Visit-to-visit Blood Pressure Variability and Arterial Stiffness: Which Came First: The Chicken or the Egg?

Abstract

Earlier studies have shown that visit-to-visit blood pressure (BP) variability (VVV) served as a significant independent risk factor of stroke, specifically, in the high-risk elderly of cardiovascular disease (CVD). Although the mechanism is not clearly understood, arterial remodeling such as carotid artery, coronary artery and large aortic artery would be a strong moderator in the relationship between VVV and CVD incidence. Recent studies have provided evidence that VVV predicted the progression of arterial stiffness. While the class of antihypertensive agents is suggested to be an important determinant of VVV, long-acting calcium channel blockers use (CCBs) is associated with the reduction of VVV, and thus, is suggested to decrease the arterial stiffness. Specifically, the relationship between VVV and coronary arterial remodeling has never been reviewed until now. This article summarizes the recent literature on these topics. In the elderly hypertensives, strict BP control using CCBs could play a pivotal role in suppressing arterial stiffening via VVV reduction.

Visit‐to‐visit office blood pressure variability combined with Framingham risk score to predict all‐cause mortality: A post hoc analysis of the systolic blood pressure intervention trial

“…To some extent, atherosclerosis/arteriosclerosis might explain this phenomenon. Visit‐to‐visit BPV was believed to have tight association with arterial stiffness in various mesures 26 . Nagai and colleagues found exaggerated visit‐to‐visit BP fluctuations were significant indicators for carotid artery atherosclerosis and stiffness independently of average BP 18 .…”

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries

“…The mechanism is unknown for the relationship between visit-to-visit BP variability and either cardiovascular risk outside pregnancy or adverse pregnancy outcomes. The pathophysiology proposed has included arterial remodeling and antihypertensive agent (with calcium channel blockers associated with less variability), 24 as well as environmental and behavioral influences (such as lack of sleep), and cardiovascular homeostasis. 25 Whether the mechanisms are the same outside and in pregnancy is also unknown.…”

Association of 1-Year Blood Pressure Variability With Long-term Mortality Among Adults With Coronary Artery Disease

“…55 Higher BP variability was also bidirectionally associated with greater arterial stiffness and remodeling in human studies and population-based cohorts. [56][57][58][59] Evidence suggests that increased arterial stiffness is associated JAMA Network Open | Cardiology 59,60 Also, for women, estrogen has an intricate role to play in vascular function. 61 It is possible that the present cohort, being older and with a higher proportion of women in menopause, had higher BP variability and possibly a stronger association with mortality.…”