PS-BPC04-6: INCREASED VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH LEFT ATRIUM ENLARGEMENT AND HIGH RDW-CV IN HYPERTENSIVE PATIENTS

Abstract

Objective: Visit-to-visit blood pressure variability (BPV) has been shown to be associated with incidence of atrial fibrillation and poor prognosis of heart failure with preserved ejection fraction (HFpEF). However, it is unknown why BPV induces AF or worsening of HFpEF. Objectives of this study are to investigate whether visit-to visit BPV affected cardiac remodeling and to explore the factors that associate with visit-to visit BPV. Methods: Out-patient with hypertension who received blood tests and echocardiography twice at an about 1-year interval in our hospital from 2014 to 2016 were included. Exclusion criteria were the number of blood pressure measurement less than 3, hospital admission between 2 tests, significant valvular heart disease, atrial fibrillation, hypertrophic cardiomyopathy, and hemodialysis. Visit-to visit BPV was evaluated with coefficient of variation of systolic blood pressure (SBP-CV) between 2 tests. Data were obtained from electronic health record of the hospital. Logarithmic transformations were used for values of red cell distribution width (RDW-CV) and left atrial volume index (LAVI) because they skewed to the left. Changing rate (Δ) of test value was calculated as follows: (2nd test value-1st test value)/[1st test value × test interval (years)]. This is a retrospective observational study and approved by the Institutional Ethics Committee. Results: One hundred and thirty-eight patients were included (median of age was 69, male 71%). In univariate analysis, SBP-CV was significantly correlated with age (P = 0.002), DBP-CV (P < 0.001), ΔlogLAVI (P = 0.001), logRDW-CV (P = 0.002), A wave (P = 0.011), and laxative use (P = 0.032). Multivariate analysis revealed that SBP-CV was significantly correlated with ΔlogLAVI (P = 0.009) and logRDW-CV (P = 0.022) Conclusions: Increase in visit-to-visit systolic BPV was associated with enlargement of left atrium and high red cell distribution width in patients with hypertension. Increased BPV was shown to be associated with impaired left ventricular (LV) diastolic dysfunction in cross sectional study. We found the association of increased visit-to visit BPV and enlargement of left atrium, the most sensitive marker of LV diastolic dysfunction, in longitudinal study for the first time. Experimental study using rats that received sinoaortic denervation showed that exaggerated BPV induced LV fibrosis and hypertrophy. BPV may cause LV diastolic dysfunction via LV fibrosis in patients with hypertension. We also found that SBP-CV was significantly correlated with RDW-CV. RDW-CV has been thought to be a marker of chronic inflammation. Chronic inflammation may causally relate to increased BPV.