Blood Pressure Variability In Patients Research Articles

#1488 Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study

Abstract Background and Aims Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibited an increased cardiovascular risk than hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137 mEq/L) compared to standard (140 mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. Method In a randomized cross-over manner, 29 patients with IDH underwent 4 hemodialysis sessions with low (137 mEq/L) followed by 4 sessions with standard (140 mEq/L) dialysate sodium or vice versa according to randomization arm. 48-h ABPM was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48-h, 24-h, day-time and night-time periods were calculated with validated formulas. Results Mean 48-h BP was lower by 5.3/2.6 mmHg with low compared to standard dialysate sodium concentration, (p = 0.005/p = 0.007) respectively). All 48-h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg; p = 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p = 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p = 0.392 and SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p = 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some further comparisons relevant to a trend for lower BPV during daytime 2 and higher BVP during nighttime 2 during treatment with low dialysate sodium. Conclusion Low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should further explore alternative interventions to reduce BP and BPV in this high-risk population.

Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery

BackgroundDynamic fluctuations of arterial blood pressure known as blood pressure variability (BPV) may have short and long-term undesirable consequences. During surgical procedures blood pressure is usually measured in equal intervals allowing to assess its intraoperative variability, which significance for peri and post-operative period is still under debate. Lidocaine has positive cardiovascular effects, which may go beyond its antiarrhythmic activity. The aim of the study was to verify whether the use of intravenous lidocaine may affect intraoperative BPV in patients undergoing major vascular procedures.MethodsWe performed a post-hoc analysis of the data collected during the previous randomized clinical trial by Gajniak et al. In the original study patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive intravenous infusion of 1% lidocaine or placebo at the same infusion rate based on ideal body weight, in concomitance with general anesthesia. We analyzed systolic (SBP), diastolic (DBP) and mean arterial blood (MAP) pressure recorded in 5-minute intervals (from the first measurement before induction of general anaesthesia until the last after emergence from anaesthesia). Blood pressure variability was then calculated for SBP and MAP, and expressed as: standard deviation (SD), coefficient of variation (CV), average real variability (ARV) and coefficient of hemodynamic stability (C10%), and compared between both groups.ResultsAll calculated indexes were comparable between groups. In the lidocaine and placebo groups systolic blood pressure SD, CV, AVR and C10% were 20.17 vs. 19.28, 16.40 vs. 15.64, 14.74 vs. 14.08 and 0.45 vs. 0.45 respectively. No differences were observed regarding type of surgery, operating and anaesthetic time, administration of vasoactive agents and intravenous fluids, including blood products.ConclusionIn high-risk vascular surgery performed under general anesthesia, lidocaine infusion had no effect on arterial blood pressure variability.Trial registrationClinicalTrials.gov; NCT04691726 post-hoc analysis; date of registration 31/12/2020.

The impact of novel coronavirus infection on blood pressure variability in patients undergoing painless gastrointestinal endoscopy

ObjectiveThis study aims to examine the impact of COVID-19 infection on blood pressure variability among patients undergoing painless gastrointestinal endoscopy. Materials and methodsWe conducted an analysis on a cohort of 53 patients who received painless gastroscopy at the First Affiliated Hospital of Zhengzhou University between November 2022 to January 2023. Non-invasive cuff pressure measurements were taken every minute upon the patient's arrival. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Pulse Pressure (PP) were recorded both 5 min before and after induction. The variability in these parameters was calculated as the standard deviation (SD) over the mean, multiplied by 100%. Patients were grouped based on their history of COVID-19 infection. ResultsOur findings revealed significant differences in blood pressure variability between patients with a history of COVID-19 infection and those without. Prior to, substantial increases in variability were observed in DBP, MAP, and PP, while no significant change was in SBP. Following induction, COVID-19 positive patients exhibited heightened variability in all parameters. The most pronounced changes were seen in Pulse Pressure both before and after induction, suggesting a heightened cardiovascular response in patients with a history of COVID-19. These differences were statistically significant, indicating a clear impact of COVID-19 on cardiovascular stability during endoscopic procedures. ConclusionThe study underscores the influence of COVID-19 on increased blood pressure variability in patients undergoing painless gastrointestinal endoscopy. These findings highlight the need for vigilant cardiovascular monitoring in COVID-19 affected individuals during similar medical procedures.

