Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension

Verdecchia, Paolo; Angeli, Fabio; Gattobigio, Roberto; Rapicetta, Cristian; Reboldi, Gianpaolo

doi:10.1016/j.amjhyper.2006.07.017

Cited by 166 publications

(134 citation statements)

References 27 publications

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“…Possible limitations of previous studies were a lack of statistical power, 2-5 selection of specific groups of patients, [5][6][7] categorization of variability by arbitrary cutoff points, 2,4,[7][8][9] and sole reliance on fatal end points. 10,11 Moreover, various parameters can capture short-term blood pressure variability over 24 hours, but most studies only considered the SD of systolic 4,6,12 or diastolic blood pressure or both.…”

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confidence: 99%

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

et al. 2010

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Abstract-In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke.Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (PՅ0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: Ն1.07) with the exception of cardiac and coronary events (HR: Յ1.02; PՆ0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (PϽ0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: Ն1.07), with the exception of cardiac and coronary events (HR: Յ1.03; PՆ0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added Ͻ1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP. (Hypertension. 2010;55:1049-1057.)Key Words: blood pressure variability Ⅲ ambulatory blood pressure Ⅲ population science Ⅲ risk factors Ⅲ epidemiology A mbulatory blood pressure monitoring not only provides information on the blood pressure level but on the diurnal changes in blood pressure as well. Blood pressure variability includes both short-term and circadian components, which can be estimated by the SD of the blood pressure values over a defined period of the day or by the night:day blood pressure ratio, respectively. We recently reported in Ͼ7000 subjects recruited from 6 populations on the prognos- Although the aforementioned analyses shed light on the association between outcome and long-term blood pressure variability, the predictive value of short-term reading-toreading blood pressure variability remains uncertain. Possible limitations of previous studies were a lack of statistical power, 2-5 selection of specific groups of patients, 5-7 categorization of variability by arbitrary cutoff points, 2,4,7-9 and sole reliance on fatal end points. 10,11 Moreover, various parameters can capture short-term b...

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Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

et al. 2010

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“…The relations of daytime BP variability with cardiac events and that of daytime and nighttime BP variability with cerebrovascular events were not significant in a multivariate analysis. 56 Again, 24-hour ABP is clearly superior to home BP for the assessment of BP variability because of the higher number of BP measurements scattered over a longer period of time, which may include periods of stress, rest, work, and so on, with a consequently more reliable estimate of random BP variability.…”

Section: Bp Variabilitymentioning

confidence: 99%

Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring

Verdecchia¹,

Mazzotta

Gentile³

et al. 2009

Hypertension

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“…[1][2][3][4][5][6][7][8][9][10] Where some papers emphasize the importance of BP variability in prediction of risk of vascular events, 1,2,6,9 others question its prediction of cardiovascular outcome. 4,5,10 Despite this upsurge of recent papers, consistent evidence over the past three decades lends support that both target organ damage and the rate of cardiovascular events of hypertensive patients are significantly and independently related to the degree of BP variability.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Schutte

Huisman

et al. 2011

Hypertens Res

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The prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention. The need for early markers of cardiovascular dysfunction is imperative in black South Africans who have a significant risk for cardiovascular disease. We therefore compared 24-h BP variability with various traditional and advanced BP measurements, regarding their association with sub-clinical organ damage in black and white South Africans. The study included 409 African and Caucasian teachers aged 25-60 yrs. We measured office BP, 1-min continuous (finger) BP, ambulatory BP, BP reactivity and determined weighted 24-h BP variability. Albumin-to-creatinine ratio, Cornell product and carotid cross-sectional wall area (CSWA) were measures of organ damage. Africans had higher 24-h BP, BP variability, BP reactivity and sub-clinical organ damage (Po0.001). Correlations of BP variability with organ damage were overall weak when compared with other BP measurements. In normotensive groups, we found an independent association of 24-h systolic BP (SBP) variability with Cornell product only in Africans (r¼0.37; P¼0.01), confirmed in multiple regression models, with 24-h SBP included in the model. Only in hypertensive Caucasians, a significant correlation between CSWA and 24-h SBP variability was evident (r¼0.30; P¼0.01), although CSWA indicated stronger correlations with office or 24-h SBP than 24-h SBP variability. To conclude, 24-h SBP variability could potentially be an effective measure for the early detection of normotensive Africans at increased risk for the development of cardiovascular complications. Its usefulness based on associations with target organ damage in hypertensive groups seems to be less than traditional office or 24-h BP measurements. Hypertension Research (2011Research ( ) 34, 1127Research ( -1134 doi:10.1038/hr.2011; published online 28 July 2011Keywords: albumin-to-creatinine ratio; ethnicity; intima-media thickness; left ventricular hypertrophy INTRODUCTIONThe prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention in the literature. [1][2][3][4][5][6][7][8][9][10] Where some papers emphasize the importance of BP variability in prediction of risk of vascular events, 1,2,6,9 others question its prediction of cardiovascular outcome. 4,5,10 Despite this upsurge of recent papers, consistent evidence over the past three decades lends support that both target organ damage and the rate of cardiovascular events of hypertensive patients are significantly and independently related to the degree of BP variability. [11][12][13][14][15] A limitation of many of these papers is that either BP variability alone was investigated, or various measures of BP variability (such as s.d. of 24-h BP, average real variability index 16 and weighted 24-h BP s.d. 17 ) were being compared, regarding the strength of their association with target organ damage.The question therefore arises how BP variability would benchmark against a comprehensive range of both traditional and advanced

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Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension

Abstract: An enhanced variability in SBP during the night-time is an independent predictor of cardiac events in initially untreated hypertensive subjects.

Cited by 166 publications

References 27 publications

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

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