Skip to content

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

Research output: Contribution to journalArticle

  • Jessica K. Barrett
  • Raphael Huille
  • Richard Parker
  • Yuichiro Yano
  • Michael Griswold
Original languageEnglish
Pages (from-to)1855-1868
Number of pages14
JournalStatistics in Medicine
Issue number10
Early online date21 Dec 2018
DateAccepted/In press - 28 Nov 2018
DateE-pub ahead of print - 21 Dec 2018
DatePublished (current) - 10 May 2019


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.

    Research areas

  • cardiovascular disease, heteroscedasticity, joint model, mixed effects model, repeated measurements, survival analysis

Download statistics

No data available



  • Full-text PDF (final published version)

    Rights statement: This is the final published version of the article (version of record). It first appeared online via Wiley at . Please refer to any applicable terms of use of the publisher.

    Final published version, 961 KB, PDF document

    Licence: CC BY-NC


View research connections

Related faculties, schools or groups