24-hour Systolic Blood Pressure Variability Research Articles

Abstract 148: Increased Systolic Blood Pressure Variability During the First 24-hours of Hospitalization Associates With Poor 90-day Outcome After Intracerebral Hemorrhage

Introduction: Prospective studies and secondary analyses from clinical trials have identified increased systolic blood pressure variability (SBPV) as a risk factor for poor outcomes. Evidence of this association in real-world intracerebral hemorrhage (ICH) hospitalization is lacking, however. Methods: Data for adult (≥18) patients with primary ICH were retrieved from the REINAH cerebrovascular research database. Systolic blood pressure measurements from the first 24 hours of admission were retrieved and SBPV was calculated as the Coefficient of Variation (CV) = (standard deviation/mean)*100. Socioeconomic deprivation was assessed using the state Area Deprivation Index (ADI), with high deprivation assessed at ADI ≥ 8. The primary outcome was severe disability or death (SDD; modified Rankin Scale ≥4) at 90-days after discharge. Differences in SBPV across SDD were assessed using the Mann-Whitney U test. Associations between SBPV and SDD were assessed using multivariable logistic regression models adjusted for patient characteristics. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Final cohort included 807 patients (median [IQR]: 66 [54-77], 45.6% female), with an ethno-racial distribution of 41.9% White, 25.9% Black, 23.9% Hispanic, 5.7% Asian, and 2.6% Other. The median CV was 12.07 [9.50-15.59] and 485 (60.1%) patients experienced SDD. Patients with SDD showed significantly higher SBPV than non-SDD patients (12.90 [10.33-17.11] vs 10.99 [8.72-13.72]; p<0.001). Patients with 24-hour SBPV in the 3 rd (1.86 [1.16-2.96]) and 4 th quartile (3.10 [1.89-5.09]) had higher independent odds of SDD (vs. 1 st quartile) (Figure 1). Discussion: Patients with high SBPV during the first 24 hours of admission have higher odds of severe disability or death at 90-days after discharge.

1013: OUTCOME FROM SPONTANEOUS INTRAPARENCHYMAL HEMORRHAGE DURING CRITICAL CARE RESUSCITATION UNIT STAY

Introduction: Patients with spontaneous intraparenchymal hemorrhage (sIPH) often have high morbidity and mortality. Previous studies found that the first 24-hour systolic blood pressure variability (SBPV) was associated with worse functional outcome in patients. However, whether SBPV in the hyperacute phase in patients with sIPH is not known. We hypothesized that sBPV during patients’ resuscitation phase at the Critical Care Resuscitation (CCRU) at the University of Maryland Medical Center would correlate with increased hematoma progression (HP) and patients’ outcome. Methods: We retrospectively analyzed charts from adult patients who were admitted to the CCRU for management of sIPH from Jan. 2016 to Jan. 2021. Forward multivariable stepwise logistic regression was performed for the primary outcome of HP. We also performed multiple linear regression with Box-Cox transformation to normalize continuous components of BPV, namely Standard Deviation and Successive Variation in SBP (SBPSD) and SBPSV, respectively. Multivariable ordinal logistic regression was also performed for hospital disposition, ranking from discharge home to Dead/hospice. Results: We preliminarily analyzed 60 patients. Eighteen (30%) patients had HP. During CCRU stay, 23 (38%) required ventilation, 39 (65%) needed at least 1 antihypertensive infusion, 23 (38%) received hyperosmolar therapy, and 17 (28%) underwent external ventricular drain placement. Twelve (12, 20%) patients were discharged to home, 30 (50%) to rehabilitation facilities, 6 (10%) to skilled nursing homes, and 12 (20%) died. Our multivariable logistic regression found no factors in CCRU associated with HP. Highest SBP during CCRU stay (SBPmax) was associated with higher SBPSD (correlation coefficient =0.03, P< 0.001) and SBPSV (corr. coef. = 0.02, P< 0.001). High ICH score was associated with hospital disposition, higher ICH score was more likely associated with patient mortality (corr. Coeff = -1.2, OR 0.3, 95% CI 0.15-0.6, P< 0.001) Conclusions: SBPmax during CCRU stay was associated with higher SBPV in patients with sIPH during the resuscitation phase at the CCRU. Additionally, only one patients’ clinical factor, ICH score, was associated with levels of their hospital disposition. Additional studies with larger sample sizes are needed.

