Clinical impact of blood pressure variability in patients with COVID-19 and hypertension

Nam, Jong-Ho; Park, Jong Il; Kim, Byung-Jun; Kim, Hun-Tae; Lee, Jung‐Hee; Lee, Chanhee; Son, Jang‐Won; Kim, Ung; Park, Jong Seon; Shin, Dong‐Gu; Hong, Kyung Soo; Jang, Jong Geol; Ahn, Jae‐Jun; Jin, Hyun Jung; Choi, Eun Young; Shin, Kyeong‐Cheol; Chung, Jin Hong; Lee, Kwan Ho; Hur, Jun; Hong, Young-Hoon; Lee, Choong‐Ki

doi:10.1097/mbp.0000000000000544

Cited by 16 publications

(12 citation statements)

References 27 publications

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“… 4 , 5 , 20 , 21 After we adjusted for these confounders, in this study, the variability of SBP, but not DBP, could consistently predict adverse outcomes among COVID‐19 patients with hypertension. Although Li eand coworkers 31 , 32 conducted similar studies, this study included larger sample size and excluded cases without sufficient BP readings to reduce its confounding impact. Our data implied that stable level of blood pressure has better prognosis than fluctuating level in COVID‐19 patients with hypertension.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension

Liu

Yang

et al. 2022

J of Clinical Hypertension

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Hypertension is the most common comorbidity in patients with coronavirus disease 2019 (COVID‐19) and increases in‐hospital mortality. Day‐by‐day blood pressure (BP) variability (BPV) is associated with clinical outcomes in hypertensive patients. However, little information is available on the association of BPV with the outcomes of COVID‐19 patients with hypertension. This study aimed to demonstrate whether day‐by‐day in‐hospital BPV had prognostic significance in these patients. The authors included 702 COVID‐19 patients with hypertension from Huoshenshan Hospital (Wuhan, China), who underwent valid in‐hospital BP measurements on at least seven consecutive days. Day‐by‐day BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM). Overall, patients with severe COVID‐19 and non‐survivors had higher BPV than moderate cases and survivors, respectively. Additionally, higher BPV was correlated with greater age and higher levels of C‐reactive protein, procalcitonin, high‐sensitive cardiac troponin I, and B‐type natriuretic peptide. In multivariable Cox regression, SD of systolic BP (SBP) was predictive of mortality [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.05–1.30] as well as acute respiratory distress syndrome (ARDS) (HR 1.09, 95% CI 1.01–1.16). Similar trends were observed for CV and VIM of SBP, but not indices of diastolic BP variability. The authors demonstrated that day‐by‐day in‐hospital SBP variability can independently predict mortality and ARDS in COVID‐19 patients with hypertension. And high BPV might be correlated with severe inflammation and myocardial injury. Further studies are needed to clarify whether early reduction of BPV will improve the prognosis of these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension

Liu

Yang

et al. 2022

J of Clinical Hypertension

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“…Whether this variability decreases or increases, it will affect the self-regulation of the human body and cause damage to corresponding organs. In patients with a history of cardiovascular and cerebrovascular diseases, including hypertension, it has been confirmed that BPV is related to the injury of target organs (10)(11)(12). BPV is only a substitute index, and the underlying mechanism and factors that cause and affect its fluctuation are the essence.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of blood pressure variability for organ dysfunction in patients with sepsis

