The Effect of Blood Pressure Variability on Hypertensive Patients’ Prognosis

Abstract

Objective:Our study aims to compare the effects of blood pressure variability (BPV) during ambulatory blood pressure measurement (ABPM) and visit-to-visit measurements to predict future cardiovascular complications among hypertensive patients.Methods:This is a retrospective case-control study of patients with hypertension over 10 years. All adult patients with at least one recorded ABPM, and at least three recorded visit measurements were included. Patients with incomplete ABPM readings, a history of a tested outcome, or the occurrence of any of the tested outcomes within the measurement period were excluded. The outcome was the development of any of the following: acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), or stroke.Results:Of the 305 cases reviewed, 152 were included. The mean follow-up was 6.6±2.3 years. The mean age was 53.5±14.3 years. Eighty-two (53.9%) patients were male, while 70 (46.1%) were female. Risk factors included diabetes mellitus (53.9%), dyslipidemia (39.5%), obesity (16.4%), and smoking (8.6%). Comorbidities included stroke (2%), ACS (8.6%), IHD (20.4%), HF (2.6%), and renal failure (1.3%). One or more complications were seen in 22.4 % of the included patients. The variation of the daytime systolic ABP had been found to predict the future risk of developing IHD (OR=1.94; 95% CI=1.09–3.45; p=0.025). Moreover, IHD was associated with night-time systolic standard deviation (SD) in ABPM (OR=1.23; 95% CI=1.00–1.51; p=0.048). On the other side, ACS was found to be associated with systolic SD in visit-to-visit measurement (OR=1.10; 95% CI=1.01–1.21; p=0.04).Conclusion:Hypertensive patients with high variability of daytime and night-time SD in ABPM are more likely to have IHD. Whereas, having high variability in systolic SD in visit-to-visit measurements is associated with developing ACS.

24‐Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea

“…In the present study, we determined that children with OSA had increased SBP variability during the nighttime. This finding was consistent with those of studies on adults 22,50,51 . Future studies should further investigate the relationship between BP variability and other cardiovascular outcomes in children with OSA.…”

“…Another method to assess BP variability in 24‐hour ambulatory BP monitoring is using the standard deviation of BP measurements 22,50,51 . Studies by Steinhorst et al 50 and Martynowicz et al 22 reported similar findings that OSA increased nighttime BP variability in adult patients.…”

“…OSA is often associated with hypertension and other cardiovascular diseases. BP variability is part of the measurement of cardiovascular risk 20 and has been demonstrated to be altered in adults with OSA 22,48–51 . Several studies have evaluated short‐term BP variability in adults with OSA by employing 24‐hour ambulatory BP monitoring 22,49–51 .…”

“…BP variability is part of the measurement of cardiovascular risk 20 and has been demonstrated to be altered in adults with OSA. 22,[48][49][50][51] Several studies have evaluated short-term BP variability in adults with OSA by employing 24-hour ambulatory BP monitoring. 22,[49][50][51] One study reported that in the 24-hour recording, BP frequently featured a "nondipping" profile in adults with OSA.…”

“…22,[48][49][50][51] Several studies have evaluated short-term BP variability in adults with OSA by employing 24-hour ambulatory BP monitoring. 22,[49][50][51] One study reported that in the 24-hour recording, BP frequently featured a "nondipping" profile in adults with OSA. 49 A meta-analysis conducted by Cuspidi et al in 2019 confirmed this finding and demonstrated that OSA in adults was associated with a significantly increased (approximately 1.5-times higher) likelihood of nondipping compared with adults without OSA.…”