Abstract 10574: Disrupted Sleep is Associated With Increased 24-Hour Systolic Blood Pressure Variability in Caregivers

Introduction. A growing body of research shows an association between caregiving and increased cardiovascular disease (CVD) risk. Blood pressure variability (BPV) is known as a surrogate marker of CVD development. However, BPV in caregivers has rarely been used to assess for CVD risk, especially in relation to psychological and behavioral factors. The purpose of this study was to examine the associations of psychological symptoms (i.e., caregiving burden and depressive symptoms) and sleep quality with 24-hour BPV among caregivers of individuals with chronic illness. Methods. Thirty caregivers (25 female; 27 non-Hispanic white; mean age 62 years) who provided in-home care were recruited from the community in this cross-sectional study. Caregiver demographic data, caregiving stress (Zarit Burden Interview), and depressive symptoms (Patient Health Questionnaire-9) were obtained. Sleep quality (i.e., sleep efficiency, wake after sleep onset, the number of awakenings) was assessed using an actigraph for 7 consecutive days. Systolic and diastolic BPV over 24 hours, while awake (daytime), and while sleeping (night time) were obtained by ambulatory BP monitoring. Pearson's correlations and multiple linear regression were conducted to examine associations of psychological symptoms and sleep quality with BPV. Results. Sleep efficiency was negatively correlated with diastolic BPV while awake ( r = -0.368, p = 0.045). The number of awakenings during sleep was positively correlated with systolic BPV while awake ( r = 0.426, p = 0.019) and diastolic BPV while awake ( r = 0.422, p = 0.020). Caregiving stress and depression were not correlated with BPV. After controlling for age and mean arterial pressure, the number of awakenings was associated with increased systolic BPV over 24 hours ( B = 0.194, p = 0.018) and systolic BPV while awake ( B = 0.280, p = 0.002), respectively. Conclusion. Caregivers’ disrupted sleep represented by frequent awakenings may play a role in increased CVD risk as evidenced by increased BPV. While future large clinical studies should be conducted to confirm these findings, improving sleep quality would need to be considered for CVD prevention strategies for caregivers.

Correlation Between Serum Total Bilirubin Levels and Blood Pressure Variability in Patients With Hypertension

Abstract Background To investigate the effect of serum total bilirubin levels on blood pressure and its variability in patients with hypertension. Methods This study was a retrospective observational study. A total of 189 subjects were recruited from September 2019 to March 2020. All hypertensive patients were scheduled for ambulatory blood pressure and a 24-hour dynamic electrocardiography. Standard deviations of 24-hour systolic and diastolic blood pressure were used as blood pressure variability indicators. A multiple linear regression was used to analyze the relationship between total bilirubin serum levels and blood pressure variability in hypertensive patients. Results All patients were divided into 3 groups according to tertile values of total bilirubin: low (≤12.2 µmol/l, n = 64), moderate (12.3–16.7 µmol/l, n = 64), and high (&amp;gt;16.8 µmol/l, n = 62) total bilirubin groups. Compared with low total bilirubin group, 24-hour mean systolic and diastolic blood pressure, 24-hour systolic blood pressure standard deviation, systolic blood pressure coefficient of variability, and 24-hour systolic blood pressure load were reduced in the moderate and high total bilirubin groups (all P &amp;lt; 0.05). Multiple linear regression analysis showed that female (B = −1.408, P = 0.013), age (B = 0.043, P = 0.035), diabetes (B = 2.624, P &amp;lt; 0.001), and moderate and high bilirubin grouping (B = −1.582, −3.079; both P &amp;lt; 0.05) were influencing factors of 24-hour systolic pressure standard deviation. Serum total bilirubin levels had no effect on the standard deviation of 24-hour diastolic blood pressure(P &amp;gt; 0.05). Conclusions In hypertensive patients, the total bilirubin serum level is an influencing factor for 24-hour systolic blood pressure variability.

