Office Blood Pressure Variability as a Predictor of Brain Infarction in Elderly Hypertensive Patients.

Abstract

Large 24-h blood pressure (BP) variability and an excessive drop in BP during nighttime are associated with a higher risk of cardiovascular events. Data are lacking regarding the prognostic significance of variability in BP measured during office visits. We analyzed the relationship between office BP variability and the risk of brain infarction in elderly patients receiving antihypertensive therapy. Patients who experienced their first-ever stroke at the age of 60 years or over were registered in the study. At least 2 sex-and age-matched control patients were registered for each case patient. Office BP at each clinic visit and known cardiovascular risk factors were recorded. The BP variability was defined as the variation coefficient (VC) of office BP.In this report, we analyze the data of brain infarction patients. The VC of both systolic and diastolic BPs was significantly higher in the brain infarction patients than in the control patients.Higher office BP variability was associated with a higher risk of brain infarction after adjustment for BP level and other confounding factors. Regarding diastolic BP, the association of brain infarction with the maximal value for the difference of office BPs taken at any consecutive two visits (Max-dBP) or the difference between the highest and lowest values of office BP (BP-range) recorded during a 1-year period prior to the event was also significant. In conclusion, a retrospective case-control study suggested that office BP variability was an independent predictor of brain infarction. Either the Max-dBP or the BP-range may be surrogate indices of diastolic BP variability. (Hypertens Res 2000; 23: 553-560)

Office blood pressure variability as a predictor of acute myocardial infarction in elderly patients receiving antihypertensive therapy

“…However, several points deserve discussion. First, as well as in our previous study focusing on the relationship between the office BP variability and the risk of brain infarction, 7 the VC of diastolic BP positively correlated to age and pulse pressure. These findings suggest that larger variability of BP was a consequence of reduced compliance of large elastic arteries due to advanced arteriosclerosis.…”

“…2 Concerning the long-term variability of office BP, to our knowledge, only two studies have examined the relationship between variability of office BP and subsequent morbidity and mortality. Larger variability of office BP was associated with a higher risk of stroke in elderly hypertensive patients 7 and with higher mortality from all causes in end-stage renal disease patients undergoing haemodialysis. 8 These and the present findings suggest that long-term variability of BP predicts the risk of cardiovascular complications including stroke, MI, and mortality from all causes.…”

“…We recently demonstrated that larger variability of office BP was associated with a higher risk of stroke. 7 Larger long-term variability of systolic BP was associated with higher mortality from all causes in endstage renal disease patients undergoing haemodialysis. 8 In the present case-control study, we focused on the relationship between office BP variability and the occurrence of acute MI.…”

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

“…There are many different ways of expressing blood pressure variability, ranging from beat-to-beat changes 9 to long-term changes between office visits. 10 Although there have been some studies supporting a pathological role of increased variability, 10,11 it remains unclear to what extent such adverse effects are a manifestation of more extensive target organ damage impairing the baroreflex regulation of blood pressure (and hence increasing blood pressure variability) as opposed to a direct effect of the variability itself.…”

Comparison of central blood pressure and cardio-ankle vascular index for association with cardiac function in treated hypertensive patients

“…1,2 Brachial blood pressure, which is usually measured in clinical settings, is an essential parameter for the evaluation and management of blood pressure. On the other hand, central blood pressure (CBP), reflecting ascending aortic blood pressure, has also been important because its elevation induces coronary atherosclerosis.…”