Blood pressure variability in relation to autonomic nervous system dysregulation: the X-CELLENT study

Zhang, Yi; Agnoletti, Davide; Blacher, Jacques; Safar, Michel E.

doi:10.1038/hr.2011.203

Cited by 33 publications

(21 citation statements)

References 17 publications

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“…It is possible that elderly individuals with lower BPV may have less BP reduction and thus experience reduced consequences of orthostatic hypotension. It is important to note that many studies reported that high BPV is associated with autonomic dysfunction; however, we did not find any studies performed in the elderly and it is possible that autonomic dysfunction in the elderly may manifest differently. Another possible explanation for the apparent increased mortality in the elderly with low BPV is that in hypertensive patients, low BPV may represent a poor response to treatment or nonadherence, because, in hypertensive patients, BPV may be at least partially attributed to response to treatment.…”

Section: Discussioncontrasting

confidence: 58%

Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study

Weiss

Beloosesky

Koren‐Morag

et al. 2017

J of Clinical Hypertension

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To evaluate the association between blood pressure variability (BPV) and mortality in the elderly, all blood pressure measurements recorded in a cohort of individuals 65 years and older were collected and the association between BPV coefficient of variation (BPV divided by mean arterial pressure) was calculated. Mortality during a 10-year period was compared between BPV coefficient of variation quartiles. Overall, 39 502 individuals 65 years and older were included in the analysis, of which 31 737 (80.3%) were hypertensive; 12 817 (32.4%) individuals died during the study period. Mortality was lower in the second and third blood pressure quartiles compared with the first quartile in both the normotensive and hypertensive groups. In both normo-tensive and hypertensive individuals, mortality was higher in the fourth quartile, but it was more pronounced in normotensive individuals (odds ratio, 1.18; 95% confidence interval, 1.06-1.31 in hypertensive individuals vs odds ratio, 1.27; 95% confidence interval, 1.17-1.37 in normotensive individuals). High and low BPV are associated with mortality in both hypertensive and normotensive elders. 1 | INTRODUCTION Although mean arterial pressure is probably the single most important factor associated with cardiovascular morbidity and mortality, systolic blood pressure (SBP) variability (BPV), defined as variation in SBP levels over a period, has been proposed to play a pivotal role in the association between blood pressure (BP) control and cardiovascular morbidity and mortality. Systolic BPV has been found to be associated with mortality and adverse cardiovascular outcomes in several studies 1-3 but not in others. 4 Data regarding the association of long-term systolic BPV with mortality in the elderly are lacking. In this paper, the association between long-term systolic BPV and mortality was evaluated in a large cohort of hypertensive and normotensive community-dwelling individuals 65 years and older. 2 | PATIENTS AND METHODS 2.1 | Setting and patients Clalit Health Services (CHS) is the largest health management organization in Israel, with more than 4 million members. Its comprehensive computerized data warehouse aggregates and stores continuous real-time input from physicians and health service providers, including demographic parameters, medical diagnoses, findings from in-hospital and outpatient laboratory tests, and medications dispensed, for each of its members. The cohort for the present retrospective study consisted of individuals insured by CHS-Tel Aviv District branch, which insures a mainly urban and Jewish population. All individuals who had at least one available BP measurement in 2002 were identified, but only those in whom BP was recorded at least five times in different years were included in the analysis. Systolic BPV was calculated as the standard deviation of SBP from the mean of all SBP measurements (normally distributed) recorded during the follow-up period (2002-2012). For the purpose of analysis, we used the BPV coefficient of variation (CV). This val...

