{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T13:41:33Z","timestamp":1775050893638,"version":"3.50.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3]]},"abstract":"\n Background:<\/jats:title>\n Visit-to-visit office blood pressure (BP) variability (BPV) has been associated with morbidity and mortality outcomes in several cardiovascular conditions. The aim of this study was to evaluate the association between BPV and outcomes in patients with heart failure and reduced ejection fraction and the effect of eplerenone on BPV.<\/jats:p>\n <\/jats:sec>\n \n Methods and results:<\/jats:title>\n We evaluated the associations between BPV, calculated as SBP coefficient of variation (SBP-CoV\u200a=\u200aSD\/mean\u200a\u00d7\u200a100%), and the primary composite endpoint of cardiovascular mortality or heart failure hospitalization (HFH), and its components, in 2549 patients from the Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms trial. Lower SBP-CoV was independently associated with a higher risk of all the studied outcomes, while higher as well as lower SBP-CoV were associated with a higher risk of cardiovascular death. After a median follow-up period of 21 months the risk of the composite outcome of cardiovascular death or HFH was almost double in the lower SBP-CoV tertile as compared with the intermediate tertile [adjusted hazard ratio: 2.01, 95% confidence interval (1.62\u20132.51), P<\/jats:italic>\u200a<\u200a0.001]. The relationship between SBP-CoV and outcomes was not modified by eplerenone (P<\/jats:italic> value for interaction\u200a=\u200a0.48). An interaction was detected between mean SBP and SBP-CoV for the primary outcome (P<\/jats:italic>\u200a=\u200a0.048) and for HFH (P<\/jats:italic>\u200a=\u200a0.018). The effect modification was slight, but lower SBP-CoV was associated with worse outcomes in patients with both low and high SBP, while this interaction was less clear for patients with SBP in the \u2018normal\u2019 range.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n In our patients with heart failure and reduced ejection fraction and mild symptoms, both a lower and higher SBP-CoV were associated with worse outcomes. SBP-CoV did not modify the benefit of eplerenone. Further studies are warranted to clarify the role of BPV in heart failure.<\/jats:p>\n <\/jats:sec>\n \n ClinicalTrials.gov identifier:<\/jats:title>\n NCT00232180.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/hjh.0000000000002275","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T14:47:50Z","timestamp":1570200470000},"page":"420-425","source":"Crossref","is-referenced-by-count":20,"title":["Visit-to-visit blood pressure variation and outcomes in heart failure with reduced ejection fraction: findings from the Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms trial"],"prefix":"10.1097","volume":"38","author":[{"given":"Luca","family":"Monzo","sequence":"first","affiliation":[{"name":"Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, \u2018Sapienza\u2019 University, Rome, Italy"}]},{"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d\u2019Investigations Cliniques-Plurith\u00e9matique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"}]},{"given":"Paula","family":"Abreu","sequence":"additional","affiliation":[{"name":"Pfizer, New York, New York, USA"}]},{"given":"Annette","family":"Szumski","sequence":"additional","affiliation":[{"name":"Pfizer, New York, New York, USA"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Saarland University, Homburg, Saarland, Germany"}]},{"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"The British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"University of Michigan School of Medicine, Ann Arbor, Michigan, USA"}]},{"given":"Karl","family":"Swedberg","sequence":"additional","affiliation":[{"name":"Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}]},{"given":"Dirk J.","family":"van Veldhuisen","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d\u2019Investigations Cliniques-Plurith\u00e9matique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"}]},{"given":"John","family":"Vincent","sequence":"additional","affiliation":[{"name":"Pfizer, New York, New York, USA"}]},{"given":"Faiez","family":"Zannad","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d\u2019Investigations Cliniques-Plurith\u00e9matique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d\u2019Investigations Cliniques-Plurith\u00e9matique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"}]}],"member":"276","reference":[{"key":"R1-20230912","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1161\/HYPERTENSIONAHA.114.03903","article-title":"Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis","volume":"64","author":"Diaz","year":"2014","journal-title":"Hypertension"},{"key":"R2-20230912","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1161\/HYPERTENSIONAHA.115.06960","article-title":"The association between antihypertensive medication nonadherence and visit-to-visit variability of blood pressure: findings from the antihypertensive and lipid-lowering treatment to prevent heart attack trial","volume":"68","author":"Kronish","year":"2016","journal-title":"Hypertension"},{"key":"R3-20230912","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1161\/HYPERTENSIONAHA.110.162255","article-title":"The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994","volume":"57","author":"Muntner","year":"2011","journal-title":"Hypertension"},{"key":"R4-20230912","doi-asserted-by":"crossref","first-page":"329","DOI":"10.7326\/M14-2803","article-title":"Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: a cohort study","volume":"163","author":"Muntner","year":"2015","journal-title":"Ann Intern Med"},{"key":"R5-20230912","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1161\/HYPERTENSIONAHA.112.193094","article-title":"Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women's Health Initiative","volume":"60","author":"Shimbo","year":"2012","journal-title":"Hypertension"},{"key":"R6-20230912","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1161\/HYPERTENSIONAHA.117.09788","article-title":"Visit-to-visit office blood pressure variability and cardiovascular outcomes