{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T14:35:01Z","timestamp":1791124501472,"version":"4.1.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Although high visit-to-visit blood pressure variability (BPV) is an independent risk factor for cardiovascular events, the frequency of high BPV is unknown. We conducted this study to define the frequency of high BPV in primary care patients, clinical correlates, and association with antihypertensive therapies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Retrospective cohort study using electronic medical record data (with previously validated case definitions based on billing codes, free text analysis of progress notes, and prescribing data) from the Canadian Primary Care Sentinel Surveillance Network of 221,803 adults with multiple clinic visits over a 2-year period. We <jats:italic>a priori<\/jats:italic> defined a standard deviation&gt;13.0 mm Hg in visit-to-visit systolic blood pressure (SBP) as \u201chigh BPV\u201d based on prior literature.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 85,455 (38.5%) patients had hypertension (mean 6.56 visits with SBP measurement, mean SBP 134.4 with Standard Deviation [SD] 11.3, 33.2% exhibited high BPV) and 136,348 did not (mean 3.96 visits with SBP measurement, mean SBP 120.9 with SD 8.2, 16.5% had high BPV). BPV increased with age regardless of whether individuals had hypertension or not; at all ages BPV varied across antihypertensive treatment regimens and was greater in those receiving renin angiotensin blockers or beta-blockers (p&lt;0.001). High BPV was more frequent in patients with diabetes, chronic kidney disease, dementia, depression, chronic obstructive pulmonary disease, or Parkinson\u2019s disease.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>High visit-to-visit BPV is present in one sixth of non-hypertensive adults and one third of hypertensive individuals and is more common in those with comorbidities. The frequency of high BPV varies across antihypertensive treatment regimens.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248362","type":"journal-article","created":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T17:26:53Z","timestamp":1617384413000},"page":"e0248362","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Visit-to-visit blood pressure variability is common in primary care patients: Retrospective cohort study of 221,803 adults"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7435-3341","authenticated-orcid":true,"given":"Finlay A.","family":"McAlister","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan Cord","family":"Lethebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajdeep S.","family":"Padwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"pone.0248362.ref001","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1038\/nrcardio.2013.1","article-title":"Assessment and management of blood-pressure variability","volume":"10","author":"G Parati","year":"2013","journal-title":"Nat Rev Cardiol"},{"key":"pone.0248362.ref002","doi-asserted-by":"crossref","first-page":"2596","DOI":"10.1016\/j.jacc.2019.02.063","article-title":"Risk factor variability and cardiovascular outcome","volume":"73","author":"FH Messerli","year":"2019","journal-title":"J Am Coll 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Rothwell","year":"2010","journal-title":"Lancet"},{"key":"pone.0248362.ref006","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":"P Muntner","year":"2015","journal-title":"Ann Intern Med"},{"key":"pone.0248362.ref007","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1097\/HJH.0000000000000739","article-title":"Blood pressure variability predicts cardiovascular events independently of traditional cardiovascular risk factors and target organ damage: a LIFE substudy","volume":"33","author":"JK Vishram","year":"2015","journal-title":"J Hypertens"},{"key":"pone.0248362.ref008","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/jch.13346","article-title":"Blood pressure variability predicts adverse events and cardiovascular outcomes in SPRINT","volume":"20","author":"K 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Attack Trial","volume":"16","author":"P Muntner","year":"2014","journal-title":"J Clin Hypertens"},{"key":"pone.0248362.ref012","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/ije\/dyw248","article-title":"Data Resource Profile: national electronic medical record data from the canadian primary care Sentinel Surveillance Network (CPCSSN)","volume":"46","author":"S Garies","year":"2017","journal-title":"Int J Epidemiol"},{"key":"pone.0248362.ref013","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1370\/afm.1644","article-title":"Validating the 8 CPCSSN case definitions for chronic disease surveillance in a primary care database of electronic health records","volume":"12","author":"T Williamson","year":"2014","journal-title":"Ann Fam Med"},{"key":"pone.0248362.ref014","first-page":"31","article-title":"Methods for identifying 30 chronic conditions: application to administrative data","volume":"15","author":"for the Alberta Kidney Disease 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An insight into the mechanisms","volume":"68","author":"G Mancia","year":"2016","journal-title":"Hypertension"},{"key":"pone.0248362.ref018","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":"IM Kronish","year":"2016","journal-title":"Hypertension"},{"key":"pone.0248362.ref019","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.jacc.2016.06.054","article-title":"Association of systolic blood pressure variability with mortality, coronary heart disease, stroke, and renal disease","volume":"68","author":"EO Gosmanova","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"pone.0248362.ref020","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jacc.2016.06.006","article-title":"Searching for Adherence: Can We Fulfill the Promise of Evidence-Based Medicines?","volume":"68","author":"PW Armstrong","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"pone.0248362.ref021","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/archinte.167.8.847","article-title":"Physician Follow-up and Provider Continuity Are Associated With Long-term Medication Adherence: A Study of the Dynamics of Statin Use","volume":"167","author":"MA Brookhart","year":"2007","journal-title":"Arch Intern Med"},{"key":"pone.0248362.ref022","doi-asserted-by":"crossref","first-page":"e025322","DOI":"10.1136\/bmjopen-2018-025322","article-title":"Number of blood pressure measurements needed to estimate long-term visit-to-visit systolic blood pressure variability for predicting cardiovascular risk: a 10-year retrospective cohort study in a primary care clinic in Malaysia","volume":"9","author":"HM Lim","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0248362.ref023","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.9778\/cmajo.20140128","article-title":"Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study","volume":"4","author":"JA Queenan","year":"2016","journal-title":"CMAJ Open"},{"key":"pone.0248362.ref024","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1016\/S0140-6736(19)32317-7","article-title":"Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis","volume":"394","author":"MA Suchard","year":"2019","journal-title":"Lancet"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248362","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T17:27:11Z","timestamp":1617384431000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248362"}},"subtitle":[],"editor":[{"given":"Hans-Peter","family":"Brunner-La Rocca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,2]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248362","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,2]]}}}