Prognostic Value of Different Indices of Blood Pressure Variability in Hypertensive Patients

Pierdomenico, Sante D.; Nicola, Marta Di; Esposito, Anna L.; Mascio, Rocco Di; Ballone, Enzo; Lapenna, Domenico; Cuccurullo, Franco

doi:10.1038/ajh.2009.103

Cited by 227 publications

(229 citation statements)

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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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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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“…6 Most studies have found that high 24-hour BP variability is associated with organ damage and may contribute to cardiovascular risk prediction, over and beyond mean BP. [7][8][9][10][11][12][13][14][15][16][17] However, the degree to which variability improves the prediction of cardiovascular risk is controversial. [18][19][20] Previous studies have shown that nighttime BP is generally a better predictor of cardiovascular outcomes than daytime BP in patients with hypertension, and diminished nocturnal decline in BP is associated with or predictive of organ damage and cardiovascular events.…”

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confidence: 99%

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain

et al. 2017

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El acceso a la versión del editor puede requerir la suscripción del recurso Access to the published version may require subscription Three observer-measured home BPs and 24-hour ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP standard deviation and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime, and nighttime systolic BP standard deviations and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (p<0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-hour but not daytime or nighttime BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (p<0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (p<0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (p<0.001). In conclusion, 24-hour BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.

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“…SD has been questioned as an appropriate index of shortterm BPV, considering that SD only reflects the dispersion of values around the mean, does not account for the order in which BP measurements are obtained, and is sensitive to the low sampling frequency of ABPM [16]. In order to improve the prognostic value of short-term BPV, the average real variability (ARV) of daytime and nighttime BP has been introduced as a new index of BPV.…”

Section: Short-term Blood Pressure Variabilitymentioning

confidence: 99%

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

Höcht

2013

ISRN Hypertension

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Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs.

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Prognostic Value of Different Indices of Blood Pressure Variability in Hypertensive Patients

Cited by 227 publications

References 17 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

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

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