Predictive value of blood pressure variability for organ dysfunction in patients with sepsis.

Sepsis is a common disease in the intensive care unit, accompanied by many complications and high mortality. Organ dysfunction is a major risk factor for death in patients with sepsis. Analyzing the related factors of organ dysfunction caused by sepsis can provide more clinical prevention and treatment targets, and better predict patients' prognoses. This study aimed to investigate the relationship between blood pressure variability (BPV) and organ dysfunction in patients with sepsis. One hundred and two patients with sepsis treated in our hospital from January 2019 to January 2021 were retrospectively collected as an observation group, and 102 healthy people were collected as a control group. The 24-hour systolic blood pressure variability (24h SBPV) and 24-hour diastolic blood pressure variability (24h DBPV) of the two groups were compared, and the correlation between 24h SBPV, 24h DBPV, and organ function damage to sepsis patients were analyzed. Compared with the control group, the 24h DBPV in the observation group was significantly higher (0.56±0.16 vs. 0.37±0.16, P=0.000). 24h SBPV increased significantly (0.56±0.16 vs. 0.36±0.17, P=0.000). Pearson linear correlation analysis showed 24h SBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.301, 0.216 and 0.218, P<0.05). 24h DBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.302, 0.212 and 0.210, P<0.05). 24h SBPV and 24h DBPV are of certain value in the diagnosis of multiple organ failure in patients with sepsis, and the area under the curve was [0.649 (95% CI: 0.539-0.759), P=0.010] and [0.650 (0.540-0.760), P=0.009], respectively. 24h SBPV and 24h DBPV are of certain value in the diagnosis of persistent organ failure in patients with sepsis, and the area under the curve was [0.647 (95% CI: 0.538-0.757), P=0.010] and [0.647 (95% CI: 0.538-0.757), P=0.010], respectively. The increase of BPV in patients with sepsis has a certain value in predicting the prognosis and organ function damage to patients with sepsis.

Vitamin D, vitamin D binding protein, vitamin D receptor levels and cardiac dysautonomia in patients with multiple sclerosis: a cross-sectional study.

Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = -0.406). There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system.

A7650 24-hour systolic blood pressure variability is associated with the presence of coronary artery calcium

A7650 24-hour systolic blood pressure variability is associated with the presence of coronary artery calcium

GW29-e1852 Coronary Artery Calcification Mediates the Association between 24-Hour Systolic Blood Pressure Variability and Major Adverse Cardiac Events

Blood pressure variability (BPV), have been recently identified as an important risk factor for the development of cardiovascular diseases (CVD) independent of mean blood pressure. Coronary artery calcification (CAC) has demonstrated to be an independent predictor of major adverse cardiac events (

Metabolomic Profiling of Nonproteinogenic Amino Acids in Patients with Type 2 Diabetes and Hypertension

