Average Real Variability Research Articles

Glycohemoglobin Variations and Long-term Risk of Incident Heart Failure in Patients With Type 2 Diabetes.

Glycohemoglobin Variations and Long-term Risk of Incident Heart Failure in Patients With Type 2 Diabetes.

Semiquantitative 131I MIBG Scintigraphy Predicts Intraoperative Blood Pressure Fluctuation in Patients Undergoing Surgery for Pheochromocytoma and Paraganglioma.

Severe blood pressure (BP) fluctuation happens during surgery for pheochromocytoma and paraganglioma (PPGL) due to the release of catecholamines. 131I MIBG scintigraphy indicates the capacity of PPGL to retake and reserve catecholamines. This study aims to utilize 131I MIBG scintigraphy to predict intraoperative BP fluctuation in patients undergoing PPGL surgery, thereby guiding preoperative preparation. This study included 159 patients receiving 131I MIBG scintigraphy before surgery for PPGL. Uptake of 131I MIBG was assessed with an MIBG score ranging from 2 to 8. Factors that may be related to hemodynamic stability were collected. BP fluctuation was evaluated by systolic blood pressure average real variability (SBP ARV) and mean arterial pressure average real variability (MAP ARV). One hundred fifty-nine consecutive patients with PPGL were included in this study. Patients with an MIBG score of 2 (10.3±4.6mmHg) had lower SBP ARV than patients with a score of 5 (14.9±5.6mmHg, p=0.012), score of 7 (13.8±5.0mmHg, p=0.013) and score of 8 (14.7±7.3mmHg, p=0.007). Patients with 131I MIBG score of 2 (7.6±3.2mmHg) also had a lower MAP ARV than patients with a score of 5 (10.3±4.3mmHg, p=0.045) and a score of 8 (9.8±4.5mmHg, p=0.029). In multiple linear regression analyses, MIBG score (p=0.010), metanephrine (p=0.014), and maximum preoperative blood pressure (p=0.021) were correlated with SBP ARV. Preoperative 131I MIBG scintigraphy is associated with intraoperative BP fluctuation in patients with PPGL. Metanephrine, maximum preoperative blood pressure, and 131I MIBG scintigraphy can predict intraoperative BP fluctuation independently. Personalized preoperative management can be offered to patients based on these assessments.

Hypoxia disrupts neurovascular regulation of blood pressure in normotensive and untreated hypertensive men.

Hypoxia is a common feature of arterial hypertension that does not consistently elevate blood pressure (BP), but triggers exaggerated increases in muscle sympathetic nerve activity (MSNA) and may disturb sympathetic transduction and baroreflex sensitivity in hypertensive individuals. Elevated resting MSNA, enhanced sympathetic transduction, and reduced baroreflex sensitivity are all associated with increased blood pressure variability (BPV), a marker of target organ damage independent of absolute BP levels. We hypothesized that hypoxia would elicit greater BPV in hypertensive individualscompared to normotensive controls METHODS: Nine young- to middle-aged men with untreated stage 1-2 hypertension (HT) and normotensive controls (NT) were exposed to normoxia (21% O2) and isocapnic hypoxia (IH, 10% O2). During both conditions, oxygen saturation, beat-to-beat BP, MSNA, and end-tidal CO2 (PetCO2) were continuously monitored, with PetCO2 clamped. BPV was quantified using standard deviation, coefficient of variation, and average real variability for systolic (SBP), diastolic (DBP), and mean BP (MBP). Sympathetic transduction was assessed using a time-domain signal averaging technique. Cardiac baroreflex sensitivity (cBRS) was evaluated using the sequence method, and sympathetic baroreflex sensitivity (sBRS) was calculated via MSNA-DBP regression RESULTS: IH induced comparable oxygen desaturation in both groups (NT: -25.7 ± 3.3% vs. HT: -21.2 ± 4.0%, p > 0.05). Although BP and PetCO2 remained unchanged, MSNA responses were significantly greater in HT (NT: +8 ± 2 vs. HT: +12 ± 2 bursts/min, p = 0.03). IH increased all indices of BPV and sympathetic transduction, while both cBRS and sBRS were similarly impaired in the two groups. In conclusion, IH similarly exacerbates BPV and disrupts sympathetic transduction and baroreflex function in normotensive and untreated hypertensive men, despite greater MSNA reactivity in the hypertensive group.

Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study.

