Abstract
BackgroundBlood pressure (BP) variability is associated with target organ damage in hypertension and diabetes. The 24 h ambulatory blood pressure monitoring (24 h-ABPM) has been proposed as an evaluation for BP variability using several indexes [standard deviation (SD) of mean BP, coefficient of variation (CV), BP variation over time (time-rate index)].MethodsWe evaluated the association between BP variability measured by 24 h-ABPM indexes and echocardiographic variables in a cross-sectional study in 305 diabetic-hypertensive patients.ResultsTwo groups were defined by the median (0.55 mmHg/min) of time-rate systolic BP (SBP) index and classified as low or high variability. Age was 57.3 ± 6.2 years, 196 (64.3 %) were female. Diabetes duration was 10.0 (5.0–16.2) years, HbA1c was 8.2 ± 1.9 %. Baseline clinical characteristics were similar between low (n = 148) and high (n = 157) variability groups. Office SBP and systolic 24 h-ABPM were higher in the high variability group (139.9 mmHg vs 146.0 mmHg, P = 0.006; 128.3 mmHg vs 132.9 mmHg, P = 0.019, respectively). Time-rate index, SD and CV of SBP, were higher in high variability group (P < 0.001; P < 0.001 and P = 0.003, respectively). Time-rate index was not independently associated with the echocardiography’s variables in multiple linear model when adjusting for age, 24 h-ABPM, diabetes duration and HbA1c. The multiple linear regression model revealed that the significant and independent determinants for septum thickness, relative wall thickness and posterior wall thickness (parameters of left ventricular hypertrophy) were: age (p = 0.025; p = 0.010; p = 0.032, respectively) and 24 h-SBP (p < 0.001 in the three parameters).ConclusionBP variability estimated by 24 h-ABPM is not independently associated with echocardiographic parameters in diabetic-hypertensive patients.
Highlights
Blood pressure (BP) variability is associated with target organ damage in hypertension and diabetes
Exclusion criteria were body mass index (BMI) ≥ 35 kg/m,2 cancer, arrhythmias that could interfere with BP measurement and 24 24 h ambulatory BP monitoring (h-ABPM) recordings
Previous history of stroke, use of statins were higher in low variability group; insulin use was higher in the high variability group
Summary
Blood pressure (BP) variability is associated with target organ damage in hypertension and diabetes. The 24 h ambulatory blood pressure monitoring (24 h-ABPM) has been proposed as an evaluation for BP variability using several indexes [standard deviation (SD) of mean BP, coefficient of variation (CV), BP variation over time (time-rate index)]. Observational studies had consistently shown the continuous relationship between office systolic and diastolic blood pressure (BP) and cardiovascular events [1]. The causal role of high BP for cardiovascular disease was fully confirmed by clinical trials [2]. The evidence that high BP highers the risk for cardiovascular events, and the consistent reduction of these events by clinical trials of BP-lowering agents are robust proofs of the concept that high BP is a major cardiovascular determinant [3]
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