Visit-to-visit blood pressure variability, average BP level and carotid arterial stiffness in the elderly: a prospective study

Abstract

In a cross-sectional study, visit-to-visit blood pressure (BP) variability was shown to be associated with artery remodelling. Here, we investigated the impact of visit-to-visit BP variability and average BP on the carotid artery remodelling progression in high-risk elderly according to different classes of antihypertension medication use/non-use. BP measurements and carotid ultrasound were performed in the common carotid artery in 164 subjects (mean age 79.7 years at baseline, 74.7% females) with one or more cardiovascular risk factors. Based on 12 visits (1 × /month for 1 year), we calculated visit-to-visit BP variability expressed as the standard deviation (s.d.), coefficient of variation (CV), maximum BP, minimum BP and delta (maximum-minimum) BP. We measured mean intima-media thickness (IMT) as well as stiffness parameter β were measured at baseline and at the mean 4.2-year follow-up. In a multiple regression analysis, the maximum, minimum, s.d. and average of systolic BP (SBP) were significantly associated with a change in β-values between the baseline and follow-up after adjustment for age, smoking, lower high-density lipoprotein level, baseline β-value and follow-up period. There were no significant associations between the visit-to-visit BP variability measures and the change in mean IMT. Significant associations of maximum, minimum, s.d. and average SBP were found with increased β-values in the subjects without calcium channel blocker (CCB) use and in the subjects using renin-angiotensin system inhibitors (RASIs). Thus, exaggerated visit-to-visit SBP variability and a high average SBP level were significant predictors of progression in carotid arterial stiffness in high-risk elderly without CCBs use and in those using a RASI.

Vascular Smooth Muscle Remodeling in Conductive and Resistance Arteries in Hypertension

“…In this regard, a cross-sectional study of elderly patients with at least one risk factor for cardiovascular disease showed an association between carotid arterial stiffness, high average systolic blood pressures and high visit-to-visit systolic blood pressure 23 . In another clinical study, increased aortic stiffness (measured by pulse wave velocity) correlated significantly with negative end organ effects in the heart and kidney in patients with mild hypertension 24 .…”

Single‐pill combination of cilnidipine, an l‐/n‐type calcium channel blocker, and valsartan reduces the day‐by‐day variability of morning home systolic blood pressure in patients with treated hypertension: A sub‐analysis of the HOPE‐combi survey

“…25 In elderly hypertensive patients, the BP variability is also reported as a risk factor for mortality 26,27 and cardiovascular death 28 and a predictor of arterial stiffness progression. 29 Our conclusion that the SPC of Cil/Val reduces age-related increased home BP variability may have clinical significance. This benefit needs to be confirmed in the future.…”

Visit‐to‐visit office blood pressure variability revisited in SPRINT

“… 12 During the mean follow‐up period of 4.2 years, VVV SBP had a significant positive association with the change of carotid stiffness parameter β. 12 In the coronary artery risk development in young adults (CARDIA) study, 13 the association between VVV SBP and 10‐year percent change in arterial stiffness was investigated among 1122 middle‐aged individuals without antihypertensive medications. In a multiple linear regression analysis, the group with the highest quintile of VVV SBP had a higher decline in the distensibility coefficient as well as a higher progression in Young's elastic modulus compared with those in the lowest quintile of VVV SBP independently of average SBP level.…”