Average Real Variability Of Systolic Blood Pressure Research Articles

Sex influences blood pressure but not blood pressure variability in response to dietary sodium and potassium in salt-resistant adults.

Dietary sodium and potassium have been shown to affect blood pressure (BP) but their influence on BP variability (BPV) is less studied as is the influence of sex. The aim of this study was to compare 24 h BP and short-term BPV in response to varying dietary levels of sodium and potassium in healthy non-obese normotensive salt-resistant adults. We hypothesized that high sodium would increase short-term BP and BPV while the addition of high potassium would counteract this increase. Furthermore, we hypothesized that women would experience greater increases in BPV under high sodium conditions compared to men while potassium would attenuate this response. Thirty-seven participants (17 M/20 W; 27 ± 5 years old; BMI 24.3 ± 3 kg/m2) completed seven days each of the following randomized diets: moderate potassium/low sodium (MK/LS), moderate potassium/high sodium (MK/HS) and high potassium/high sodium (HK/HS). BP and short-term BPV were assessed using 24 h ambulatory BP monitoring starting on day 6. BPV was calculated using the average real variability (ARV) index. Twenty-four hour, daytime, and nighttime systolic BP (SBP) were lower in women compared to men regardless of diet. However, 24 h and daytime SBP were lowered in women on the HK/HS diet compared to the MK/HS diet. There were no significant effects of diet or sex for 24 h, daytime or nighttime SBP ARV. However, men exhibited a higher 24hDBP ARV than women regardless of diet. In conclusion, a high potassium diet lowered BP under high sodium conditions in women alone while men exhibited higher short-term BPV that was not influenced by diet.

Association between napping and 24-hour blood pressure variability among university students: A pilot study.

Blood pressure variability (BPV) has been reported to be a predictor of cardiovascular and some cognitive diseases. However, the association between napping and BPV remains unknown. This study aimed to explore the association between napping and BPV. A cross-sectional study including 105 university students was conducted. Participants' 24 h ambulatory blood pressure monitoring (24 h ABPM) were measured, and napping behaviors were investigated. BPV were measured by the 24 h ABPM, included standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Among the participants, 61.9% reported daytime napping. We found that nap duration was significantly associated with daytime CV of diastolic blood pressure (DBP) (r = 0.250, P = 0.010), nighttime CV of systolic blood pressure (SBP) (r = 0.217, P = 0.026), 24 h WCV of DBP (r = 0.238, P = 0.014), 24 h ARV of SBP (r = 0.246, P = 0.011) and 24 h ARV of DBP (r = 0.291, P = 0.003). Compared with the no napping group, 24 h WCV of DBP, daytime CV of DBP, and daytime SD of DBP were significantly higher in participants with napping duration >60 min. With multiple regression analysis we found that nap duration was an independent predictor for 24 h ARV of SBP (β = 0.859, 95% CI, 0.101-1.616, P = 0.027) and 24 h ARV of DBP (β = 0.674, 95% CI, 0.173-1.175, P = 0.009). Napping durations are associated with BPV among university students. Especially those with napping durations >60 min had a significantly higher BPV than those non-nappers.

S-17-4: EFFECTIVENESS OF STATIN INTENSIVE THERAPY IN TYPE 2 DIABETES WITH HIGH VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY

Objective: Intensive lipid-lowering therapy is recommended in type 2 diabetes mellitus (T2DM) patients with target organ damage. However, evidence is insufficient to stratify the patients who will benefit from the intensive therapy among them. High visit-to-visit variability in systolic blood pressure (SBP) is associated with increased risk of cardiovascular events. Thus, we hypothesized that the benefit of intensive lipid-lowering therapy is larger in T2DM patients with high visit-to-visit SBP variability who are considered at higher risk. This study aimed to investigate the effectiveness of intensive versus standard statin therapy in primary prevention of cardiovascular events among T2DM patients with retinopathy stratified by visit-to-visit SBP variability. Design and method: The EMPATHY study was the first randomized trial comparing statin intensive therapy targeting low- density lipoprotein cholesterol (LDL-C) < 70 mg/dL and standard therapy targeting LDLC ®100 to < 120 mg/dL in T2DM patients with retinopathy without known cardiovascular disease. Using this dataset, we divided the patients into two subpopulations based on standard deviation (SD) and average real variability (ARV) of clinic SBP within initial 6 months. The outcome was the composite incidence of cardiovascular events, including cardiac, cerebral, renal, and vascular events or death associated with cardiovascular events. Results: In a total of 4899 patients, 240 composite cardiovascular events were observed during a median follow-up of 37.3 months. The number of blood pressure measurements was 6.6 ± 1.6. The median value of SD and ARV of SBP was 9.78 mmHg and 10.29 mmHg, respectively. These median values were used as cutoffs. In multivariable-adjusted model comparing intensive versus standard therapy, the hazard ratios for composite cardiovascular events were 0.64 (95% CI 0.45–0.90, p = 0.012) and 1.21 (95% CI 0.82–1.80, p = 0.34) in patients with high and low SBP variability as defined by SD, respectively. Interaction between SBP variability and statin therapy was significant (p = 0.018). The analysis using ARV of SBP showed similar results (high ARV: hazard ratio 0.62, 95% CI 0.44–0.88, p = 0.008; low ARV: hazard ratio 1.15, 95% CI 0.78–1.70, p = 0.48; p for interaction = 0.022.). Conclusion: Statin intensive therapy targeting LDL-C < 70 mg/dL had benefits in primary prevention of cardiovascular events compared with standard therapy among T2DM patients with retinopathy having high, but not low, visit to visit SBP variability. Stratification based on visit-to-visit SBP variability might be a novel and useful strategy to determine the target LDL-C levels in statin lipid-lowering therapy among T2DM patients with microvascular complications.