Introduction: Identifying the amino acid signature of increased blood pressure might help us understand hypertension pathophysiology. We aimed to investigate the relationship of non-proteinogenic amino acids with ambulatory blood pressure mean and variability in type 2 diabetes patients. Methods: Serum non-proteinogenic amino acids’ profiling was performed by high performance liquid chromatography coupled with mass spectroscopy analysis. Blood pressure variability was calculated as standard deviation of mean systolic and diastolic blood pressure evaluated over 24-hour ambulatory monitoring. Results: The study population consisted of type 2 diabetes hypertensive patients (n=80), 58% women, aged 59.8±7.7 years old with diabetes duration 9.0±8.7 years. Serum non-proteinogenic amino acids levels (nmol/mL) were: gamma-aminobutyric acid 0.2±0.1, aminoisobutyric acid 22.6±7.9, beta-aminoisobutyric acid 1.2±0.7, 4-hydroxyproline 12.2±9.9, 3-methylhistidine 4.7±2.8, alpha-aminoadipic acid 1.0±0.5, sarcosine 11.3±5.6. In linear regression analysis, aminoisobutyric acid was significantly associated with 24-hour systolic blood pressure variability (r=0.23; p=0.044), sarcosine was significantly associated with nighttime systolic blood pressure variability (r=0.27; p=0.017), while beta-aminoisobutyric acid was significantly associated with mean daytime (r=-0.25; p=0.024) and 24-hour (r=-0.24; p=0.032) diastolic blood pressure. Conclusion: Serum metabolomes aminoisobutyric acid and sarcosine directly associated with ambulatory systolic blood pressure variability, while beta-aminoisobutyric acid inversely associated with mean diastolic blood pressure. Our results indicate changes in serum non-proteinogenic amino acids as consequences of increased blood pressure that should be further evaluated in connection to cardiovascular disease, particularly in the presence of type 2 diabetes. Disclosure D.M. Ciobanu: Other Relationship; Self; Sanofi, AstraZeneca, Merck Sharp &amp; Dohme Corp., Eli Lilly and Company, Merck KGaA. C.G. Bala: Consultant; Self; Sanofi, AstraZeneca. G. Roman: None.

PP.26.10] AMBULATORY BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR RISK

Objective: The correlation of cardiovascular risk factor apoB/apoA1and nonHDL cholesterol to 24-hour blood pressure variability in hypertensive patients. Design and method: We studied 323 hypertensive treated or newly diagnosed untreated patients (average age: 51.1 yrs, average Systolic/Diastolic Blood Pressure:151/96.8 mmHg). They were subjected to 24-hour ambulatory blood pressure monitoring and their apoA1, apoB and nonHDL cholesterol plasma levels were measured. The degree of 24-hour Systolic/Diastolic Blood Pressure variability was divided in two groups: group A with systolic blood pressure levels greater or equal than 15mmHg and group B with systolic blood pressure levels less than 15mmHg. We sought the correlation between the apoB/apoA1 ratio to the degree of systolic and diastolic blood pressure variability (ANOVA method). Results: Analysis (ANOVA) of the apob/apoA1 ratio and nonHDL cholesterol variation in different groups:Conclusions: Both apob/apoA1 ratio and non-HDL cholesterol levels do not correlate to the 24-hour systolic blood pressure variability and are significantly lower in group A (that with the greater degree of blood pressure variability) for Diastolic Blood Pressure, posing significant doubt about the role of 24-hour diastolic pressure variability.

Effects of Amlodipine and Valsartan on Blood Pressure Variability and Pulse Wave Velocity in Hypertensive Patients

ObjectivesAntihypertensive therapy is effective to control blood pressure (BP) and to prevent cardiovascular events, but the further treatment strategies for patients who cannot achieve goal BP with low-dose monotherapy is still under dispute. Our study investigates the effects of high-dose amlodipine and valsartan and their low-dose combination on blood pressure variability (BPV) and pulse wave velocity (PWV) to provide references for clinical medication. Materials and MethodsThis study was a prospective, randomized, parallel, case-controlled trial performed in a medical center. A total of 134 outpatients newly diagnosed with essential hypertension or receiving low-dose monotherapy were enrolled and 119 completed the trial. They were randomized into amlodipine 10mg group (n = 40), valsartan 160mg group (n = 38) and amlodipine 5mg + valsartan 80mg (n = 41) in a 1:1:1 allocation ratio for a 10-week treatment. Demographic data and laboratory indicators were collected at the randomization and 10 weeks after the treatment. The 24-hour ambulatory BP and brachial-ankle PWV were also monitored. ResultsAll therapies reduced systolic and diastolic BP (P < 0.05). The 24-hour systolic BPV was significantly decreased in amlodipine and combination groups (3.55 ± 2.57, 4.11 ± 2.20 versus 2.23 ± 2.54mmHg, P < 0.05). The effects on diastolic BPV differed between different treatments. PWV was lowered by 3 antihypertensive schemes; the degree of which from strongest to weakest were valsartan, combination and amlodipine (228.87 ± 60.41 versus 152.49 ± 49.25 versus 99.35 ± 35.57cm/second, P < 0.01). ConclusionsAll further strategies can effectively control BP. The combination treatment reduces both BPV and PWV noticeably, whereas double-dose amlodipine achieves the greatest BPV decrease and valsartan is best in controlling PWV.

