Association Between Long-Term Blood Pressure Variability and 10-Year Progression in Arterial Stiffness

Abstract

Experimental studies conducted on animal and human endothelium suggested that higher systolic blood pressure (SBP) variability reduces bioavailability of nitric oxide and increases vascular smooth muscle cell proliferation. These vascular wall changes could stiffen the arterial wall. Using data from the Multi-Ethnic Study of Atherosclerosis, we investigated the association between long-term SBP variability and ten-year percent change in arterial stiffness among 1122 individuals (mean age 57 years, 46% Males at baseline) who were not taking anti-hypertensive medications. Within-individual standard deviation (SD), variability independent of the mean (VIM), and coefficient of variation (CV) of SBP across 5 visits were used to capture long-term SBP variability. Carotid arterial stiffness was measured using distensibility coefficient (DC) and Young’s elastic modulus (YEM) at baseline and after a mean of 9.5 years of follow-up (visit 5). In a multivariate linear regression model, individuals in the 5th quintile as compared to those in the 1st quintile of SD, VIM, and CV of SBP had a 9.8% (95% CI: −17.0%, −2.7%), 6.4% (95% CI: −13.2%, 0.4%), and 8.7% (95% CI: −15.4%, −1.9%) higher decline in DC and a 27.5% (95% CI: 15.8%, 39.3%), 25.8% (95% CI: 14.7%, 36.9%), and 27.9% (95% CI: 16.8%, 39.1%) higher progression in YEM, respectively, after ten years of follow-up. Linear trends in the decline of DC and progression of YEM were observed across the quintiles of SBP variability indices. These findings suggest that higher long-term SBP variability may be a risk factor for arterial stiffness progression independent of mean BP.

Variability in Predialysis Systolic Blood Pressure and Long-Term Outcomes in Hemodialysis Patients

“…Increased long-term BPV was found to be associated with stroke [4], cardiovascular events [2], arterial stiffnes s [5] and decreased GFR [3] and is therefore considered an independent risk factor for all-cause and cardiovascular mortality in non-hemodialysis patients. These remain, however, less well-investigated in hemodialysis patients.…”

“…The latter includes variations in BP that occur over more prolonged periods of time, such as days, weeks, months, seasons, and even years [1]. A growing number of studies performed in the general population have shown that BPV is a risk factor for target organ damage and mortality, independent of absolute BP level [2-5]. …”

Arterial Stiffness: Pathophysiological and Genetic Aspects

“…These changes are influenced by hemodynamic forces 15,16 and extrinsic factors, such as hormones 17 and inflammatory mediators 18 , which may be related to sodium and glucose balance. 19 Arterial rigidity is modulated by means of a fine balance between production and degradation of elastin and collagen.…”

Treating Visit-to-Visit Blood Pressure Variability to Improve Prognosis

“…[4][5][6][7][8][9][10] Three interesting articles have been recently published in this journal regarding long-term visit-to-visit BPV (VVV). Tedla et al 11 showed that an increased VVV among 1122 untreated individuals was predictive of arterial stiffness progression after 10 years of follow-up. The 2 remaining papers reported data on the prognostic value of systolic VVV coming from 2 major trials: the observational extension of the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) 12 and the SPRINT (Systolic Blood Pressure Intervention Trial).…”