Zhu

Cai

et al. 2021

Ann Palliat Med

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Background: Sepsis is a common disease in the intensive care unit, accompanied by many complications and high mortality. Organ dysfunction is a major risk factor for death in patients with sepsis. Analyzing the related factors of organ dysfunction caused by sepsis can provide more clinical prevention and treatment targets, and better predict patients' prognoses. This study aimed to investigate the relationship between blood pressure variability (BPV) and organ dysfunction in patients with sepsis. Methods: One hundred and two patients with sepsis treated in our hospital from January 2019 to January 2021 were retrospectively collected as an observation group, and 102 healthy people were collected as a control group. The 24-hour systolic blood pressure variability (24h SBPV) and 24-hour diastolic blood pressure variability (24h DBPV) of the two groups were compared, and the correlation between 24h SBPV, 24h DBPV, and organ function damage to sepsis patients were analyzed. Results: Compared with the control group, the 24h DBPV in the observation group was significantly higher (0.56±0.16 vs. 0.37±0.16, P=0.000). 24h SBPV increased significantly (0.56±0.16 vs. 0.36±0.17, P=0.000). Pearson linear correlation analysis showed 24h SBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.301, 0.216 and 0.218, P<0.05). 24h DBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.302, 0.212 and 0.210, P<0.05). 24h SBPV and 24h DBPV are of certain value in the diagnosis of multiple organ failure in patients with sepsis, and the area under the curve was [0.649 (95% CI: 0.539-0.759), P=0.010] and [0.650 (0.540-0.760), P=0.009], respectively. 24h SBPV and 24h DBPV are of certain value in the diagnosis of persistent organ failure in patients with sepsis, and the area under the curve was [0.647 (95% CI: 0.538-0.757), P=0.010] and [0.647 (95% CI: 0.538-0.757), P=0.010], respectively. Conclusions:The increase of BPV in patients with sepsis has a certain value in predicting the prognosis and organ function damage to patients with sepsis.

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“…Once the balance between pro-inflammatory and anti-inflammatory factors is disrupted, various inflammatory mediators and inflammatory cells promote the occurrence and development of atherosclerosis and accelerate plaque formation, which in turn induces a series of adverse coronary events ( 60 – 62 ). Studies have shown that abnormal BPV can upregulate the expression of C-reactive protein (CRP) ( 63 , 64 ). On one hand, elevated CRP can induce vascular endothelial cells to secrete chemotactic factors and cell adhesion molecules, which can promote the migration of monocytes to the subendothelial layer of blood vessels to transform into macrophages to take up lipids and promote the transformation and proliferation of smooth muscle cells ( 65 , 66 ).…”

Section: The Mechanisms Of the Impact Of Bpv On The Formation Of Coro...mentioning

confidence: 99%

The Effect of Blood Pressure Variability on Coronary Atherosclerosis Plaques

Liu

Luo

Jia

et al. 2022

Front. Cardiovasc. Med.

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Hypertension is one of the most important risk factors for coronary heart disease (CHD). The regulation of blood pressure plays a significant role in the development and prognosis of CHD. Blood pressure variability (BPV) refers to the degree of fluctuation of blood pressure over a period of time and is an important indicator of blood pressure stability. Blood pressure fluctuations are complex physiological phenomena, being affected by physiological and pharmacological effects and regulated by behavioral, environmental, hydrodynamic, and neural factors. According to the different time periods for measuring BPV, it can be divided into very short-term, short-term, mid-term, and long-term. Multiple cardiovascular disease animal models and clinical experiments have consistently indicated that abnormal BPV is closely related to coronary events and is a risk factor for CHD independently of average blood pressure. Thrombosis secondary to plaque rupture (PR) or plaque erosion can cause varying blood flow impairment, which is the main pathological basis of CHD. Plaque morphology and composition can influence the clinical outcome, treatment, and prognosis of patients with CHD. Research has shown that PR is more easily induced by hypertension. After adjusting for the traditional factors associated with plaque development, in recent years, some new discoveries have been made on the influence of abnormal BPV on the morphology and composition of coronary plaques and related mechanisms, including inflammation and hemodynamics. This article reviews the impact of BPV on coronary plaques and their related mechanisms, with a view to prevent the occurrence and development of CHD by controlling BPV and to provide new prevention and treatment strategies for the clinical treatment of abnormal blood pressure.

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Clinical impact of blood pressure variability in patients with COVID-19 and hypertension

Abstract: Supplemental Digital Content is available in the text.

Cited by 16 publications

References 27 publications

Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension

Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension

Predictive value of blood pressure variability for organ dysfunction in patients with sepsis

The Effect of Blood Pressure Variability on Coronary Atherosclerosis Plaques

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