Abstract P105: Greater 24 Hour Blood Pressure Variability is Associated With Higher 24 Hour Systolic Blood Pressure and Glucose Independent of Age and Large Elastic Artery Stiffness in Normotensive Adults

Older age is associated with elevated large elastic artery stiffness, a strong predictor of cardiovascular (CVD) risk in middle-age/older (MA/O) adults independent of blood pressure (BP). Greater 24-hour systolic BP variability (BPV) is also an independent risk factor for CVD and is linked to large artery stiffness in MA/O adults with hypertension and diabetes. However, its relation to age-related arterial stiffness in adults with low risk factor burden is unclear. We hypothesized that higher systolic BPV would be: 1) associated with advancing age, and 2) related to elevated aortic and carotid artery stiffness among healthy MA/O adults. To determine this, 98 healthy adults (ages 19-70 yrs) with measurements of systolic BPV (standard deviation of 24 hr systolic BP) via ambulatory BP monitoring, aortic stiffness (carotid-femoral pulse wave velocity, cfPWV), carotid artery stiffness (β-stiffness via carotid tonometry/B mode ultrasound) and circulating metabolic factors were included. In the entire cohort, greater systolic BPV was not associated with age, cfPWV, carotid β stiffness or circulating lipids/glucose (all P&gt;0.05), but was correlated (age-adjusted) with 24 hr systolic BP (r= 0.41, P&lt;0.001) and BMI (r= 0.21, P&lt;0.05). In stepwise linear regression analyses that included age, sex, BMI, only 24 hr systolic BP was associated with systolic BPV (β= 0.14 ± 0.03, Model R 2 = 0.20, P&lt; 0.001). Interestingly, there was no difference in 24 hr systolic BPV (11.4 ± 0.4 vs 11.4 ± 0.5 SD mmHg, P=0.99) in young (n=55; 29.0 ± 0.7 yrs) vs. MA/O (n= 43; 53.0 ± 1.2 yrs) adults despite higher cfPWV (594 ± 12 vs 913 ± 39 cm/sec, P&lt;0.001), carotid β-stiffness (6.8 ± 0.6 vs 9.3 ±0.9 U, P=0.001) and 24 hr systolic BP (121 ± 1 vs 125 ± 2 mmHg, P&lt;0.05). Systolic BPV was associated with BMI (r= 0.42, p&lt; 0.01) and fasting blood glucose (r= 0.54, P= 0.001) in MA/O but not young adults. In a stepwise linear regression model among MA/O, 24 hr systolic BP (β= 0.18 ± 0.04, R 2 = 0.36, P&lt;0.001) and fasting glucose (β= 0.10 ± 0.05, R 2 change= 0.07, P&lt;0.001) were the only significant correlates of systolic BPV (Model R 2 = 0.43, P&lt;0.001). In conclusion, 24 hr systolic BP and fasting blood glucose, but not age or large elastic artery stiffness, were the strongest determinants of higher systolic BPV in normotensive MA/O adults.

Association of Serum Uric Acid Level With Blood Pressure Variability in Newly Diagnosed Essential Hypertension.

