Introduction: Hypertension is a risk factor for cardiovascular disease (CVD). Blood pressure (BP) indices, such as maximum and visit-to-visit variability (VVV) in BP, have been reported to be associated with CVD. However, few studies have investigated the association of maximum or VVV in BP with CVD over a period of ≥10 years according to antihypertensive treatment status. Hypothesis: This study aimed to examine (1) the association of BP indices, including maximum and VVV in BP, with CVD over a period of ≥10 years and (2) whether the association differed by antihypertensive treatment. Methods: The Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN) study is a meta-analysis of individual participant data from Japanese cohorts. A total of 16,655 participants (46.3% women; mean age 57.5 years) from 6 cohorts were analyzed. We used the 1-year, 5-year mean, 5-year maximum, and 5-year mean and standard deviation (SD) values of systolic BP obtained during 5-year time periods. The outcomes were defined as the incidence or mortality of CVD. The Cox model was used to estimate the adjusted hazard ratios (HRs) per 1-SD increase in each BP index after stratification by antihypertensive treatment. Results: During a mean 10.4-year follow-up, 1,044 participants developed CVD, 666 developed stroke, and 316 developed coronary heart disease (CHD). Using the 1-year, 5-year mean, 5-year maximum, and 5-year mean and SD values of systolic BP, the adjusted HRs (95% confidence interval CI) for CVD were 1.21 (1.12–1.30), 1.42 (1.28–1.56), 1.35 (1.24–1.46), and 1.10 (1.02–1.19) in individuals without antihypertensive treatment. Meanwhile, the HRs (95%CI) for CVD were 1.11 (1.00–1.23), 1.12 (0.99–1.27), 1.11 (1.01–1.22), and 1.04 (0.96–1.12) in individuals with antihypertensive treatment. Although similar results were observed for stroke, the SD values of systolic BP were not associated with the risk of developing CHD. Conclusions: Untreated individuals showed higher HRs for CVD and stroke with 5-year mean and 5-year maximum BP values than with 1-year values. A significant association of the SD values of BP with CVD and stroke was observed in untreated participants, but not in treated participants. In individuals without antihypertensive treatment, the 5-year mean, 5-year maximum, and SD values of BP may be more important than the 1-year values in predicting the risk of CVD and stroke.
Nakayama et al. (2026) studied this question.