PS-C13-13: BLOOD PRESSURE REACTIVITY AGAINST PHYSICAL ACTIVITY “ACTISENSITIVITY” EVALUATED BY MULTISENSOR-ABPM CHANGES BEFORE AND AFTER TREATMENT OF HEART FAILURE

Introduction: The pathological significance of blood pressure (BP) variability in patients with heart failure (HF) has not been fully elucidated. We propose the term Actisensitivity to describe such BP reactivity in response to physical activity; this new aspect of BP variability can be evaluated using our recently developed device, a multisensor-ambulatory BP monitoring (ABPM) device (TM-2441, A&D Co., Tokyo) equipped with an actigraph that can detect physical movements. Methods: In the present study, actisensitivity is defined as the slope of the regression line that is calculated from ambulatory systolic BP (SBP) with the log-transformed value corresponding 5-min average of physical activity just before each BP measurement. We prospectively assessed the changes in actisensitivity and ambulatory BP (ABP) parameters between patients with and without improved cardiac function during the treatment of HF. We assessed 20 patients with diagnosed HF (mean ± SD age, 63.3 ± 14.1 years; male, 65%; ischemic heart disease, 15%; atrial fibrillation, 25%) just after initial or adjusted treatments, and reassessed the multisensor-ABPM data at follow-up from 6–12 months after tailored treatment. Second, we divided these patients into an improved (n = 11 patients) and a not-improved (n = 9) cardiac-function group; an increase in echocardiographic left ventricular ejection fraction of ≧ 10%. We then compared the changes in actisensitivity and ABP parameters between the two groups. Results: Parameters of ABP variability, i.e., SD, coefficient of variation, and average real variability of SBP, did not change between baseline and follow-up in either group. However, the actisensitivity value tended to increase from baseline to follow-up in the improved group (1.0 ± 3.5 vs. 4.5 ± 3.5, p = 0.065), but not in the not-improved group. The degree of changes in actisensitivity from baseline to follow-up tended to be higher in the improved group than the not-improved group (3.5 ± 5.6 vs. -1.2 ± 4.8, p = 0.059) (Figure). Moreover, in the overall patient group, the change of actisensitivity from baseline to follow-up was significantly related to the changes of LVEF (r = 0.553, p = 0.011). Conclusion: To our knowledge, this is the first study to prospectively observe the changes of novel BP reactivity against physical activity in HF patients using the new multisensor-ABPM device. Our findings should help to elucidate the relationships between BP variability/hemodynamics during physical activity and cardiac function in patients with HF.

Visit-to-visit variability of blood pressure and risk of macrovascular and microvascular complications in patients with type 2 diabetes: A Chinese primary-care cohort study.

