Visit-to-visit blood pressure variability in the elderly: Associations with cognitive impairment and carotid artery remodeling

Nagai, Michiaki; Hoshide, Satoshi; Nishikawa, Mami; Shimpo, Masahisa

doi:10.1016/j.atherosclerosis.2013.11.071

Cited by 59 publications

(44 citation statements)

References 47 publications

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“…19 Similarly, we have used delta SBP and found significant correlation of SBP with aortic size index. Also in our study, 24-hour SBP values >67 mm Hg independently predicted dilatation of the ascending aorta.…”

Section: Discussionmentioning

confidence: 86%

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Assessment of Short‐term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

Karataş

İpek

Çanga

et al. 2015

Clinical Cardiology

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Background: Blood pressure variability (BPV) is a novel parameter related to adverse cardiovascular findings and events, especially in hypertensive patients. The aim of the present study was to investigate the relationship between short-term BPV and ascending aortic dilatation (AAD). Hypothesis: Hypertensive patients with AAD may exhibit higher short-term BPV compared to hypertensive patients with normal diameter ascending aorta and BPV may be correlated with aortic sizes. Methods: Seventy-six hypertensive patients with AAD and 181 hypertensive patients with a normal-diameter ascending aorta were retrospectively enrolled in the study. Clinical data, echocardiographic characteristics, and 24-hour ambulatory blood pressure monitoring characteristics were compared between the 2 groups. Standard deviation (SD) and of BP were used as parameters of BPV. Results: Although 24-hour mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar between the 2 groups, the SD of SBP and SD of DBP values were significantly higher in AAD patients (17.2 ± 6.8 vs 13.8 ± 3.5, P < 0.01; and 12.1 ± 5.1 vs 10.7 ± 3.1, P = 0.02, respectively). Daytime SD of SBP values were higher in AAD patients, whereas nighttime SD of SBP values did not differ between groups. In multivariate linear regression analysis, 24-hour SD of SBP, 24-hour SBP, daytime SD of SBP, daytime SBP, and left ventricular mass index were independently correlated with aortic size index. Conclusions: Our study revealed higher levels of short-term BPV in hypertensive patients with AAD. This conclusion warrants further study.

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Section: Discussionmentioning

confidence: 86%

“…Diastolic BPV was not found to be associated with target-organ damage and cardiovascular events in most of the studies. 19 Conversely, a few studies do demonstrate the positive correlation of diastolic BPV with adverse cardiovascular events in the literature. 17,20 In our study, 24-hour diastolic BPV was significantly higher in AAD patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Short‐term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

Karataş

İpek

Çanga

et al. 2015

Clinical Cardiology

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“…11,12 These studies have used a single screening measure to assess cognitive function, such as the Mini-Mental State Examination (MMSE), 13 have based their variability indicators on only few BP measures, or have used ambulatory BP measures with measurements taken throughout the day and/or night. 9,10,14 Despite the advantages of ambulatory BP, the practice of office-type measurements and other non-ambulatory measurements in research will continue. Guidelines for treatment of hypertension emphasize multiple BP assessments, in a number of different positions.…”

Section: Introductionmentioning

confidence: 99%

Measurement-to-Measurement Blood Pressure Variability Is Related to Cognitive Performance

et al. 2014

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The objective was to investigate the association between variability in blood pressure and cognitive function for sitting, standing and reclining blood pressure values, and variability derived from all 15 measures. In previous studies only sitting blood pressure values have been examined, and only a few cognitive measures have been employed. A secondary objective was to examine associations between blood pressure variability and cognitive performance in hypertensive individuals stratified by treatment success. Cross-sectional analyses were performed on 972 participants of the Maine Syracuse Study for whom 15 serial blood pressure clinic measures (5 sitting, 5 recumbant and 5 standing) were obtained, prior to testing of cognitive performance. Using all 15 measures, higher variability in systolic and diastolic blood pressure was associated with poorer performance on multiple measures of cognitive performance, independent of demographic factors, cardiovascular risk factors, and pulse pressure. When sitting, reclining and standing systolic blood pressure values were compared, only variability in standing blood pressure was related to measures of cognitive performance. However, for diastolic blood pressure, variability in all three positions was related to cognitive performance. Mean blood pressure values were weaker predictors of cognition. Furthermore, higher overall variability in both systolic and diastolic blood pressure was associated with poorer cognitive performance in unsuccessfully treated hypertensive individuals (with blood pressure ≥140/90 mmHg), but these associations were not evident in those with controlled hypertension.

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“…In this analysis, the association of SBP variability with renal end points persisted after adjustment for medication adherence. Alternatively, increased BP variability may reflect vascular dysfunction, such as increased arterial stiffness (30,31), endothelial dysfunction (32), or increased vascular inflammation (33). Similarly, autonomic dysfunction could lead to increased BP variability while increasing the risk of vascular events (34).…”

Section: 001mentioning

confidence: 99%

Visit-to-Visit Variability of BP and CKD Outcomes

Whittle

Lynch²,

Tanner³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Design, setting, participants, & measurements We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril. The composite outcome included incident ESRD after assessment of SD of systolic BP or $50% decline in eGFR between 24 months and 48 or 72 months after randomization. We repeated the analyses using average real variability and peak value of systolic BP and for visit-to-visit variability of diastolic BP.Results Over a mean follow-up of 3.5 years, 297 outcomes occurred. After multivariable adjustment, including baseline eGFR and mean systolic BP, the hazard ratios for the composite end point were 1.29 (95% confidence interval [95% CI], 0.75 to 2.22), 1.76 (95% CI, 1.06 to 2.91), 1.46 (95% CI, 0.88 to 2.45), and 2.05 (95% CI, 1.25 to 3.36) for the second through fifth (SD of systolic BP =6. 63-8.82, 8.83-11.14, 11.15-14.56, and .14.56 mmHg, respectively) versus the first (SD of systolic BP ,6.63 mmHg) quintile of SD of systolic BP, respectively (P trend =0.004). The association was similar when ESRD and a 50% decline in eGFR were analyzed separately, for other measures of visit-to-visit variability of systolic BP, and for visit-to-visit variability of diastolic BP. ConclusionsHigher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.

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Visit-to-visit blood pressure variability in the elderly: Associations with cognitive impairment and carotid artery remodeling

Cited by 59 publications

References 47 publications

Assessment of Short‐term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

Assessment of Short‐term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

Measurement-to-Measurement Blood Pressure Variability Is Related to Cognitive Performance

Visit-to-Visit Variability of BP and CKD Outcomes

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