Impact of Successive Office Blood Pressure Measurements During a Single Visit on Cardiovascular Risk Prediction: Analysis of CARTaGENE

Abstract

BACKGROUND: Multiple office blood pressure (BP) readings correlate more closely with ambulatory BP than single readings. Whether they are associated with long-term outcomes and improve cardiovascular risk prediction is unknown. Our objective was to assess the long-term impact of multiple office BP readings. METHODS: We used data from CARTaGENE, a population-based survey comprising individuals aged 40 to 70 years. Three BP readings (BP 1 , BP 2 , and BP 3 ) at 2-minute intervals were obtained using a semiautomated device. They were averaged to generate BP 1-2 , BP 2-3 , and BP 1-2-3 for systolic BP (SBP) and diastolic BP. Cardiovascular events (major adverse cardiovascular event [MACE]: cardiovascular death, stroke, and myocardial infarction) during a 10-year follow-up were recorded. Associations with MACE were obtained using adjusted Cox models. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores and their associated C statistics. RESULTS: In the 17 966 eligible individuals, 2378 experienced a MACE during follow-up. Crude SBP values ranged from 122.5 to 126.5 mm Hg. SBP 3 had the strongest association with MACE incidence (hazard ratio, 1.10 [1.05–1.15] per SD) and SBP 1 the weakest (hazard ratio, 1.06 [1.01–1.10]). All models including SBP 1 (SBP 1 , SBP 1-2 , and SBP 1-2-3 ) were underperformed. At a given SBP value, the excess MACE risk conferred by SBP 3 was 2× greater than SBP 1 . In atherosclerotic cardiovascular disease scores, SBP 3 yielded the highest C statistic, significantly higher than most other SBP measures. In contrast to SBP, all diastolic BP readings yielded similar results. CONCLUSIONS: Cardiovascular risk prediction is improved by successive office SBP values, especially when the first reading is discarded. These findings reinforce the necessity of using multiple office BP readings.