We evaluated the effects of visit-to-visit variability of systolic blood pressure (SBP)and diastolic blood pressure (DBP) on macrovascular and microvascular complications among patients with type 2 diabetes. A total of 11 043 patientswith type 2 diabetes from primary healthcare institutions between January 2010 and June 2020 were included. The visit-to-visit blood pressure variability was calculated using three metrics: SD, coefficient of variation (CV), and average real variability (ARV), obtained over a 12-month measurement period. The associationsof visit-to-visit blood pressure variability with macrovascular and microvascular complications wereevaluated using multivariate-adjusted Cox proportional hazards models, and hazard ratio (HR) with 95% confidence interval (CI) were reported. There were 330 macrovascular events and 542 microvascular events. Compared to those for participants with the lowest quartile of SD of SBP and DBP, increased risks were observed in patients with the highest quartile of SD of SBP and DBP for macrovascular complications (SD-SBP: HR=1.78, 95% CI: 1.24-2.57; SD-DBP: HR=2.20, 95% CI: 1.50-3.25) and microvascular complications (SD-SBP: HR=1.85, 95% CI: 1.39-2.46; SD-DBP: HR=1.82, 95% CI: 1.36-2.44). CV and ARV of SBP and DBP also had statistically significant associations with macrovascular and microvascular complications. The optimal variability of blood pressure target was SD of SBP <6.45 mm Hg and SD of DBP <4.81 mm Hg. Visit-to-visit blood pressure variability may be a potential predictor for macrovascular and microvascular complications in patients with type 2 diabetes.

Effects of isometric resistance training and detraining on ambulatory blood pressure and morning blood pressure surge in young normotensives.

Isometric resistance training (IRT) has been shown to reduce resting and ambulatory blood pressure (BP), as well as BP variability and morning BP surge (MBPS). However, there are no data available regarding how long after cessation of IRT these effects are maintained. Therefore, the purpose of this study was to determine the effects of 8 weeks of detraining on resting BP, ambulatory BP and MBPS following 8 weeks of IRT in a population of young normotensive individuals and to further substantiate previously reported reductions in MBPS following IRT. Twenty-five apparently healthy participants with resting BP within the normal range (16 men, age = 23 ± 6 years; 9 women, age = 22 ± 4 years, resting BP: 123 ± 5/69 ± 7 mmHg) were randomly assigned to a training-detraining (TRA-DT, n = 13) or control (CON, n = 12) group. Resting BP, ambulatory BP and MBPS were measured prior to, after 8 weeks of bilateral leg IRT using an isokinetic dynamometer (4 × 2-min contractions at 20% MVC with 2-min rest periods, 3 days/week) and following an 8-week detraining period. There were significant reductions in 24-h ambulatory systolic BP (SBP) and calculated SBP average real variability (ARV) following IRT that were maintained after detraining (pre-to-post detraining, −6 ± 4 mmHg, p = 0.008, −2 ± 1.5 mmHg, p = 0.001). Similarly, the training-induced decreases in daytime SBP and daytime SBP ARV (pre-to-post detraining, −5 ± 6 mmHg, p = 0.001; −2 ± 1.2 mmHg, p = 0.001, respectively), MBPS (pre-to-post detraining, −6 ± 9 mmHg, p = 0.046) and resting SBP (pre-to-post detraining, −4 ± 6 mmHg, p = 0.044) were preserved. There were no changes in night-time or night-time SBP ARV across all time points (pre-to-post detraining, −1 ± 8 mmHg, p = 1.00, −0.7 ± 2.9 mmHg, p = 1.00). These results confirm that IRT causes significant reductions in resting BP, ambulatory BP, ambulatory ARV and MBPS. Importantly, the changes remained significantly lower than baseline for 8 weeks after cessation of training, suggesting a sustained effect of IRT.

Effects of a single beach tennis session on short-term blood pressure variability in individuals with hypertension: a randomized crossover trial.

Despite the importance of blood pressure (BP) variability to estimate cardiovascular risk in patients with hypertension, not all exercise modalities can reduce short-term BP variability, and no studies have measured the acute effects of recreational sports on short-term BP variability. We investigated the acute effects of a single beach tennis (BT) session on short-term BP variability in individuals with hypertension. Twenty-two participants took part in this randomized clinical trial. They were randomly allocated to a BT session and a nonexercise control session (Con). BT and Con sessions lasted 45 min. Office BP and heart rate were measured throughout the experimental sessions to calculate rate-pressure products and estimate the cardiovascular demand of BT. To determine short-term BP variability after BT and Con sessions, average real variability (ARV) of systolic BP and diastolic BP was assessed over 24 h using ambulatory BP monitoring. Compared with Con, there were lower 24-h (Δ, -0.9 ± 0.4 mmHg; P = 0.049) and daytime (Δ, -1.4 ± 0.5 mmHg; P = 0.004) ARV of diastolic BP after BT. There were no significant differences in ARV of systolic BP between Con and BT. There was a higher rate-pressure product found during BT (P < 0.001). However, after the experimental sessions, there was no significant difference between BT and Con for the rate-pressure product under ambulatory conditions. In conclusion, a single BT session reduced daytime and 24-h diastolic BP variability in adults with hypertension. Trial registration: ClinicalTrials.gov, NCT03909308.

