Estimating the association between blood pressure variability and cardiovascular disease: An application using the ARIC Study.


Journal Article

The association between visit-to-visit systolic blood pressure variability and cardiovascular events has recently received a lot of attention in the cardiovascular literature. But, blood pressure variability is usually estimated on a person-by-person basis and is therefore subject to considerable measurement error. We demonstrate that hazard ratios estimated using this approach are subject to bias due to regression dilution, and we propose alternative methods to reduce this bias: a two-stage method and a joint model. For the two-stage method, in stage one, repeated measurements are modelled using a mixed effects model with a random component on the residual standard deviation (SD). The mixed effects model is used to estimate the blood pressure SD for each individual, which, in stage two, is used as a covariate in a time-to-event model. For the joint model, the mixed effects submodel and time-to-event submodel are fitted simultaneously using shared random effects. We illustrate the methods using data from the Atherosclerosis Risk in Communities study.

Full Text

Duke Authors

Cited Authors

  • Barrett, JK; Huille, R; Parker, R; Yano, Y; Griswold, M

Published Date

  • May 10, 2019

Published In

Volume / Issue

  • 38 / 10

Start / End Page

  • 1855 - 1868

PubMed ID

  • 30575102

Pubmed Central ID

  • 30575102

Electronic International Standard Serial Number (EISSN)

  • 1097-0258

Digital Object Identifier (DOI)

  • 10.1002/sim.8074


  • eng

Conference Location

  • England