Abnormal exercise blood pressure (BP) responses are associated with hypertension and cardiovascular disease, but their relationship with home BP over a mid- to long-term time span is unknown. At an FHS (Framingham Heart Study) research examination (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing with BP measured every 2 minutes. At the same exam, English-speaking participants enrolled in the electronic FHS with an iPhone were provided with a digital BP cuff to measure home BP weekly for 1 year. Linear regression models examined associations of exercise BP with average home systolic BP (SBP), home-based hypertension, and week-to-week average real variability of home SBP, over 1-year follow-up. Participants with <3 weeks of BP return were excluded. Among 808 participants (mean age, 53 years; 58% women; 92% White individuals; 47% hypertension), higher exercise BP responses (peak SBP, SBP at 75 W, SBP/workload slope, peak diastolic BP, and diastolic BP at 75 W) were associated with higher average home SBP. Higher peak diastolic BP was associated with a greater risk for home hypertension. Additionally, higher SBP/workload slope and peak diastolic BP were associated with elevated average real variability of home SBP only in participants without antihypertensive use. Higher exercise BP responses were associated with higher average home-based BP, greater home-based hypertension risk, and increased home-based BP variability over a mid- to long-term time span. However, these associations may vary by antihypertensive medication use. Exercise BP may play an important role in hypertension prevention and treatment.

Association of long-term insulin variability before the onset of diabetes with cardiovascular outcomes in later life: Findings from the coronary artery risk development in young adults (CARDIA) study.

Association of long-term insulin variability before the onset of diabetes with cardiovascular outcomes in later life: Findings from the coronary artery risk development in young adults (CARDIA) study.

Blood Pressure Variability and Risk of Cardiovascular Events and Mortality in Real-World Clinical Settings.

The real-world applicability of long-term blood pressure (BP) variability measurements remains underexplored. We evaluated the association between visit-to-visit BP variability and the risk of cardiovascular events and all-cause mortality using electronic health records. In this retrospective cohort study at a large academic medical center in Taiwan, we calculated the variability independent of the mean (VIM) and average real variability of BP using electronic health records of 16 945 adults with at least one outpatient BP measurement in any 3 consecutive years from 2012 to 2017. We used Cox proportional hazards models to assess associations between BP variability and cardiovascular events, including cardiovascular deaths, and all-cause mortality through 2020. Over a median follow-up of 4 years, 317 patients experienced cardiovascular events, and 582 died. Adjusted hazard ratios (HRs) for cardiovascular events increased gradually across both VIM and average real variability quartiles of BP. The adjusted HRs (95% CIs) per interquartile range increase in systolic BP variability was 1.24 (1.09-1.41) for VIM and 1.11 (1.01-1.23) for average real variability. For diastolic BP, the HRs (95% CIs) were 1.22 (1.09-1.36) and 1.13 (1.02-1.24), respectively. Similar results were observed for all-cause mortality except a weaker association with average real variability of diastolic BP (HR, 1.08 [95% CI, 0.99-1.17]). The association between VIM of BP and risk of cardiovascular events was consistent across patient subgroups. In the electronic health records analysis, visit-to-visit BP variability was independently associated with the risk of cardiovascular events and all-cause mortality. Our findings indicate the applicability of BP variability indices in real-world health care settings.

The impact of short-term blood pressure variability on cognitive decline in Parkinson's disease patients without co-morbidities.

Cardiovascular dysautonomia, cognitive decline and dementia are common non-motor features of Parkinson's disease. Short-term blood pressure variability may play a role in the pathogenesis of dementia. Sixty five patients with Parkinson's disease, without cardiovascular comorbidities, with no concomitant medications affecting cardiovascular system were enrolled in this cross-sectional study. They were divided according to their cognitive status and underwent clinical examination, 24h ambulatory blood pressure monitoring, orthostatic test, brain magnetic resonance imaging and laboratory tests. Twenty patients were cognitively intact, 23 presented mild cognitive impairment and 20 had dementia. There were no differences in duration of the disease or dopaminergic therapy between the groups. Patients with dementia when compared to those cognitively intact, had higher short-term blood pressure variability, assessed as standard deviation of daytime diastolic blood pressure and average real variability of systolic blood pressure. They also had a higher frequency of supine hypertension and lower nocturnal blood pressure fall (reverse dipping). Average real variability of systolic blood pressure, supine hypertension and reverse dipping correlated with cognitive impairment, especially with visuospatial, language and executive functions. Short-term blood pressure variability, supine hypertension and reverse dipping may contribute to the pathogenesis of dementia in PD.

Stenotic Lesions of the Intracranial Arteries in Relation to the Average Level and Variability of the Home Blood Pressure: A Cross-Sectional Study.

Stenotic Lesions of the Intracranial Arteries in Relation to the Average Level and Variability of the Home Blood Pressure: A Cross-Sectional Study.

Impact of HbA1c variability and time-in-range fluctuations on large and small nerve fiber dysfunction in well-controlled type 2 diabetes: A prospective cohort observational study.