Relationship between year-to-year blood pressure variability and target organ damage in the general population

Abstract Background/Introduction Visit-to-visit blood pressure variability (BPV) is a strong predictor of cardiovascular events as well as target organ damage (TOD) in hypertension. However, effects of year-to-year BPV on the development of TOD have not been investigated in the general population. Purpose The present study was designed to investigate a possible relationship between year-to-year BPV and TOD in the general population. Methods Consecutive 5542 subjects (male=3771, 58.6±10.7 yea-old) who visited our hospital for an annual physical check-up for 5 years in a row during 2008 and 2013 were enrolled. The average, standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic blood pressure (SBP) were calculated using data during the period. Other baseline data were obtained in 2013; left ventricular hypertrophy (LVH; Sokolow-Lyon voltage &amp;gt;3.8 mV and/or Cornell product &amp;gt;2440 mm ms) and kidney impairment (estimated glomerular filtration rate; eGFR&amp;lt;60) were taken as TOD. Then, subjects without TOD at baseline (2013) (n=3801, male=2584, 57.4±10.4 yea-old) were followed up until 2019 (median = 5 years) and the impact of BPV on the development of TOD was investigated. Results The average, SD, CV and ARV of SBP were 123.8 mmHg, 8.04 mmHg, 6.50%, and 9.19 mmHg, respectively. At baseline, these parameters were higher in subjects with TOD than those without TOD (Table 1-A). During the follow-up of subjects without TOD at baseline, LVH and kidney impairment developed in 425 and 623 subjects (24.7 and 35.8 per 1000 person-year), respectively. In retrospective analysis, the average, SD, and ARV were higher in subjects with than without future TOD (Table 1-B). Although some indices of year-to-year BPV predicted future development of TOD in univariate Cox-hazard analysis, only the average of SBP predicted incident TOD after adjustment. Conclusions Year-to-year BPV is a marker of the incident TOD in the general population. However, these indices do not independently predict the onset of TOD and, thus, there may be unknown pathway that links TOD and BPV. Funding Acknowledgement Type of funding sources: None. Table 1. BP variability and TODTable 2. Cox-hazard analyses

Reproducibility of nighttime home blood pressure measured by a wrist-type nocturnal home blood pressure monitoring device.

The authors investigated the reproducibility of nighttime home blood pressure (BP) measured by a wrist‐type BP monitoring device. Forty‐six hypertensive patients (mean 69.0±11.6 years, 56.5% male) self‐measured their nighttime BP hourly using simultaneously worn wrist‐type and upper arm‐type nocturnal home BP monitoring devices at home on two consecutive nights. Using the average 7.4±1.3 measurements on the first night and the average 7.0 ± 1.8 measurements on the second night, the authors assessed the reliability and the reproducibility of nighttime BP measured on the two nights. The difference between nights in systolic BP (SBP) measured by the wrist‐device was not significant (1.6±7.0 mmHg, p = .124), while the difference in diastolic BP (DBP) was marginally significant (1.4±4.9 mmHg, p = .050). The intraclass correlation coefficients (ICCs) for agreement between nights were high both in SBP and DBP average (SBP: 0.835, DBP: 0.804). Averaging only three points of SBP resulted in lower ICC values, but still indicated good correlations (ICC > 0.6). On the other hand, the correlations of the standard deviation and average real variability of SBP between nights were low, with ICCs of 0.220 and 0.436, respectively. In conclusion, the average SBP values measured on the first night were reliable even when averaging only three readings. The reproducibility of nighttime BP variability seemed inferior to that of BP average; it might be better to measure nighttime BP over multiple nights to assess BP variability. However, this hypothesis needs verification in other study population. In addition, our study population had well‐controlled BP, which limits the generalizability of this findings to all hypertensive patients.

Effectiveness of statin intensive therapy in type 2 diabetes mellitus with high visit-to-visit blood pressure variability.

