Blood Pressure Variability and the Risk of Fracture: A Nationwide Cohort Study

Abstract

Abstract Context Although blood pressure variability (BPV) is associated with various health outcomes, only 1 study suggested that BPV is correlated with hip fractures. As cardiovascular disease and fractures share similar pathophysiology, there might be a link between BPV and fractures. Objective To investigate the association between BPV and the incident fractures. Design Retrospective cohort study. Setting Population-based, using the Korean National Health Insurance System database. Patients or Other Participants A total of 3 256 070 participants aged ≥50 who participated in ≥3 health examinations within the previous 5 years, including the index year (2009-2010), were included. Outcome data were obtained through the end of 2016. Exposure BPV was calculated using variability independent of the mean. High variability was defined as the highest quartile of variability. Main Outcome Measures Newly diagnosed fractures. Results During the median follow-up of 7.0 years, there were 337 045 cases of any fracture (10.4%). After adjusting for age, sex, income, lifestyle factors, and comorbidities, a higher risk of fracture was observed with higher quartiles of BPV than the lowest quartile group: the adjusted hazard ratios (95% CIs) for incident any fracture were 1.07 (1.06-1.08) in the higher quartile of systolic BPV, 1.06 (1.05-1.07) in that of diastolic BPV, and 1.07 (1.06-1.08) in that of both systolic and diastolic BPV. Consistent results were noted for vertebral fractures and hip fractures, as well as in various subgroup analyses. Conclusions A positive association was noted between higher BPV and fracture incidence. BPV is an independent predictor for developing fracture.