Glycemic variability (GV) is a critical factor in the development of diabetic sensorimotor polyneuropathy (DSPN). This study aimed to evaluate the association of long-term GV, measured by glycated hemoglobin (HbA1c) average real variability (ARV), and short-term GV, assessed by time-in-range (TIR) ARV, with large and small nerve fiber dysfunction in individuals with well-controlled Type 2 Diabetes (T2D). A prospective study conducted at a tertiary hospital in Taiwan included 82 T2D participants. Long-term GV was assessed using HbA1c ARV from visit-to-visit measurements at three-month intervals over 1 year. Short-term GV was evaluated as TIR ARV from seven-day fingerstick data collected quarterly. Large and small nerve functions were assessed using the Toronto Clinical Neuropathy Score (TCNS), nerve conduction studies, quantitative thermal testing, and Sudoscan. Linear regression analysis adjusted for age, diabetes duration, and renal function revealed strong correlations between HbA1c ARV, TIR ARV, and diabetes duration. At baseline, high HbA1c ARV and TIR ARV groups exhibited higher TCNS and composite nerve conduction amplitude scores but lower cold detection thresholds compared to the low median groups. At one-year follow-up, TCNS significantly increased in the high HbA1c ARV (P = 0.001) and TIR ARV (P = 0.003) groups compared to the low median groups. Both long-term and short-term GV significantly contribute to small and large nerve fiber dysfunction in T2D, yielding similar neurological outcomes despite stable mean glucose levels. Combining GV minimization strategies with standard glycemic control may be essential in reducing DSPN risk.

Association between 24-hour blood pressure variability and mortality in acute ischemic stroke patients admitted in intensive care units: a MIMIC-IV study

Introduction Acute ischaemic stroke (AIS) patients in the intensive care unit (ICU) face high mortality. This study examined the association between systolic blood pressure variability (SBPV), specifically average real variability (SBP-ARV), and short-term mortality in critically ill AIS patients. Methods We conducted a retrospective cohort study using the MIMIC-IV database. The primary outcomes were 28-day and 90-day all-cause mortality. Cox regression, Kaplan-Meier curves, restricted cubic spline (RCS) models, and subgroup analyses were used to assess associations. Results A total of 861 AIS patients were included. The 28-day and 90-day mortality rates were 20.9% and 23.3%, respectively. Higher SBP-ARV was independently associated with increased mortality. Compared with the lowest tertile, the highest tertile of SBP-ARV had significantly increased 28-day mortality (HR: 1.53; 95% CI: 1.03–2.27; p = 0.035). SBP-ARV as a continuous variable was also significantly associated with 28-day and 90-day mortality. RCS analysis showed that mortality risk increased when SBP-ARV exceeded 11.63. Conclusion Our findings suggest that elevated systolic blood pressure variability, particularly higher SBP-ARV within the first 24 h of ICU admission, is significantly associated with increased 28-day and 90-day mortality in AIS patients. SBP-ARV may serve as a valuable prognostic marker for risk stratification and early clinical intervention in critically ill stroke patients.