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Section: Discussioncontrasting

confidence: 58%

Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study

Weiss

Beloosesky

Koren‐Morag

et al. 2017

J of Clinical Hypertension

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show abstract

“…BP variability has been linked to autonomic dysfunction (Zhang et al, 2011) and cardiovascular mortality (Kikuya et al, 2000, 2008). Allan et al (2006) reported that orthostatic hypotension, one of the symptoms of autonomic dysregulation, might be related to dementia.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure

Tsang

Sperling²,

Park³

et al. 2017

Cognitive and Behavioral Neurology

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Background Although blood pressure (BP) variability has been reported to be associated with cognitive impairment, whether this relationship affects African Americans has been unclear. We sought correlations between systolic and diastolic BP variability and cognitive function in community-dwelling older African Americans, and introduced a new BP variability measure that can be applied to BP data collected in clinical practice. Methods We assessed cognitive function in 94 cognitively normal older African Americans using the Mini-Mental State Examination (MMSE) and the Computer Assessment of Mild Cognitive Impairment (CAMCI). We used BP measurements taken at the patients’ three most recent primary care clinic visits to generate three traditional BP variability indices, range, standard deviation, and coefficient of variation, plus a new index, random slope, which accounts for unequal BP measurement intervals within and across patients. Results MMSE scores did not correlate with any of the BP variability indices. Patients with greater diastolic BP variability were less accurate on the CAMCI verbal memory and incidental memory tasks. Results were similar across the four BP variability indices. Conclusions In a sample of cognitively intact older African American adults, BP variability did not correlate with global cognitive function, as measured by the MMSE. However, higher diastolic BP variability correlated with poorer verbal and incidental memory. By accounting for differences in BP measurement intervals, our new BP variability index may help alert primary care physicians to patients at particular risk for cognitive decline.

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“…Secondary analysis of data from the X-CELLENT study has also associated autonomic dysfunction with a heightened day-night systolic blood pressure gradient and more variable systolic blood pressure over 24 h in patients with essential hypertension [3]. In the current study we were unable to control for dietary salt intake, smoking, obesity and obstructive sleep apnea [26], factors that are known to influence reversal of circadian pattern.…”

Section: Discussionmentioning

confidence: 90%

“…Patients with OH often have abnormal 24-h ambulatory blood pressure monitoring (ABP) profile characterized by reversal of circadian pattern, postprandial hypotension, and non-compensatory heart rate variability [2]. Interestingly, heightened day-night systolic blood pressure gradient [3], increased nocturnal heart rate [4] and postprandial hypotension [5] on ABP have also been associated with dysfunction of the autonomic nervous system. The diagnosis of autonomic dysfunction requires a battery of testing that includes cardiovagal heart rate tests, laboratory indices of adrenergic function and sudomotor tests.…”

Section: Introductionmentioning

confidence: 99%

Office orthostatic blood pressure measurements and ambulatory blood pressure monitoring in the prediction of autonomic dysfunction

et al. 2017

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BackgroundIn this retrospective analysis we investigated the predictive performance of orthostatic hypotension (OH) and ambulatory blood pressure monitoring (ABP) to predict autonomic dysfunction.MethodsStatistical associations among the candidate variables were investigated and comparisons of predictive performances were performed using Receiver Operating Characteristics (ROC) curves.ResultsNinety-four patients were included for analysis. No significant correlations could be demonstrated between OH and components of ABP (reversal of circadian pattern, postprandial hypotension and heart rate variability), nor between OH and autonomic reflex screen. Reversal of circadian pattern did not demonstrate significant correlation (r = 0.12, p = 0.237) with autonomic reflex screen, but postprandial hypotension (r = 0.39, p = 0.003) and heart rate variability (r = 0.27, p = 0.009) demonstrated significant correlations. Postprandial hypotension was associated with a five-fold (OR 4.83, CI95% 1.6–14.4, p = 0.005) increased risk and heart rate variability with a four-fold (OR 3.75, CI95% 1.3–10.6, p = 0.013) increased risk for autonomic dysfunction. Per ROC curves, heart rate variability (0.671, CI95% 0.53–0.81, p = 0.025) and postprandial hypotension (0.668, CI95% 0.52–0.72, p = 0.027) were among the best predictors of autonomic dysfunction in routine clinical practice.ConclusionPostprandial hypotension and heart rate variability on ambulatory blood pressure monitoring are among the best predictors of autonomic dysfunction in routine clinical practice.

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Blood pressure variability in relation to autonomic nervous system dysregulation: the X-CELLENT study

Cited by 33 publications

References 17 publications

Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study

Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study

Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure

Office orthostatic blood pressure measurements and ambulatory blood pressure monitoring in the prediction of autonomic dysfunction

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