Long-Term Prognostic Value of Blood Pressure Variability in the General Population

Abstract

Abstract-The hypothesis has been advanced that cardiovascular prognosis is related not only to 24-hour mean blood pressure but also to blood pressure variability. Data, however, are inconsistent, and no long-term prognostic study is available. In 2012 individuals randomly selected from the population of Monza (Milan), 24-hour ambulatory blood pressure (Spacelabs 90207) was measured via readings spaced by 20 minutes. Systolic and diastolic blood pressure variability was obtained by calculating the following: (1) the SD of 24-hour, day, and night mean values; (2) the day-night blood pressure difference; and (3) the residual or erratic blood pressure variability (Fourier spectral analysis). Fatal cardiovascular and noncardiovascular events were registered for 148 months. When adjusted for age, sex, 24-hour mean blood pressure, and other risk factors, there was no relationship between the risk of death and 24-hour, day, and night blood pressure SDs. In contrast, the adjusted risk of cardiovascular death was inversely related to day-night diastolic BP difference (␤ coefficientϭϪ0.040; PϽ0.02) and showed a significant positive relationship with residual diastolic blood pressure variability (␤ coefficientϭ0.175; PϽ0.002). Twenty-four-hour mean blood pressure attenuation of nocturnal hypotension and erratic diastolic blood pressure variability all independently predicted the mortality risk, with the erratic variability being the most important factor. Our data show that the relationship of blood pressure to prognosis is complex and that phenomena other than 24-hour mean values are involved. They also provide the first evidence that short-term erratic components of blood pressure variability play a prognostic role, with their increase being accompanied by an increased cardiovascular risk. Key Words: population science Ⅲ risk factors Ⅲ blood pressure monitoring Ⅲ blood pressure variability Ⅲ morbidity Ⅲ mortality S everal years ago, the hypothesis was advanced that the deleterious effects of hypertension on the cardiovascular (CV) system depend not only on the increase in average blood pressure (BP) but also on an increase in the magnitude of the BP variability throughout the day and night. [1][2][3] This found support in the studies that have measured the SD of average BP over the 24 hours or shorter time intervals and showed that BP variability is greater in hypertensive than in normotensive individuals 4 -7 and that for the same increase in mean 24-hour BP, its magnitude is related to the degree of CV damage. 1-3 However, in other studies, the correlation between BP variability and organ damage disappeared after adjustment for other CV and/or metabolic and demographic variables. 8,9 Furthermore, and more importantly, the prognostic value of BP variability has never been tested by proper longitudinal studies, the few available ones 2,3 being limited by a small study size, a short follow-up, or a conclusion based on surrogate prognostic markers (progression of left ventricular hypertrophy or arterial wall thickening) ra...

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

“…Thus, this study suggests that home blood pressure measurement may be a suitable alternative if a correct blood pressure target is chosen, but more studies are needed before home blood pressure can be recommended for antihypertensive treatment titration. Finally, it has to be emphasized that in contrast to home blood pressure measurement, 24-h blood pressure measurement can give additional important information about night-time blood pressure, 9 dipping status [26][27][28] or 24-h blood pressure variability, 13 all of which may lead to improved risk stratification of individuals with hypertension. On the other hand, potential drawbacks of 24-h blood pressure measurement include additional costs and patient discomfort.…”

“…3 Accordingly, ambulatory blood pressure measurement is a better predictor of cardiovascular morbidity and mortality than office blood pressure. [8][9][10][11][12][13][14][15] Randomized studies using ambulatory blood pressure measurement for the management of antihypertensive treatment are scarce. 16 In one study, less intensive antihypertensive drug treatment was observed with the use of 24-h blood pressure measurement, whereas overall blood pressure con-trol was maintained in both treatment groups.…”

The coefficient variation of home blood pressure is a novel factor associated with macroalbuminuria in type 2 diabetes mellitus

“…or CV of BP was used as an index of variability in HBP. 3,13,14 The Ohasama study reported that the s.d. of BP was significantly and positively correlated with the ambulatory BP, but the CV of SBP was independent of SBP.…”

“…Recent studies have explored the association between variability in BP and cardiovascular events, and they demonstrated that variability in BP predicted the risk of stroke and left ventricular hypertrophy. [3][4][5] To our knowledge, no reports have explained the relationship between variability in HBP and target organ damage in diabetic patients. Therefore, we investigated the relationship between variability in HBP and diabetic nephropathy in Japanese patients with type 2 diabetes.…”

From casual blood pressure measurement to long-term blood pressure burden: better elucidation of the association between versatile blood pressures and cardiovascular events

“…It is well known that short-term variability of blood pressure, with use of 24-h ambulatory monitoring or home blood pressure recordings, predicts cardiovascular risk. 11 Furthermore, long-term blood pressure variability, as represented by s.d. of long-term clinic blood pressure measurements or maximum blood pressure reached, has been shown to independently and even more strongly associated with cardiovascular risk compared with longterm averaged blood pressure.…”