Autonomic Function in Normotensive Adults with Obesity

Introduction: Obesity can be associated with hypertension (HTN), which is a major risk factor for cardiovascular disease. Impaired autonomic function: an attenuated baroreflex sensitivity (BRS), which leads to a diminished ability to modulate blood pressure [i.e., augmented blood pressure (BP) variability (BPV)] and elevated muscle sympathetic nerve activity (MSNA), has been demonstrated in adults with HTN, but whether normotensive adults with obesity exhibit impaired autonomic function, is equivocal. We tested the hypothesis that BPV, MSNA and BRS will be impaired in normotensive adults with obesity (Ob) compared with adults without obesity (NOb). Methods: Thirty-five participants (Ob: n=5f/11m; NOb: n=13f/6m) underwent assessments of resting beat-to-beat BP, heart rate (HR), and microneurography of the fibular or radial nerve to measure MSNA for 5-10 min in the supine position. Females were assessed in the early follicular phase or placebo phase with oral contraceptives (n=5) of their menstrual cycle. Average real variability (ARV) as a novel index of short-term BPV was calculated for BP variables. MSNA was quantified as burst frequency (BF; bursts/min) and burst incidence (BI; bursts/100 heartbeats, Hb). Cardiac BRS (cBRS; Ob; n=15, NOb; n=19) was quantified to determine the slope of the relationship between systolic BP and R-R intervals. Sympathetic BRS (sBRS; Ob; n=13, NOb; n=15) was quantified as the slope of the relationship between diastolic BP and MSNA. Results: The Ob group had an elevated body mass index (Ob: 31.7±1.9 vs. NOb: 23.2±1.5 kg/m2, p &lt;0.001), but was similar in age (Ob: 29±6 vs. NOb: 33±9 yrs, p =0.21) to the NOb group. Both groups had similar levels of systolic BP (Ob: 115±11 vs. NOb: 111±9 mmHg, p =0.23), diastolic BP (Ob: 71±5 vs. NOb: 71±8 mmHg, p =0.82) and HR (Ob: 60±8 vs. NOb: 61±9 b/min, p =0.28). ARV was similar between groups for systolic BP (Ob: 1.7±0.4 vs. NOb: 1.6±0.4 mmHg, p =0.42) and diastolic BP (Ob: 1.5±0.8 vs. NOb: 1.2±1.1 mmHg, p =0.45). MSNA BF (Ob: 17±7 vs. NOb: 18±6 bursts/min, p=0.59), MSNA BI (Ob: 29±15 vs. NOb: 29±7 bursts/100Hb, p =0.96) and cBRS (Ob: 18.7±17.3 vs. NOb: 17.1±18.6 ms/mmHg, p =0.65) were similar between groups. However, sBRS was attenuated in the Ob compared with the NOb group (Ob: -1.5±0.9 vs. NOb: -2.6±2.0 bursts/100Hb/mmHg, p &lt;0.001). An association was observed between sBRS and ARV of diastolic BP in the whole cohort ( r =0.46, p =0.01), but not when stratified by group. Conclusion: Our results indicate an altered sBRS, but not MSNA and ARV, in normotensive adults with obesity. Further, independent of obesity, we observed that adults who had the lowest sBRS had the greatest diastolic ARV. These findings are important because reduced sBRS may lead to augmented BPV and subsequently, obesity-related hypertension, which may further our understanding of cardiovascular dysregulation in normotensive adults with obesity. NIH (R01HL118313, D.W.W.; K01AG064038 &amp; R21AG080503, M.L.K.R.) and the U.S. Department of Veterans Affairs (I01RX001311, D.W.W.; IK2RX003670, to K.B.). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Augmented Resting Beat-to-Beat Blood Pressure Variability in Young, Healthy, Hispanic Men

Hispanic Americans (HA) are at a higher risk for metabolic syndrome and diabetes compared to other racial groups in the United States, conditions that are well established risk factors for cardiovascular disease progression. Beat-to-beat blood pressure variability (BPV) is a known predictor of cardiovascular risk. However, racial differences in beat-to-beat BPV between HA and non-Hispanic white (WH) men have not been investigated. Therefore, we tested the hypothesis that young, healthy, HA men have greater resting beat-to-beat BPV compared to healthy age and body mass index matched WH men. We studied 8 young healthy HA men (23 ± 3 years, 24.2 ± 2.3 kg/m 2 , mean ± standard deviation) and 10 young healthy WH men (22 ± 3 years, P = 0.574; 24.1 ± 3.1 kg/m 2 , P = 0.948). During ten minutes of quiet supine rest, beat-to-beat arterial blood pressure (BP; finger photoplethysmography) was continuously recorded and brachial automated sphygmomanometry was used to verify beat-to-beat BP measurements (Welch Allyn). Stroke volume (SV) was estimated using the Modelflow method, then cardiac output (CO = SV x Heart rate) and total peripheral resistance (TPR = MAP / CO) were calculated. Standard deviation (SD), range, coefficient of variation (CV), and average real variability (ARV) were calculated for systolic (SBP), diastolic (DBP), mean arterial BP (MAP), CO and TPR. Resting SBP (HA: 116 ± 7 mmHg; WH: 118 ± 6 mmHg; P = 0.509), DBP (HA: 67 ± 4 mmHg; WH: 65 ± 5 mmHg; P = 0.432), and MAP (HA: 83 ± 4 mmHg; WH: 83 ± 5 mmHg; P = 0.830), were not different between groups. Beat-to-beat MAP SD (HA: 5.3 ± 1.3 mmHg; WH: 3.6 ± 0.9 mmHg; P = 0.004), range (HA: 30 ± 6 mmHg; WH: 20 ± 4 mmHg; P = 0.001), CV (HA: 6.4 ± 1.3 %; WH: 4.4 ± 1.1 %; P = 0.002), and ARV (HA: 1.4 ± 0.3; WH: 1.1 ± 0.3; P = 0.033) were all higher in HA men compared to WH men. Likewise, all SBP and DBP beat-to-beat variability measures were higher in HA men compared to WH men (all p &lt; 0.05). HA men also had higher TPR SD (HA: 1.3 ± 0.2 mmHg/min/L; WH: 0.9 ± 0.2 mmHg/min/L; P = 0.009) and range (HA: 9 ± 2 mmHg/min/L; WH: 6 ± 2 mmHg; P = 0.009) compared to WH men, however there were no differences in any CO variability measures (P &gt; 0.05). Despite normal resting BP, these preliminary data suggest that beat-to-beat BPV is higher in HA men compared to WH men, which was accompanied by an augmented TPR variability. This heightened BP and TPR variability in HA men warrants additional investigation. This work was supported by the College of Nursing and Health Innovation. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Combined androgen excess polycystic ovary syndrome and obesity are associated with elevated blood pressure variability in adult women

