Influence of blood pressure variability on early carotid atherosclerosis in hypertension with and without diabetes

Abstract

Carotid intima-media thickness (IMT) has been one widely used index of early carotid atherosclerosis. We speculated that the influence of blood pressure variability (BPV) on early carotid atherosclerosis may be varied by the location of the carotid artery and diabetes history. Thus, the goal of this study was to evaluate the effects of BPV on early arteriosclerosis progression in different segments of the carotid artery for hypertension with and without diabetes.A total of 148 hypertension patients who underwent 24 hours ambulatory blood pressure (BP) monitoring and carotid ultrasonography were enrolled in this study. Of them, 84 subjects were without diabetes, and 64 subjects were with diabetes. Short-term BPV during daytime, nighttime, and over 24 hours were evaluated through standard deviation (SD) and average real variability (ARV). We measured carotid IMT at left and right common carotid artery (CCA), carotid bulb, and the origin of the internal carotid artery (ICA). The associations between segment-specific measurements of carotid IMT and 24 hours ambulatory BPV were analyzed.We found that IMT at the common carotid artery (CCA-IMT) and IMT at the internal carotid artery (ICA-IMT) were more closely associated with BPV than was carotid bulb IMT. In addition, for all subjects, BPV was clearly associated with left CCA-IMT but not with right CCA-IMT. Furthermore, in diabetes patients, nighttime systolic BPV was independently related to mean CCA-IMT (P < 0.01) and mean bulb IMT (P < 0.01). In contrast, in nondiabetes patients, daytime and 24 hours systolic BPV was positively associated with mean CCA-IMT (P < 0.05), but not independent after adjusting for baseline characteristics such as age and sex.The findings of our study indicate a segment-specific association between carotid IMT and 24 hours ambulatory BPV, and the associations also vary according to the diabetes history. We conclude that BPV plays a distinct role in early carotid arteriosclerosis progression within different segments of the carotid artery, especially for the hypertensions with and without diabetes.

Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients

“…BPV has been reported to be closely associated with CAS [13][14][15]20]. However, due to the existence of various BPV indices and poor reproducibility of these indices, it is difficult to draw solid conclusions about the relationship between BPV and CAS.…”

“…Based on 24h ambulatory BP measurements, several studies have reported that both visit-to-visit BPV and short-term BPV were correlated with AS [10][11][13][14][15]. BPV has been reported to be closely associated with CAS [13][14][15]20].…”

“…Although many studies have provided evidence that CAS is closely associated with BPV [13][14][15]18], the relationship between CAS and BPV has not been quantified. In addition, different studies have used different BPV indices.…”

“…Many studies have reported that BPV is a risk predictor for organ damage, and considered that BPV is more valuable than increased blood pressure (BP), leading to the suggestion that reducing BPV is more important than lowering BP [9][10][11][13][14][15]. Recent research has also suggested that BPV is higher in hypertensive patients than in the healthy subjects [9][10][11].…”

24‐Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta‐Analysis

“…Comparison on the BPV parameters in a mixed model with backward selection regression showed that only ARV maintained a significant relationship to intima‐media thickness, which remained significant after adjustment for baseline characteristics and mean BP. Wu et al concluded that ARV had greater prognostic significance than SD for evaluating the carotid intima‐media thickness in hypertensive patients with diabetes mellitus . Another study found that ARV had the strongest relationship to arterial stiffness, followed by the wSD and SD, after adjustment for age, sex, and 24‐hour BP .…”