Intensive lipid-lowering therapy is recommended in type 2 diabetes mellitus (T2DM) patients with target organ damage. However, the evidence is insufficient to stratify the patients who will benefit from the intensive therapy among them. High visit-to-visit variability in systolic blood pressure (SBP) is associated with increased risk of cardiovascular events. We investigated the effectiveness of intensive versus standard statin therapy in the primary prevention of cardiovascular events among T2DM patients with retinopathy stratified by visit-to-visit SBP variability. The standard versus intensive statin therapy for hypercholesterolemic patients with diabetic retinopathy study was the first trial comparing statin intensive therapy targeting low-density lipoprotein cholesterol (LDL-C) <70 mg/dl and standard therapy targeting LDL-C ≥100 to <120 mg/dl in T2DM patients with retinopathy without known cardiovascular disease. Using this dataset, we divided the patients into two subpopulations based on standard deviation (SD) and average real variability (ARV) of clinic SBP within the initial 6 months. In a total of 4899 patients, 240 composite cardiovascular events were observed during a median follow-up of 37.3 months. In multivariable-adjusted model comparing intensive versus standard therapy, the hazard ratios for composite cardiovascular events were 0.64 (95% CI 0.45-0.90) and 1.21 (95% CI 0.82-1.80) in patients with high and low SBP variability as defined by SD, respectively. Interaction between SBP variability and statin therapy was significant (P = 0.018). The analysis using ARV of SBP showed similar results. Statin intensive therapy targeting LDL-C <70 mg/dl had benefits in primary prevention of cardiovascular events compared with standard therapy among T2DM patients with retinopathy having high, but not low, visit-to-visit SBP variability.

Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study

ObjectiveThis study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs).DesignProspective cohort study.SettingThe average real...

Comparison of Blood Pressure Variability Between Losartan and Amlodipine in Essential Hypertension (COMPAS-BPV)

Antihypertensive therapy using renin-angiotensin system blockers and calcium channel blockers to target blood pressure variability (BPV) has not yet been established. We aimed to compare the ability of losartan and amlodipine to lower BPV and systolic blood pressure (SBP) in essential hypertensive patients. Patients were randomly assigned either losartan 50 mg or amlodipine 5 mg. Medications were uptitrated and hydrochlorothiazide was added according to protocol for 6 months. The primary endpoint was the office visit-to-visit SD of SBP. The secondary endpoints included average real variability (ARV), office SBP, and home SBP. The losartan group (n = 71) and amlodipine group (n = 73) finished the scheduled visits between April 2013 and May 2017. The office visit-to-visit SD of SBP was comparable between the losartan and amlodipine groups (11.0 ± 4.2 vs. 10.5 ± 3.8, P = 0.468). The office visit-to-visit ARV of SBP was significantly elevated in the losartan group (10.6 ± 4.3 vs. 9.1 ± 3.4, P = 0.02). The absolute SBP decrement from baseline to 6 months was similar between groups, although the office mean SBP at 6 months was higher in the losartan group (132.3 ± 12.9 vs. 127.5 ± 9.0 mm Hg, P = 0.011). In home blood pressure analysis, evening day-to-day BPV indexes (SD and ARV) were significantly higher in the losartan group at 6 months. The lowering effect of the office visit-to-visit SD of SBP was similar between losartan and amlodipine. However, the losartan group showed a higher office visit-to-visit ARV of SBP and evening day-to-day home BPV indexes. Therefore, amlodipine may be better to lower BPV in essential hypertensive patients.

Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke

Background and purpose—Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of BPV on a 3-month functional outcome in patients with acute ischemic stroke or TIA. Methods—In this prospective observational study, a consecutive series of 400 patients were enrolled with acute ischemic stroke or TIA within 7 days. All patients were referred and monitored for BP at 2-hour intervals in the first 24 hours. Afterward, the BP was recorded every four hours up to the 7th day, with 1-hour deviation the daytime and 2 hours at night. All BP results were recorded into an electronic medical record (EMR) system. Average real variability (ARV) was used to analyze the blood pressure variability (BPV). All patients were followed up as planned for 90 days. The primary outcome was evaluated by the modified Rankin Scale (mRS); an unfavorable outcome was mRS≥2. For comparison, patients were respectively divided into two groups based on systolic blood pressure ARV (SBP ARV) or diastolic blood pressure ARV (DBP ARV). A multivariate logistic regression model was used to estimate the effect of between ARV BPV on functional outcomes. Results—Among the 400 patients, 46 (11.4%) had an unfavorable outcome (mRS>2) at 90 days. Their mean 24h DBP ARV was significantly higher than others (10.42±3.63 vs. 9.83±4.27 mm Hg; p=0.03). The high 24hDBPARV was defined above the median of 7.75 mmHg, which was statistically associated with an unfavorable outcome (64.7% vs. 35.3%; P=0.004). Further stepwise logistic regression analysis indicated that 24h high DBPARV was the independent predictor of an unfavorable outcome (adjusted OR 2.44%, 95% confidence interval: 1.24-4.74, P<0.01). Conclusions—High DBPARV during the acute phase is an independent and significant predictor of 90-day functional outcome for ischemic stroke or TIA.