Androgen excess polycystic ovary syndrome (AE-PCOS) is a common endocrine-metabolic disorder in women of reproductive age and is associated with elevated cardiovascular disease risk. However, the relationship between AE-PCOS and blood pressure variability (BPV), a marker of cardiovascular disease risk, has not been investigated. The purpose of this study was to examine BPV across obese women with AE-PCOS and lean and obese healthy control women. We hypothesized that BPV would be elevated in women with AE-PCOS compared to obese and lean women without AE-PCOS. We recruited 14 women with AE-PCOS (27±6 y; 37.9±5.6 kg·m2, 27.1–44. 8 kg·m2), and 12 obese (27±5 y; 35.6±6.0 kg·m2, 27.4–50.3 kg·m2) and 25 lean women (26±6 y; 22.9±3.6 kgxm2, 19.2–33.1 kg·m2) without AE-PCOS. Beat-to-beat BP was measured via finger photoplethysmography (Finometer Pro) over a 6 min resting period. Standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and range were calculated for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). We used Kruskal-Wallis one-way ANOVA with multiple comparisons to assess differences between measurements of BPV across groups. Data are presented as mean±SD with significance set at α = 0.05. Women with AE-PCOS had elevated resting SBP (lean: 113±12 mmHg; AE-PCOS: 125±9 mmHg; P = 0.002), DBP (lean: 73±8 mmHg; AE-PCOS: 82±8 mmHg; P = 0.006), and MAP (lean: 86±9 mmHg; AE-PCOS: 96±8 mmHg, P = 0.009) compared to lean controls. Resting blood pressure in obese women without AE-PCOS was similar to lean women and to women with AE-PCOS. Compared to lean controls, obese women with AE-PCOS had elevated ARV for SBP (lean: 1.6±0.4 mmHg; AE-PCOS: 2.5±0.7 mmHg, P=0.001), DBP (P=0.005), and MAP (P=0.033). In addition, DBP SD was also greater in AE-PCOS compared to lean controls (lean: 3±1 mmHg; AE-PCOS: 4±1 mmHg, P=0.005). Whereas only SBP ARV was elevated in obese controls compared to lean controls (P=0.043). These preliminary findings suggest that obese women with AE-PCOS exhibit increased BPV, which may contribute to the greater risk for cardiovascular disease in this group. NIH HL135089/P20GM 121334/R01HL161000 This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Influence of type 2 diabetes and central fat distribution on beat-to-beat blood pressure variability