Serum uric acid (UA) is independently associated with hypertension and blood pressure (BP) variability (BPV) is associated with cardiovascular events and mortality in hypertensive patients. The aim of the present study was to assess the association of serum UA with BPV in 300 untreated essential hypertension patients (mean age 57.3±13.6years). BPV was quantified as the standard deviation (SD) of the 24-hour, daytime, and nighttime mean values obtained by using ambulatory BP monitoring. In correlation analysis, log UA values were found to be positively correlated with 24-hour systolic BPV and nighttime systolic and diastolic BPV (Pearson coefficients of 0.246, 0.280, and 0.353, respectively; P<.001 for all). In multivariate analysis, log UA had an independent association with 24-hour systolic BPV and nighttime systolic and diastolic BPV. This study show for the first time that increased serum UA is independently associated with BPV in untreated essential hypertension patients.

PP.03.33

Objective: To investigate the impacts of amlodipine, valsartan and the two drugs combination on blood pressure variability(BPV) and pulse wave velocity(PWV) Design and method: It's a prospective,open, parallel control study.119 participants who were newly diagnosed essential hypertension or receiving single antihypertensive drug were recruited and divided into three groups (amlodipine, valsartan and two drugs combination treatment). Each patient's relevant demographic data and laboratory indicators were collected, in line with his/her 24 hours ambulatory blood pressure monitoring and brachial ankle pulse wave velocity monitoring taken. All participants were given treatment respectively for 10 weeks, and then rechecked the baseline indicator, comparing their effects on BPV and PBV. Results: Amlodipine can most effectively reduce 24-hour systolic blood pressure variability and diurnal systolic blood pressure variability. Amlodipine is the most effective and valsartan is the least in terms of reducing 24-hour diastolic blood pressure variability(P < 0.05).Three kinds of antihypertensive scheme can reduce arterial stiffness (baPWV), degree from strong to weak is: valsartan, two drug combination, amlodipine. The relationship between baPWV and 24 h average systolic blood pressure, 24 h systolic/diastolic blood pressure variability, 24 h average pulse pressure, daytime highest/average systolic blood pressure, daytime systolic/diastolic blood pressure variability, daytime highest diastolic blood pressure, daytime average pulse pressure, nighttime minimum systolic blood pressure are all positively correlated (P < 0.05 or P < 0.01).Between baPWV and nocturnal systolic blood pressure drop rate is a positive correlation (P < 0.05). The relationship between baPWV and nighttime diastolic blood pressure drop rate, however, has no statistical significance. Conclusions: Three treatments can all effectively control blood pressure. Amlodipine has the strongest antihypertensive effect and can effectively reduce BPV. Valsartan has independent effect in improving arterial stiffness. Arterial stiffness is associated with blood pressure levels and BPV, and its relationship between systolic blood pressure is greater than diastolic blood pressure.

The relationship between blood pressure variability and cardiovascular risk factors in patients with primary hypertension

Abstract Objective: The aim of the study is to assess 24-hour blood pressure variability, circadian blood pressure profile and its relation to 24-hour blood pressure and cardiovascular risk factors in primary hypertension without any associated disease versus associated with a disease such as diabetes or chronic kidney disease. Methods: This observational study included 90 hypertensive patients, 49 with primary hypertension without associated disease and 41 patients with primary hypertension and diabetes or chronic kidney disease. Circadian blood pressure profile and 24-hour variability were assessed using ambulatory monitoring. Laboratory data regarding cardiovascular risk factors and demographic data were collected in a questionnaire. Results: The number of dipper patients was higher in the group without associated disease, but the difference was not statistically significant (p=0.27). In both groups a positive correlation was found between 24-hour systolic blood pressure variability and 24-hour systolic blood pressure (p=0.029) and was related to age (p=0.031). In the second group, systolic variability showed a positive correlation with serum triglycerides (p=0.006, r=0.416, CI: 0.1252 to 0.6422). Conclusion: Our findings suggest that systolic blood pressure variability is related to age, systolic blood pressure values and serum lipid levels. To prevent end organ damage in hypertension, the assessment of ambulatory monitoring derived 24-hour systolic blood pressure variability and its reduction may be at least as important as blood pressure lowering.

