5% vs. 37.8%, p=0.033; salt intake: 1278.44 ± 43.02 mg vs. 1495.85 ± 45.26 mg, p= 0.038). After adjusted to other covariates, the difference remain significant only for non-adherence (model I: multivariate adjusted difference, β= 3.89 (95%CI: 1.23 – 12.34; p<0.05), model II: β= 3.9 (1.12 – 14.15) (95l%CI: 1.12 – 14.15; p<0.05).
Conclusion: Non-adherence to antihypertensive medication significantly associated with higher VVV of SBP, independent to other possible contributing factors. Further study needed to assess whether improving adherence could also improve VVV and cardiovascular outcome.
KEYWORDS : visit-to-visit-variability, non-adherence, salt intake