Type 2 diabetes (T2D) is among the most prevalent diseases in the United States and is accompanied by an increased risk for cardiovascular disease. Resting beat-to-beat blood pressure variability (BPV) plays a predictive role in adverse cardiovascular outcomes, providing additional information over absolute blood pressure alone. Notably, the majority of patients with T2D are obese exhibiting an increased central fat distribution (CFD), which carries an independent cardiovascular risk. This raises the question as to how T2D and comorbid CFD contribute to beat-to-beat BPV in patients with T2D. Therefore, the purpose of this study was to test the hypothesis that patients with T2D have greater beat-to-beat BPV compared to body weight matched controls with CFD alone and lean controls. Beat-to-beat blood pressure (finger photoplethysmography) was measured continuously during a quiet, supine resting baseline in 26 T2D patients with CFD (T2D; Age: 55 ± 9 years, BMI: 32.5 ± 4.1 kg/m 2 ), 21 bodyweight matched controls with CFD (BWM; Age: 53 ± 12 years, BMI: 31.5 ± 4.7 kg/m 2 ), and 17 lean controls (Lean; Age: 54 ± 10 years, BMI: 22.2 ± 1.7 kg/m 2 ). CFD was determined by a waist circumference greater than 102 cm for obese (BMI ≥ 30.0 kg/m 2 ) men, 88 cm for obese women, 94 cm for overweight (BMI = 25.0 - 29.9 kg/m 2 ) men, and 80 cm for overweight women. Beat-to-beat BPV was quantified through calculations of standard deviation (SD), range, coefficient of variation (CV), and average real variability (ARV) for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Absolute resting SBP, DBP, and MAP were determined by averaging 3 brachial blood pressure readings during the baseline. Resting absolute SBP (T2D: 130 ± 14 mmHg; BWM: 128 ± 15 mmHg; Lean: 113 ± 10 mmHg; P = 0.0004), DBP (T2D: 79 ± 7 mmHg; BWM: 79 ± 7 mmHg; Lean: 71 ± 7 mmHg; P = 0.0026), and MAP (T2D: 96 ± 10 mmHg; BWM: 97 ± 10 mmHg; Lean: 85 ± 7 mmHg; P = 0.0004) were greater in T2D and BWM than in lean controls. Beat-to-beat SD was greater in T2D than in lean controls for SBP (T2D: 6.9 ± 1.7 mmHg; BWM: 6.3 ± 2.0 mmHg; Lean: 5.1 ± 1.0 mmHg; P = 0.004) and MAP (T2D: 4.9 ± 1.2 mmHg; BWM: 4.5 ± 1.1 mmHg; Lean: 4.0 ± 0.8 mmHg; P = 0.027). Similarly, MAP ARV (T2D: 1.7 ± 0.6 mmHg; BWM: 1.5 ± 0.4 mmHg; Lean: 1.2 ± 0.5 mmHg; P = 0.003) was greater in T2D than in lean controls, while SBP ARV (T2D: 3.4 ± 1.5 mmHg; BWM: 2.8 ± 0.8 mmHg; Lean: 1.9 ± 0.6 mmHg; P = 0.0001) was greater in T2D and in BWM than in lean controls. There were no differences in CV for SBP, DBP, or MAP (P &gt; 0.05). Range was greater for SBP (T2D: 40 ± 10 mmHg; BWM: 35 ± 12 mmHg; Lean: 31 ± 7 mmHg; P = 0.017) in T2D than in lean controls. These data suggest that beat-to-beat BPV for SBP and MAP is greater in those with T2D and CFD than in lean controls. Most of these differences were not observed between those with CFD alone and lean controls, suggesting that the combination of T2D and CFD drives these differences. Support or Funding Information: This work was supported by the College of Nursing and Health Innovation. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

The Association Between Short Term Blood Pressure Variation and Inflammation in Young Adults

Background: Blood pressure variability (BPV) has been associated with both cardiovascular disease (CVD) and systemic inflammation in adults. While studies have linked inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) with blood pressure outcomes, the connection between short-term BPV and inflammation in young, healthy adults remains unexplored. Thus, the present study sought to show evidence of the association between short term BPV and inflammation in this un-evaluated population. Methods: Data was analyzed from the Georgia Stress and Heart (GSH) study, a cohort of African American and European American participants initially recruited from Richmond County, Georgia, between 1989 and 1998. Participants aged 5 to 16 years at baseline were screened for normotensive blood pressure and only included if they had no known medical diagnoses. This analysis included data from three visits where both 24-hour ambulatory blood pressure and serum inflammatory markers were measured. BPV was assessed using the average real variability (ARV), while inflammatory markers (CRP, IFN-γ, IL-6, TNF-α) were measured via microfluidic and ELISA assays.The associations between inflammatory markers and ARV were analyzed using generalized estimating equations (GEE) with an unstructured correlation structure to account for the correlation between repeated measurements within subjects. Models were adjusted for potential confounders, including age, sex, race, and body mass index. Results: 447 participants (age of 22.9 ± 3.11 years) were included in the study. Diastolic BPV exhibited significant associations with inflammatory biomarkers while no such associations existed with systolic BPV. Specifically, the 20-hour diastolic BPV showed a significant positive association with CRP (p = 0.005) and TNF-α (p = 0.024). Daytime diastolic BPV correlated with elevated CRP (p = 0.020), and night-time diastolic BPV correlated with TNF-a (p = 0.021). In contrast, systolic BPV measures were not significantly associated (all p &gt; 0.05) with any inflammatory markers, and other cytokines, including IL-6 and interferon-gamma (IFN-γ), demonstrated weaker or non-significant relationships with BPV. Conclusions: These findings suggest that diastolic BPV may serve as a marker of systemic inflammation in normotensive, apparently healthy individuals. Monitoring diastolic BPV, especially over nighttime and extended periods, could provide valuable insights into the inflammatory status of individuals and their risk for future cardiovascular events. Further research is needed to elucidate the underlying mechanisms and explore whether targeting diastolic BPV could reduce inflammation and improve long-term cardiovascular outcomes. Research was supported by HL086530 and HL69999 from the National Heart, Lung and Blood Institute as well as 0730156N from the American Heart Association. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Resting Blood Pressure Variability in Premenopausal Women with PTSD: the Influence of Depression