9 LOW CORRELATION BETWEEN VISIT-TO-VISIT VARIABILITY AND 24-HOUR VARIABILITY OF BLOOD PRESSURE

Background: Higher visit-to-visit variability (VVV) and 24-hour variability of systolic blood pressure (SBP) have been associated with increased cardiovascular disease risk. Few data are available on the correlation of VVV and 24-hour variability. Design and methods: We assessed the correlation between VVV and 24-hour SBP variability using data from 146 untreated, mostly normotensive participants (mean age 47.9 years; 64% women) in the Masked Hypertension Study who attended 6 study visits and had ambulatory BP monitoring (ABPM) performed. VVV was estimated by the standard deviation (SDvvv) and average real variability (ARVvvv). We used ABPM data to calculate the day-night SD (SDdn) and the ARV over 24 hours (ARV24). Results: The average SDvvv and SDdn were 6.3 ± 2.5 and 8.8 ± 1.8 mmHg, respectively, and the ARVvvv and ARV24 were 7.2 ± 3.2 and 7.0 ± 2.2 mmHg, respectively. The Spearman correlation coefficient between SDvvv and SDdn was rs = 0.25 and between ARVvvv and ARV24 was rs = -0.02. Participants in the lowest quartile of SDdn and ARV24 were 1.33 (95% CI: 0.69 – 2.33) and 0.67 (95% CI: 0.24 – 1.45) times as likely to be in the lowest versus upper three quartiles of SDvvv and ARVvvv, respectively. Also, participants in the highest quartile of SDdn and ARV24 were 1.66 (95% CI: 0.93 – 2.75) and 1.22 (95% CI: 0.61 – 2.19) times as likely to be in the highest versus lowest three quartiles of SDvvv and ARVvvv of BP. Conclusion: In the current study, the correlation between VVV and 24-hour variability was low. These data suggest that VVV and 24-hour variability are not interchangeable.

D-006 LARGE ARTERIAL STIFFNESS AND 24-HOUR BLOOD PRESSURE VARIABILITY IN UNTREATED PATIENTS

Objective Short time blood pressure variability (BPV), such as 24-hour ambulatory BPV, was an independent predictor for adverse cardiovascular outcome. We hypothesized that arterial stiffness, as a surrogate of cardiovascular endpoints, could be influenced by BP level as well as by BPV. Methods We performed 24-hour ambulatory BP monitoring in 439 subjects (47.4% male, mean age 53 years) who were not taking antihypertensive drugs. Standard deviation (SD) of 24-hour BP, day-night weighted average SD of daytime and nighttime BP (SDdn), and reading-to-reading average real variability of BP (ARV) were calculated as 24-hour short BPV measures. Carotid-femoral pulse wave velocity (cf-PWV) was obtained by using SphygmoCor system (Australia). Brachial-ankle PWV (ba-PWV) was measured by Omron Colin VP-1000 device (Japan). Results Pearson simple correlation analyses showed that 3 measures of systolic BPV were all positively correlated with cf-PWV and ba-PWV (r = 0.18–0.37, P < 0.001). SDdn and ARV of diastolic BP were significantly correlated with cf-PWV only (P < 0.05). Multivariate regression analyses showed that after adjustment for age, sex, body mass index, 24-hour pulse rat, current smoking and corresponding 24-hour BP level, only ARV of systolic BP was significantly associated with cf-PWV (P = 0.016) and ba-PWV(P = 0.049), whereas other systolic and diastolic BPV measures were not associated with arterial stiffness indexes (P ≥ 0.11). With 1-SD elevation in ARV of systolic BP (2.4mmHg), cf-PWV and ba-PWV increased by 0.17m/s and 0.21m/s, respectively. However, ARV added only 1% to the explained variance of cf-PWV or ba-PWV while accounting for conventional risk factors including 24-hour systolic blood pressure level. Conclusions Increased 24-hour systolic BPV, if measured as ARV, was an independent risk factor for large arterial stiffness, but its contribution was small. It indicated that in clinical practice we should mainly focus on blood pressure level, but at the same time not to ignore BPV.

