Is home blood pressure variability itself an interventional target beyond lowering mean home blood pressure during anti-hypertensive treatment?

Abstract

It is unknown whether home blood pressure (BP) variability reduction is associated with target organ damage (TOD) protection independently of home mean BP reduction. We enrolled 310 hypertensive patients whose systolic BP (SBP) at home was over 135 mm Hg. The subjects measured their BP in the morning and evening for 7 days. In addition, we measured urinary albumin excretion (UAE) as a marker of TOD before and after 6 months of candesartan treatment ( þ thiazidediuretics). At baseline, UAE was associated with average home SBP (r ¼ 0.24, Po0.001), the s.d. of home SBP (r ¼ 0.15, P ¼ 0.011), and the maximum home SBP (r ¼ 0.27, Po0.001). During the intervention, significant reductions were found in average home SBP (146 ± 13 vs. 132 ± 12 mm Hg, Po0.001), s.d. of home SBP (12.9 ± 4.8 vs. 11.8 ± 4.4 mm Hg, Po0.001), and maximum home SBP (172.5±18.0 vs. 155.9±17.5 mm Hg, Po0.001). UAE levels were significantly reduced after 6months of therapy compared with baseline (18.9 vs. 12.1 mg g À1 Cre, Po0.001). In multiple regression analysis, the treatment-induced reduction in UAE was significantly associated with that of average home BP (P ¼ 0. Keywords: day-to-day blood pressure variability; home blood pressure; urinary albumin excretion INTRODUCTION Many studies have focused on the association between blood pressure (BP) variability (BPV) and target organ damage (TOD) or cardiovascular prognosis. 1-5 Studies based on ambulatory BP monitoring have provided evidence that BPV over 24 h was associated with the severity of organ damage and the rate of cardiovascular events. 6,7 Recently, in conventional office BP measurements, increased visit-tovisit variability, calculated as the s.d. of the mean of repeated recordings and maximum systolic BP (SBP) over a certain period, has been reported to indicate increased cardiovascular risk. 5 We have reported that not only office BPV but also day-to-day BPV evaluated by home BP (HBP) monitoring (HBPM) is associated with TOD (that is, cardiac hypertrophy and carotid artery remodeling) independently of average office or HBP levels. 8,9 Moreover, Kikuya et al. 4 reported that the increased day-to-day BPV, calculated as the s.d. of HBP, was associated with cardiovascular mortality in a community-dwelling population. However, it is not clear whether home BPV itself, beyond the mean HBP level, can contribute directly to the development of TOD. The treatment-induced change in TODs assessed by cardiovascular biomarkers, such as the level of urinary albumin excretion (UAE), is associated with prognosis; 10-12 therefore,

Questionable link between normo- to microalbuminuria and home-measured blood pressure variability in hypertension

“…19 By contrast, a recent study reported that day-by-day BP variability, as assessed by home BP measurements, had no significant association with the progression of chronic kidney disease. 20 In line with this finding, the current study by Hoshide et al 21 of Kario's Laboratory, which was performed as a posthoc sub-analysis of the Japan Morning SurgeTarget Organ Protection (J-TOP) study, failed to find a significant association between the improvement in home BP variability and the reduction of normo-and microalbuminuria (baseline UAE mg g À1 creatine (interquartile range), 18.9 (9.1-48.5)), in spite of a significant association between home BP variability and UAE at baseline, and questioned the clinical relevance of home BP variability in the progression of albuminuria, in a range of normo-to microalbuminuria in hypertensive patients. The findings by Hoshide et al would be also consistent with a previous report from the same Kario's Laboratory showing a relatively weak association between home BP variability and albuminuria in a range of normo-to microalbuminuria, which is in contrast to the strong association that has been observed between home BP variability and cardiac hypertrophy in a cross-sectional study.…”

Home blood pressure is the predictor of subclinical target organ damage like ambulatory blood pressure monitoring in untreated hypertensive patients

“…Also, recent study showed higher ABPV was associated with early depressed LV systolic function in newly diagnosed untreated hypertensive patients (31). Although the importance of BPV as an independent risk factor remains controversial (32,33), our study may be possibly included as one of the prospective pilot studies which handle BPV and TOD in untreated hypertensive.…”

Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement

“…Interventional studies assessing the effects of antihypertensive treatment on home BPV have been inconsistent. A study in hypertensive patients showed reduction in average HBPM and BPV after 6 months of ARB treatment, yet only the change in average HBPM and not in home BPV or in maximum systolic HBPM was associated with albuminuria decline [71]. A study in hypertensive patients showed reduction in average HBPM and BPV after 6 months of ARB treatment, yet only the change in average HBPM and not in home BPV or in maximum systolic HBPM was associated with albuminuria decline [71].…”