Abstract P2052: Differential Association of Measures of Adiposity With 24-Hour Ambulatory Blood Pressure Control in Adults on Antihypertensive Monotherapy

Background: Regional measures of adipose distribution, such as visceral adiposity and waist circumference, are more strongly associated with metabolic activity of adipose tissue and longitudinal cardiovascular risk than broader metrics, such as body mass index (BMI) and total fat mass. Little is known about the differential relationship of BMI, waist circumference, visceral adiposity, and total fat mass with degree of blood pressure (BP) control on 24-hour ambulatory BP monitoring (ABPM) in adults with hypertension (HTN). Methods: We performed 24-hour ABPM in adults recruited from primary care clinics with a diagnosis of HTN on a stable dose of a single antihypertensive agent. Dual x-ray absorptiometry (DXA) was performed to determine visceral adiposity and total fat mass (indexed by height). Results: Of the 97 participants, mean age was 56 (+/- 13) years, with 56 (58%) women, 46 (47%) black, 28 (29%) with diabetes, and 13 (13%) smokers. Mean BMI was 31.7 (+/- 7.2) kg/m 2 and mean waist circumference was 104 (+/- 17) cm. Mean 24-hour systolic BP (SBP) was 135 (+/- 13) mmHg, mean 24-hour SBP average real variability (ARV) was 13 (+/- 3), 47 (48%) were non-dippers, 26 (27%) had masked HTN, and 21 (22%) had uncontrolled HTN. After adjusting for age, sex, race, and antihypertensive class, the highest quartiles of waist circumference and visceral adiposity were associated with higher 24-hour mean SBP (waist circumference β = 9.5, 95% CI 1.9-17.2; visceral adiposity β = 8.6, 95% CI 0.5-16.8) and SBP ARV (waist circumference β = 2.8, 95% CI 1.0 to 4.6; visceral adiposity β = 2.9, 95% CI 1.1 to 4.7) compared to the lowest quartiles; BMI and total fat mass were not associated with these ABPM parameters. Individuals in the highest quartile of visceral adiposity had a 6.3-fold greater odds (95% CI 1.2-33.1) of masked HTN compared to the lowest quartile; no other adiposity measures were associated with masked HTN. Conclusions: Elevated visceral adiposity is associated with high 24-hour SBP and SBP variability in individuals with HTN. Unlike other measures of adiposity, higher visceral adiposity is strongly linked with masked hypertension. Measurement of visceral adiposity may help to identify those individuals who would benefit most from 24-hour ABPM to screen for masked hypertension.

Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke

Background and purpose-Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of BPV on a 3-month functional outcome in patients with acute ischemic stroke or TIA. Methods—In this prospective observational study, a consecutive series of 400 patients were enrolled with acute ischemic stroke or TIA within 7 days. All patients were referred and monitored for BP at 2-hour intervals in the first 24 hours. Afterward, the BP was recorded every four hours up to the 7th day, with 1-hour deviation the daytime and 2 hours at night. All BP results were recorded into an electronic medical record (EMR) system. Average real variability (ARV) was used to analyze the blood pressure variability (BPV). All patients were followed up as planned for 90 days. The primary outcome was evaluated by the modified Rankin Scale (mRS); an unfavorable outcome was mRS≥2. For comparison, patients were respectively divided into two groups based on systolic blood pressure ARV (SBP ARV) or diastolic blood pressure ARV (DBP ARV). A multivariate logistic regression model was used to estimate the effect of between ARV BPV on functional outcomes. Results-Among the 400 patients, 46 (11.4%) had an unfavorable outcome (mRS&gt;2) at 90 days. Their mean 24h DBP ARV was significantly higher than others (10.42±3.63 vs. 9.83±4.27 mm Hg; p=0.03). The high 24hDBPARV was defined above the median of 7.75 mmHg, which was statistically associated with an unfavorable outcome (64.7% vs. 35.3%; P=0.004). Further stepwise logistic regression analysis indicated that 24h high DBPARV was the independent predictor of an unfavorable outcome (adjusted OR 2.44%, 95% confidence interval: 1.24-4.74, P&lt;0.01). Conclusions—High DBPARV during the acute phase is an independent and significant predictor of 90-day functional outcome for ischemic stroke or TIA.

High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease.