in SPRINT (Systolic Blood Pressure Intervention Trial)","volume":"70","author":"Chang","year":"2017","journal-title":"Hypertension"},{"key":"R7-20230912","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1097\/HJH.0000000000001742","article-title":"Visit-to-visit blood pressure variation is associated with outcomes in a U-shaped fashion in patients with myocardial infarction complicated with systolic dysfunction and\/or heart failure: findings from the EPHESUS and OPTIMAAL trials","volume":"36","author":"Ferreira","year":"2018","journal-title":"J Hypertens"},{"key":"R8-20230912","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1161\/HYPERTENSIONAHA.111.190397","article-title":"Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSIDIAL","volume":"60","author":"Rossignol","year":"2012","journal-title":"Hypertension"},{"key":"R9-20230912","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ijcard.2015.03.169","article-title":"Increased visit-to-visit blood pressure variability is associated with worse cardiovascular outcomes in low ejection fraction heart failure patients: insights from the HEAAL study","volume":"187","author":"Rossignol","year":"2015","journal-title":"Int J Cardiol"},{"key":"R10-20230912","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S0140-6736(10)60309-1","article-title":"Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension","volume":"375","author":"Rothwell","year":"2010","journal-title":"Lancet"},{"key":"R11-20230912","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0140-6736(10)60308-X","article-title":"Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension","volume":"375","author":"Rothwell","year":"2010","journal-title":"Lancet"},{"key":"R12-20230912","doi-asserted-by":"crossref","first-page":"2813","DOI":"10.1093\/eurheartj\/ehx250","article-title":"Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial","volume":"38","author":"Vidal-Petiot","year":"2017","journal-title":"Eur Heart J"},{"key":"R13-20230912","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/jhh.2015.26","article-title":"Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial","volume":"30","author":"Hong","year":"2016","journal-title":"J Hum Hypertens"},{"key":"R14-20230912","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/jch.12230","article-title":"Visit-to-visit blood pressure variability and cardiovascular death in the Systolic Hypertension in the Elderly Program","volume":"16","author":"Kostis","year":"2014","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"R15-20230912","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1161\/HYPERTENSIONAHA.116.07139","article-title":"Visit-to-visit blood pressure variability: an insight into the mechanisms","volume":"68","author":"Mancia","year":"2016","journal-title":"Hypertension"},{"key":"R16-20230912","doi-asserted-by":"crossref","first-page":"e002160","DOI":"10.1161\/JAHA.115.002160","article-title":"Effect of visit-to-visit variation of heart rate and systolic blood pressure on outcomes in chronic systolic heart failure: results from the Systolic Heart Failure Treatment with the if Inhibitor Ivabradine Trial (SHIFT) trial","volume":"5","author":"Bohm","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"R17-20230912","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms","volume":"364","author":"Zannad","year":"2011","journal-title":"N Engl J Med"},{"key":"R18-20230912","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1093\/eurheartj\/eht247","article-title":"The impact of eplerenone at different levels of risk in patients with systolic heart failure and mild symptoms: insight from a novel risk score for prognosis derived from the EMPHASIS-HF trial","volume":"34","author":"Collier","year":"2013","journal-title":"Eur Heart J"},{"key":"R19-20230912","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"R21-20230912","doi-asserted-by":"crossref","first-page":"R815","DOI":"10.1152\/ajpregu.00051.2002","article-title":"Arterial baroreflex function and cardiovascular variability: interactions and implications","volume":"283","author":"Lanfranchi","year":"2002","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"R22-20230912","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1038\/hr.2010.26","article-title":"Diurnal blood pressure variation and sympathetic activity","volume":"33","author":"Grassi","year":"2010","journal-title":"Hypertens Res"},{"key":"R23-20230912","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1097\/00005344-199612000-00001","article-title":"Circadian variation in blood pressure and heart rate in nonhypertensive congestive heart failure","volume":"28","author":"Giles","year":"1996","journal-title":"J Cardiovasc Pharmacol"},{"key":"R24-20230912","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/S0735-1097(01)01116-0","article-title":"Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure","volume":"37","author":"Tsutamoto","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"R25-20230912","doi-asserted-by":"crossref","first-page":"2512","DOI":"10.1161\/01.CIR.0000071081.35693.9A","article-title":"Eplerenone: cardiovascular protection","volume":"107","author":"Brown","year":"2003","journal-title":"Circulation"},{"key":"R26-20230912","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction","volume":"348","author":"Pitt","year":"2003","journal-title":"N Engl J Med"},{"key":"R27-20230912","doi-asserted-by":"crossref","first-page":"e5673","DOI":"10.1371\/journal.pone.0005673","article-title":"Factors affecting blood pressure variability: lessons learned from two systematic reviews of randomized controlled trials","volume":"4","author":"Musini","year":"2009","journal-title":"PLoS One"}],"container-title":["Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/HJH.0000000000002275","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T03:24:02Z","timestamp":1694489042000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/HJH.0000000000002275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1097\/hjh.0000000000002275","relation":{},"ISSN":["0263-6352","1473-5598"],"issn-type":[{"value":"0263-6352","type":"print"},{"value":"1473-5598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}