Although the adverse cardiovascular consequences of hypertension largely depend on absolute blood pressure (BP), recent studies have shown that increased blood pressure variability (BPV) is a powerful predictor of cardiovascular events and confers strong prognostic value beyond the absolute BP level. Our study aimed to investigate indices of BPV in otherwise healthy young women with post-traumatic stress disorder (PTSD), an emerging risk factor for cardiovascular disease. We hypothesized that premenopausal women with PTSD (PTSD+) will present with augmented beat-to-beat BPV compared to trauma-exposed women without PTSD (PTSD-). We recruited twenty-two PTSD+ (28 ± 6 years) and twenty-two PTSD- (25 ± 6 years) women, and collected mental health questionnaires and baseline hemodynamics data. Resting beat-to-beat BP (finger plethysmography) and heart rate (electrocardiography) were continuously measured for 10 min, and we calculated standard deviation and average real variability as BPV indices. PTSD symptom severity was assessed using the PTSD Checklist for DSM-5 (PCL-5) and depression symptom severity using the Beck’s Depression Inventory (BDI). We used an unpaired t-test to compare questionnaire and hemodynamic data between the two groups. PTSD+ women had higher body mass index (29.09 ± 6.45 vs 24.74 ± 3.63 kg/m2, p=0.008) and higher BDI score (23.32 ± 11.40 vs 14.73 ± 12.47 a.u., p=0.022) compared to the PTSD- women. As expected, PCL-5 score was higher in PTSD+ compared to PTSD- (39.95 ± 14.57 vs 25.14 ± 15.55 a.u., p=0.002). To test our hypothesis, we ran a univariate analysis of covariance exploring the differences in systolic and diastolic BPV between the two groups of women, while controlling for body mass index and BDI score. Our analysis of covariance revealed that systolic BPV was lower [F(1,40) = 2.92, p = 0.048] in PTSD- compared to PTSD+ (1.50 ± 0.34 mmHg vs 1.60 ± 0.34 mmHg), when controlling for body mass index and BDI. However, diastolic BPV was comparable between the groups. Overall, this study suggests that depression, a condition that is highly comorbid with PTSD, may influence systolic BPV in premenopausal women with PTSD. Future research should explore depression as a potential moderator of dynamic fluctuations of BP over time in women diagnosed with PTSD. This study was supported by grants K01HL161027, UMN CTSI UL1TR002494, and U54AT012307. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Weight fluctuation and incidence of end-stage renal disease in Korea: a nationwide cohort study

Background: The impact of weight or weight changes on kidney function remains a matter of debate. This study aimed to investigate the association between weight fluctuation and the incidence of end-stage renal disease (ESRD) using data from the Korean National Health Insurance Corporation health checkups (2009–2015).Methods: The study included 2,310,667 participants (1,546,749 men and 763,918 women), aged ≥40 years. Weight fluctuation was assessed using the average real variability (ARV) of weight and categorized into quartiles (Q1–Q4). Hazard ratios (HRs) and 95% confidence intervals for ESRD incidence were calculated using multivariable Cox proportional hazards models.Results: After adjustment for comorbidities, increased body mass index was associated with a decreased HR for ESRD. The highest quartile of weight variability (ARV Q4) demonstrated a higher probability and HR for ESRD compared to the lower variability quartiles (Q1–Q3). Among men, individuals with sustained weight, and those with weight gain, the ARV Q4 group showed significantly increased HRs for ESRD (HR of 1.372, 1.222, and 1.49, respectively). Furthermore, irrespective of changes in creatinine levels, all ARV Q4 groups exhibited increased HRs for ESRD (HR of 1.342, 1.472, and 1.299, respectively).Conclusions: High weight fluctuation (ARV Q4) was associated with an increased incidence of ESRD in the general Korean population, with notable significance in men and in groups with sustained or increased weight. Clinically, individuals in the ARV Q4 category should be considered at risk for ESRD, and early interventions should be pursued for this population.

Assessing the relationship between short-term blood pressure variability and glycation profile in young and middle-aged nondiabetic hypertensive individuals