Relation of C-Reactive Protein and Tumor Necrosis Factor-Alpha to Ambulatory Blood Pressure Variability in Healthy Adults

Elevated blood pressure (BP) variability has been linked to an increased risk for adverse cardiovascular events, but the biologic factors that promote elevated BP variability are not entirely understood. This cross-sectional study examined whether inflammatory factors might be associated with elevated BP variability during 24-hour ambulatory BP monitoring. Subjects were 140 healthy, normotensive adults. Inflammatory markers included C-reactive protein (CRP) and tumor necrosis factor-alpha. BP variability was calculated as the within-subject SD of BP values obtained during the daytime, nighttime, and 24-hour periods. In linear regression models that were adjusted for mean BP and other factors, CRP quartiles were positively associated with daytime systolic BP variability; for subjects in the lowest to highest CRP quartiles, the mean within-subject SDs of daytime systolic BP were 9.31, 9.62, 10.55, and 11.17, respectively (p for linear trend = 0.001). CRP showed similar positive associations with nighttime and 24-hour systolic BP variability. In contrast, tumor necrosis factor-alpha was not independently associated with systolic BP variability during any of the time periods. With respect to diastolic BP variability, significant positive associations were found between CRP and diastolic BP variability during all time periods and between tumor necrosis factor-alpha and daytime diastolic BP variability. In conclusion, there are positive associations between markers of inflammation and BP variability in healthy, normotensive adults, suggesting that inflammation may be 1 of the factors that promotes increased BP variability.

Effects of Long-Term Treatment with Candesartan on Hemodynamics and Organ Damage in Spontaneously Hypertensive Rats

This study was designed to investigate the effects of candesartan on blood pressure (BP) and blood pressure variability (BPV) reductions, baroreflex sensitivity (BRS) amelioration, and organ protection in spontaneously hypertensive rats (SHR). Studies were performed in two groups of SHR (n = 13 for control rats; and n = 20 for candesartan-treated rats) and one group of WKY rats (n = 13). Candesartan (3 mg /kg/d) was given in rat chow for 4 months. BP was then continuously recorded for 24 hours in conscious state. After the determination of BRS, rats were killed for organ-damage evaluation. Long-term treatment with candesartan significantly reduced BP and BPV expressed by both standard deviation and variation coefficient of BP, enhanced BRS and produced obvious organ protection. Compared with BP level, BPV and BRS values showed a closer or similar relationship with organ-damage parameters in SHR. Multiple regression analysis showed that the decrease in left ventricular hypertrophy was most closely associated with the increase in BRS, whereas the decrease in aortic hypertrophy was most closely associated with the decrease in 24-hour systolic BPV, and the amelioration in renal lesions, with the increase in BRS and the decrease in 24-hour systolic BPV. long-term treatment with candesartan results in organ protection in SHR. Besides BP reduction, the decrease in BPV and the restoration of BRS are significantly related to this organ protection.

Neurobiology of Birth Weight Influence on Blood Pressure Values and Variability in Children and Adolescents

To the Editor: Lurbe et al1 find an independent and significant inverse relationship for birth weight and 24-hour systolic blood pressure in 630 healthy children, ages 4 to 18 years ( P <0.001). Likewise, birth weight was independently and inversely correlated with 24-hour systolic blood pressure variability ( P <0.03). Neurobiological features are suggested by a report that dopamine is a potent inhibitor of growth hormone and by studies linking anxiety and vasospasm with dopamine abnormalities …