Trajectory of systolic blood pressure fluctuation and its influencing factors in community-dwelling patients with hypertension

Abstract

Objective To analyze and construct systolic blood pressure (SBP) fluctuation trajectory in a community population with hypertension and to analyze the factors influencing different trajectories. Methods This is a community-based retrospective cohort study. A latent class trajectory model was used to identify and construct longitudinal trajectories of blood pressure change. Multinomial logistic regression analysis was performed to identify the associated factors of blood pressure trajectories by adjusting for different confounders. Potential confounding factors were identified using a directed acyclic graph based on a priori knowledge. Results A total of 793 patients with hypertension were enrolled in the analysis. They were divided into 3 groups by LCTM-fitted systolic blood pressure trajectories, namely stable low-level group (n=561, 70.74%), declining group (n=170, 21.44%) and rising group (n=62, 7.82%). Significant differences were observed among the 3 trajectories groups in terms of age, frequency of exercise, ways of follow-up, salt intake, compliance behavior, and referral (P<0.05). Compared to the stable low-level group and adjusting for corresponding confounding factors, the male patients and the patients with "outpatient follow-up" were more likely to be classified into "declining group", with OR and 95% CI of 1.436 (1.016~2.030) and 1.702 (1.202~2.410), respectively. The participants aged ≥65 years, who did not exercise or occasionally exercised, and had moderate and severe salt intake, were more likely to be classified into the "rising group"(OR=1.949, 2.284, 2.433, 4.540, 95%CI: 1.145~3.317, 1.305~3.998, 1.272~4.654, 1.291~15.963). Conclusion SBP trajectories in community-dwelling hypertensive population can be divided into stable low-level, declining and rising groups. Gender, age, salt intake, exercise frequency, and follow-up methods may be influencing factors for SBP blood pressure trajectory.

Keywords

• community population
• hypertension
• latent class trajectory model
• systolic blood pressure trajectory
• influencing factors