Introduction:Elevated short-term blood pressure (BP) variability (BPV) has been associated with a poorer cardiovascular prognosis. The glycation profile is related to BPV in diabetic and prediabetic individuals. However, little is known about the relationship between glycation levels and BPV in hypertensive patients with optimal glycemic control.Objectives:This observational study aimed to elucidate the relationship between glycated hemoglobin (HbA1c) levels and short-term BPV in young and middle-aged hypertensive patients over 18 years with HbA1c levels below 5.7%.Methods:We collected and analyzed data on 24-h ambulatory BP monitoring, demographic, epidemiological, clinical, and laboratory variables from 143 hypertensive patients. BPV was measured as the standard deviation (SD) and average real variability (ARV) in millimeters of mercury, as well as the dimensionless coefficient of variation (CV).Results:Depending on the index, each one unit increase in nighttime SD and CV indices was associated with a 17–24% higher likelihood of elevated HbA1c levels (higher than 5.2%). Regarding BPV dipping, each 1% decrease in nighttime SD and CV dipping was associated with a 10–20% higher risk of increased HbA1c levels. Additionally, each 1% decrease in nighttime ARV DBP dipping was also associated with a 10% higher risk of elevated HbA1c levels. A one-standardized-unit increase in the overall combined BPV index, as a pooled measure of BPV, was associated with a 45% higher likelihood of raised HbA1c levels.Conclusion:Even within the optimal range, elevated HbA1c levels may reflect an underlying increase in BPV, which may be particularly relevant given the prognostic implications of short-term BPV.

Higher blood pressure variability during hospitalisation is associated with lower cerebral white matter integrity in COVID-19 patients

Background High blood pressure variability (BPV) is associated with cerebrovascular damage and dementia, but it is unknown whether short-term BPV during hospitalisation is also associated with cerebral white matter (WM) damage. We examined whether BPV, measured in-hospital using continuous monitoring, is associated with WM microstructural integrity in COVID-19 patients. Methods We included hospitalised COVID-19 patients from the CORONavirus and Ischemic Stroke (CORONIS) study who underwent continuous vital signs monitoring using a wearable device during hospital admission and had an MRI shortly after discharge. Systolic BPV was calculated as Average Real Variability (ARV) and Coefficient of Variation (CV) with 1-, 5- and 20-minute intervals. We used diffusion tensor imaging to assess fractional anisotropy (FA) and peak width of skeletonised mean diffusivity (PSMD) as markers of WM integrity. Associations between BPV and WM integrity were examined with linear regression adjusted for age, mean systolic blood pressure (BP), number of BP measurements and type of respiratory support. Results We included 47 COVID-19 patients (mean age: 59.6 years). BP was measured 6306 ± 4343 times per patient (median admission: 11 days (Interquartile Range [IQR] 7.5–15.0). Both higher ARV and CV were associated with lower WM microstructural integrity, reflected by lower FA (ARV: β = −0.40, p = .010; CV: β = −0.33, p = 0.026) and higher PSMD (CV: β = 0.28, p = .038) after adjustment for confounders. Correction for WM hyperintensities did not change these results. Conclusions High BPV during hospitalisation is associated with lower WM integrity in COVID-19 patients, although causality needs to be demonstrated. Our findings need validation in hospitalised patients without COVID-19 to examine generalisability.

Impacts of Average Real Variability Parameters of Blood Pressure on Recovery Following Posterior Fixation Surgery for Thoracolumbar Vertebral Fractures.

This study aimed to investigate the influence of average real variability (ARV) parameters of blood pressure on the recovery following posterior fixation surgery for thoracolumbar vertebral fractures. A retrospective analysis was conducted on 190 patients who underwent posterior fixation surgery for thoracolumbar vertebral fractures at Ningbo Medical Center Lihuili Hospital between January 2021 and December 2023. Patients were divided into two groups based on their postoperative recovery: the good recovery group (n = 140) and the poor recovery group (n = 50). Univariate and binary logistic regression analyses were performed to identify factors influencing postoperative recovery. Pearson correlation analysis was used to assess the relationships between ARV and other variables, while receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of ARV in postoperative recovery. No statistically significant differences were observed between the two groups in terms of age, body mass index (BMI), gender, place of residence, monthly family income, occupation, education level, surgery duration, intraoperative blood loss, fracture type, fracture location, or fracture stage (p > 0.05). However, significant differences were noted in complication rates, ARV levels, and self-efficacy scores (p < 0.05). Pearson linear correlation analysis revealed that ARV was positively correlated with the presence of complications (r = 0.151, p < 0.05). Binary logistic regression analysis identified complications, ARV, and self-efficacy as significant factors influencing postoperative recovery (p < 0.05). Patients were divided into four groups based on ARV quartiles: Group 1 (ARV < 0.79), Group 2 (0.79 ≤ ARV < 0.89), Group 3 (0.89 ≤ ARV < 0.98), and Group 4 (ARV ≥ 0.98). A statistically significant difference in complication rates was observed across the groups (p < 0.05). ROC analysis showed that the area under the curve (AUC) for ARV in predicting postoperative recovery was 0.724 (95% confidence interval (CI): 0.612-0.836, p < 0.001). ARV is a significant factor influencing recovery following posterior fixation surgery for thoracolumbar vertebral fractures. Higher ARV levels are associated with increased postoperative complications, leading to poorer recovery outcomes.