Few studies focused on the intraoperative blood pressure in Moyamoya disease (MMD) patients. We aimed to clarify whether or not it relates to early cerebral infarction after revascularization. We reviewed a retrospective cohort of Moyamoya disease from 2011 to 2018 in Beijing Tiantan Hospital, and patients with radiologically confirmed early postoperative infarction were included in the analysis. Controls were matched based on age, sex, and revascularization modality at a ratio of 1:5. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. A total of 52 patients out of 1497 revascularization surgeries (3.5%) who experienced CT or MRI confirmed early postoperatively cerebral infarction, aged 38.46 ± 11.70; 26 were male (50.0%). Average real variability (ARV)-systolic blood pressure (SBP) (OR 3.29, p = 0.003), ARV-diastolic blood pressure (DBP) (OR 4.10, p = 0.005), ARV-mean arterial pressure (MAP) (OR 4.08, p = 0.004), and the maximum drops of DBP (OR 1.08, p = 0.003) and MAP (OR 1.06, p = 0.004) were associated with early postoperative infarction. In patients who experienced massive cerebral infarction, the maximum drops of DBP (OR 1.11, p = 0.004) and MAP (OR 1.11, p = 0.003) are independent risk factors, whereas ARVs of SBP (OR 3.90, p < 0.001), DBP (OR 4.69, p = 0.008), and MAP (OR 4.72, p = 0.003) are significantly associated with regional infarction. High variance of intraoperative blood pressure and drastic blood pressure decline are independent risk factors for postoperative infarction in MMD patients who underwent revascularization surgery. Maintaining stable intraoperative blood pressure is suggested to prevent early postoperative cerebral infarction in MMD patients.

Impact of body mass index on long-term blood pressure variability: a cross-sectional study in a cohort of Chinese adults

BackgroundObesity and overweight are related to changes in blood pressure, but existing research has mainly focused on the impact of body mass index (BMI) on short-term blood pressure variability (BPV). The study aimed to examine the impact of BMI on long-term BPV.MethodsParticipants in the Kailuan study who attended all five annual physical examinations in 2006, 2008, 2010, 2012, and 2014 were selected as observation subjects. In total, 32,482 cases were included in the statistical analysis. According to the definition of obesity in China, BMI was divided into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24.0 ≤ BMI < 28.0 kg/m2), and obese (BMI ≥ 28.0 kg/m2). We used average real variability to evaluate long-term systolic BPV. The average real variability of systolic blood pressure (ARVSBP) was calculated as (|sbp2 − sbp1| + |sbp3 − sbp2 | + |sbp4 − sbp3| + |sbp5 − sbp4|)/4. Differences in ARVSBP by BMI group were analyzed using analysis of variance. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of BMI on ARVSBP.ResultsParticipants’ average age was 46.6 ± 11.3 years, 24,502 were men, and 7980 were women. As BMI increases, the mean value of ARVSBP gradually increases. After adjusting for other confounding factors, stepwise multivariate linear regression analysis showed that ARVSBP increased by 0.077 for every one-unit increase in BMI. Multiple logistic regression analysis indicated that being obese or overweight, compared with being normal-weight, were risk factors for an increase in ARVSBP. The corresponding odds ratios of being obese or overweight were 1.23 (1.15–1.37) and 1.10 (1.04–1.15), respectively.ConclusionsThere was a positive correlation between BMI and ARVSBP, with ARVSBP increasing with a rise in BMI. BMI is a risk factor for an increase in ARVSBP.Trial registrationRegistration No.: CHiCTR-TNC1100 1489; Registration Date: June 01, 2006.

Abstract P233: Blood Pressure Variability and Rhythmicity in Adolescents With Spurious Hypertension

Objective: Spurious hypertension (sHTN) is characterized by elevated systolic blood pressure (BP) in peripheral arteries but normal central BP. The BP variability and characteristics of BP rhythms in sHTN is unknown. We therefore analyzed BP variability and rhythmicity in adolescents with sHTN in comparison with other forms of hypertension (HTN). Patients and Methods: We studied 265 children (54 girls; 15.1 ±2.5 years) referred with arterial HTN, in whom secondary HTN was excluded. We assessed BP levels - office BP, ABPM, central systolic BP (cSBP), systolic BP average real variability (SBPARV) and mean MAP rhythmicity (amplitudes and acrophases). Anova with TukeyHSD post hoc test was used to compare groups. One tailed t-test was used to compare MAP amplitudes and acrophases with normative values for children with Bonferroni correction for multiple tests. Results: 115 subjects had white coat hypertension (WCH; office BP&gt;95 th perc+ABPM&lt;95 th perc), 25 had ambulatory prehypertension (preHTN; office BP&lt;95 th perc+ABPM&lt;95 th perc+ABPM load &gt;25%), 43 had sHTN (office BP+ABPM &gt;95th perc+cSBP&lt;95 th perc), 82 had true hypertension (tHTN; office BP+ABPM+cSBP &gt;95th perc. There were no significant differences between groups in age, weight and BMI. The median SBPARV was 8.87 in WCH, 8.63 in preHTN, 9.25 in sHTN and 9.28 in tHTN (not significantly different between groups). The prevalence of 24h rhythms ranged from 77 to 88%, not significantly from norms or among groups. The prevalence of 12h rhythms was not significantly different compared to norms and ranged from 50 to 60% (NS among groups). There were also no significant differences in the prevalence of 8h and 6h rhythms. All groups had significantly decreased 24h amplitudes compared to norms, but not significantly different among groups. There were no differences in 12h, 8h and 6 amplitudes between WCH, preHTN, sHTH, tHTN and norms. 24h acrophases were significantly prolonged in sHTN, 12h acrophases were significantly prolonged in preHTN, sHTN and tHTN. Conclusions: Adolescents with spurious hypertension have significantly lower prevalence of 24h rhythms, decreased 24h amplitudes and prolonged 24h and 12h acrophases suggesting increased sympathetic drive similarly to patients with other hypertensive phenotypes.

