Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks

Mehlum, Maria H; Liestøl, Knut; Kjeldsen, Sverre E.; Julius, Stevo; Hua, Tsushung A.; Rothwell, Peter M.; Mancia, Giuseppe; Parati, Gianfranco; Weber, Michael A.

doi:10.1093/eurheartj/ehx760

Cited by 168 publications

(150 citation statements)

References 31 publications

(23 reference statements)

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“…Meanwhile, as median layer calcification can decrease aortic compliance, making BP more likely to be affected by factors such as fluid load, posture and cardiac output change, it may increase mid‐term BPV. As BPV has been suggested to be a risk factor of cardiovascular events and mortality, it may contribute to the high mortality in CKD patients with VC.…”

Section: Disccusionmentioning

confidence: 99%

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Liao

Wang

et al. 2019

Nephrology

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Aim Vascular calcification (VC) is a common complication in chronic kidney disease (CKD) and has been shown to be associated with increased cardiovascular events and mortality. This study was to explore the role of Wnt‐signaling pathway in CKD VC, and the association between VC and blood pressure variability (BPV) which is a risk factor of cardiovascular events. Methods Adult male Sprague‐Dawley rats were divided into adenine‐induced CKD group (n = 5), 5/6 nephrectomy CKD group (n = 5), sham group (n = 5) and control group (n = 5). Low‐calcium‐high‐phosphate diets were introduced to induce vascular calcification. Both daytime (hour‐to‐hour during the day) and mid‐term (day‐to‐day for 9 days) blood pressure (BP) were collected and analyzed for BPV metrics. At sacrifice, kidney, heart and aorta samples were taken for histological analyses. Calcium deposition in aorta was identified with Alizarin Red stain and graded. Immunohistochemistry stain and western blot were performed for Wnt3a, Wnt5a, β‐catenin, sclerostin, osteopontin, and α‐SMA. Results Compared with control rats, CKD rats suffered from markedly severer VC (Grade 2.6 ± 0.2 and 1.8 ± 0.8 vs 0.0 ± 0.0 and 0.2 ± 0.4, P = .0010). VC was positively correlated with vascular Wnt3a and β‐catenin expression (P = .0032 and .0000), but not significantly associated with Wnta5a or sclerostin. Besides, CKD rats showed increased BPV (P < .001), which was also positively correlated with VC. Conclusion We confirmed that CKD rats had enhanced Wnt‐signaling in vascular tissue and severer aorta calcification together with increased BPV. Wnt pathway may be a potential target in future VC and BPV management in CKD.

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Section: Disccusionmentioning

confidence: 99%

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Liao

Wang

et al. 2019

Nephrology

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“…But there is no consensus yet on the relationship between BP, BPV, and cardiovascular risk. Mehlum et al [6] noticed that in patients with lower mean systolic BP, the association between BPV and cardiovascular events were stronger, while in several other studies, BPV was found to predict cardiovascular mortality independent of BP [5,7].…”

Section: Introductionmentioning

confidence: 97%

“…Although the treatment guidelines focus on average BP, evidences favoring BPV as the preferred metric are increasingly reported [5][6][7]. But there is no consensus yet on the relationship between BP, BPV, and cardiovascular risk.…”

Section: Introductionmentioning

confidence: 99%

The Association between Long- and Intra-Dialytic Blood Pressure Variability with All-Cause Mortality in Hemodialysis Patients

Liao

Lin

et al. 2019

Blood Purif

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Background: Blood pressure variability (BPV) is a potential prognostic predictor for all-cause mortality. Objectives: We conducted a retrospective cohort study to compare the prognostic value of long-term BPV with intra-dialytic BPV in hemodialysis (HD) patients. Materials and Methods: We included 611 HD patients and collected their baseline blood pressure (BP) measurements for 1 year and monitored them for 40 months. Long-term BPV was assessed by pre-dialysis BP SD and pre-dialysis absolute BP residual metric. Intra-dialytic BPV was assessed by intra-dialytic BP average real variability and intra-dialytic absolute BP residual. Results: Long-term systolic BPV showed a weak correlation with mean BP, but a stronger correlation with intra-dialytic BPV. High long-term systolic blood pressure (SBP) SD and long-term SBP residual metrics were associated with high all-cause mortality (p = 0.0084 and 0.0056, respectively), while no such association was found for intra-dialytic BPV or diastolic BPV. According to receiver operating characteristic curve with mortality as dependent variable, long-term SBP residual metric showed the strongest prognostic ability (area under curve [AUC] 0.679, p = 0.0006), which was even stronger in patients with BP ≥140/90 mm Hg (AUC 0.713, p = 0.0004). After completely adjusting for confounders, long-term SBP residual metric remained significantly associated with all-cause mortality (hazard ratio 1.628 per quartile; 95% CI 1.086–2.441). Conclusions: Our results suggest long-term SBP residual metric to be a better predictor of all-cause mortality in HD patients, which could be used as an additional target for BP management.

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“…Guidelines for treatment of arterial hypertension recommend the assessment of the mean of office BP readings over several visits as the preferential method to assess the risk of cardiovascular events attributable to BP values and the need for antihypertensive therapy . However, several studies conducted on the general population have documented a relationship between increased long‐term blood pressure variability (BPV) and cardiovascular events and death, independently of mean BP . Similarly, high short‐term variability has been related to an increased cardiovascular risk by observational studies, although the level of evidence on the topic is still limited …”

Section: Introductionmentioning

confidence: 99%

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

Chiriacò

Pateras

Virdis

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate the associations of blood pressure variability (BPV), expressed as long‐term (visit‐to‐visit) and short‐term (ambulatory blood pressure monitoring [ABPM] and home blood pressure monitoring [HBPM]) and all‐cause mortality, major adverse cardiovascular events (MACEs), extended MACEs, microvascular complications (MiCs) and hypertension‐mediated organ damage (HMOD) in adult patients with type 2 diabetes. Materials and methods PubMed, Medline, Embase, Cinahl, Web of Science, http://clinicaltrials.gov and grey literature databases were searched for studies including patients with type 2 diabetes, at least one variable of BPV (visit‐to‐visit, HBPM, ABPM) and evaluation of the incidence of at least one of the following outcomes: all‐cause mortality, MACEs, extended MACEs and/or MiCs and/or HMOD. The extracted information was analyzed using random effects meta‐analysis and meta‐regression. Results Data from a total of 377 305 patients were analyzed. Systolic blood pressure (SBP) variability was associated with a significantly increased risk of all‐cause mortality (HR 1.12, 95% CI 1.04–1.21), MACEs (HR 1.01, 95% CI 1.04–1.17), extended MACEs (HR 1.07, 95% CI 1.03–1.11) and MiCs (HR 1. 12, 95% CI 1.01–1.24), while diastolic blood pressure was not. Associations were mainly driven from studies on long‐term SBP variability. Qualitative analysis showed that BPV was associated with the presence of HMOD expressed as carotid intima‐media thickness, pulse wave velocity and left ventricular hypertrophy. Results were independent of mean blood pressure, glycaemic control and serum creatinine levels. Conclusions Our results suggest that BPV might provide additional information rather than mean blood pressure on the risk of cardiovascular disease in patients with type 2 diabetes.

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Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks

Cited by 168 publications

References 31 publications

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

The Association between Long- and Intra-Dialytic Blood Pressure Variability with All-Cause Mortality in Hemodialysis Patients

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

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