PS 17-51 VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES PATIENTS IN GHANA

Objective: Visit-to-visit blood pressure (BP) variability is an important predictor cardiovascular diseases. In this study, we investigated association between visit-to-visit BP variability and chronic kidney disease (CKD) in type 2 diabetes (T2DM) patients in Ghana. Design and method: An average of 6 BP measurements from 282 T2DM patients, measured within the previous 3 years, were used to compute BP variability as standard deviation (SD), coefficient of variation (CV) and average real variability (ARV) of systolic BP (SBP). Serum creatinine was used to estimate glomerular filtration rate (eGFR) using CKD-EPI algorithm. CKD was defined as eGFR < 60 ml/min/1.73m2. Results: The prevalence of CKD in our study population was 20.8%. CKD patients had higher maximum SBP (160 ± 20 vs 147 ± 23 mmHg, p = 0.028), SD of SBP (11 ± 4 vs 15 ± 7 mmHg, p = 0.016), CV of SBP (0.16 ± 0.04 vs 0.1 ± 0.02, p = 0.002) and ARV of SBP (19 ± 8 vs 14 ± 6 mmHg, p = 0.041). In multivariable logistic regression model, maximum SBP [OR (95% CI), 1.68 (1.12 – 3.1), p = 0.037], SD of SBP [1.21 (1.08 – 2.54), p = 0.031] and CV of SBP [1.31 (1.04 – 3.43), p = 0.023] were independently associated with CKD. ARV of SBP was not associated with CKD [1.48 (0.89 – 4.01), p = 0.11]. Conclusions: Visit-to-visit BP variability may be an independent determinant of CKD in T2DM patients in our study population.

The association of reduced lung function with blood pressure variability in African Americans: data from the Jackson Heart Study.

BackgroundAfrican Americans (AAs) have lower lung function, higher blood pressure variability (BPV) and increased risk for hypertension and cardiovascular disease (CVD) compared with whites. The mechanism through which reduced lung-function is associated with increased CVD risk is unclear.MethodsWe evaluated the association between percent predicted lung-function and 24-hour BPV in 1008 AAs enrolled in the Jackson Heart Study who underwent ambulatory blood pressure (BP) monitoring. Lung-function was assessed as forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and the ratio of FEV1-to-FVC during a pulmonary function test using a dry rolling sealed spirometer and grouped into gender-specific quartiles. The pairwise associations of these three lung-function measures with two measures of 24-hour BPV, (1) day-night standard deviation (SDdn) and (2) average real variability (ARV) were examined for systolic BP (SBP) and, separately, diastolic BP (DBP).ResultsSDdn of SBP was not associated with FEV1 (mean ± standard deviation from lowest-to-highest quartile: 9.5 ± 2.5, 9.4 ± 2.4, 9.1 ± 2.3, 9.3 ± 2.6; p-trend = 0.111). After age and sex adjustment, the difference in SDdn of SBP was 0.0 (95 % CI −0.4,0.4), −0.4 (95 % CI −0.8,0.1) and −0.3 (95 % CI −0.7,0.1) in the three progressively higher versus lowest quartiles of FEV1 (p-trend = 0.041). Differences in SDdn of SBP across FEV1 quartiles were not statistically significant after further multivariable adjustment. After multivariable adjustment, no association was present between FEV1 and ARV of SBP or SDdn and ARV of DBP or when evaluating the association of FVC and FEV1-to-FVC with 24-hour BPV.ConclusionLung-function was not associated with increased 24-hour BPV.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0182-2) contains supplementary material, which is available to authorized users.