Retracted: Correlation between Carotid Stenosis Degree and Blood Pressure Variability in Patients with Carotid Stenosis

Retracted: Correlation between Carotid Stenosis Degree and Blood Pressure Variability in Patients with Carotid Stenosis

Effect of the combination of tetrahydrocannabinol and melatonin (IGC‐AD1) on blood pressure variability in patients with mild to moderate Alzheimer’s Disease

AbstractBackgroundBlood pressure (BP) variability (BPV) is a risk factor for Alzheimer’s disease (AD). Medications, such as atypical antipsychotics used to treat neuropsychiatric symptoms (NPS) common in AD, contribute to altering BP. Here we present preliminary data on the use of IGC‐AD1, a combination intervention of tetrahydrocannabinol (THC) and melatonin, on BP and BPV.MethodParticipants with hypertension (n = 12) and mild (15.38%) to moderate (84.6%) AD (NIA‐criteria, 10‐active, 2‐placebo, 81.5±5.5yrs, 69.2% women) were enrolled in a three‐Cohort Phase‐1, MAD, safety and tolerability trial (IND146069, NCT04749563). In Cohort‐1, Cohort‐2 and Cohort‐3, one ml QD, BID, and TID of IGC‐AD1 were administered respectively for 14‐days with a minimum of 4‐days washout between Cohorts. For all Cohorts, BP was recorded daily. Coefficients of variation (CV), ∆DBP and ∆SBP (diastolic and systolic blood pressure) were calculated to assess SBP‐variability for each Cohort. A chi‐square was performed to verify whether the difference between controlled and uncontrolled SBP (>140mmHg in more than 20% of values per participant) was related to IGC‐AD1. SBP‐CV difference among Cohorts was determined with a one‐way ANOVA. The difference between active and placebo for each Cohort was assessed with independent t‐tests (dplr R‐Studio). BP‐associated adverse events (AEs) were evaluated daily.ResultVariability measures fell within the normal range (∆DVP = 45.0±13.5 mmHg, ∆SBP = 66.44±22.9 mmHg, CV = 7.6±5.3 mmHg) for all three Cohorts. Cohort‐1 (mmHg): ∆SBP = 42.3±15.56, ∆DVP = 25.6±8.86, CV = 10.14±3.84; Cohort‐2 (mmHg): ∆SBP = 41.9±11.73, ∆DVP = 23±9.7, CV = 8.95±1.96; Cohort‐3 (mmHg): ∆SBP = 39.6±11.76, ∆DVP = 23.6±7.82, CV = 8.84±7.83. IGC‐AD1 had no statistically significant effect between controlled and uncontrolled SBP (X2(2) = 1.15, p = 0.562). There was no SBP‐CV mean‐difference among Cohorts (F (2,27) = 0.589, p = 0.562). No differences were detected between placebo and active (Cohort‐1: t(1.64) = 0.315, p = 0.788, Cohort‐2: t(1.31) = ‐0.225, p = 0.85, Cohort‐3: t(3.53) = 1.63, p = 0.188). While BP related AEs were reported, none were deemed, by the PI, to be associated with IGC‐AD1.ConclusionPreliminary data indicate that IGC‐AD1, a cannabis‐based formulation, in trials to treat NPS did not statistically affect BP or BPV in a MAD study indicating that it may not contribute as a risk factor for AD; warranting a larger placebo‐controlled trial.

Association between salt sensitivity and blood pressure variability in patients with essential hypertension and predictive value for cardiovascular events.

We aimed to explore the association between salt sensitivity and blood pressure variability in patients with essential hypertension. A total of 730 patients with essential hypertension treated from 2016 to 2019 were subjected to salt-sensitivity risk stratification according to 24-hour ambulatory blood pressure monitoring. Their clinical data were compared among groups with different grades of salt-sensitivity risk, and the association between salt sensitivity and blood pressure variability was analysed. The influencing factors for cardiovascular events in patients with essential hypertension were analysed through multivariate regression analysis, and their predictive value was detected using receiver operating characteristic (ROC) curves. Salt sensitivity was positively correlated with night-time and 24-hour systolic standard deviation and 24-hour systolic blood pressure coefficient of variation. Age ≥ 55 years, family history of cardiovascular diseases, high risk of salt sensitivity, night-time systolic standard deviation ≥ 14 mmHg, 24-hour systolic standard deviation ≥ 20 mmHg and 24-hour systolic blood pressure coefficient of variation ≥ 13.5% were all independent risk factors for cardiovascular diseases in patients with essential hypertension (p < 0.05). The area under the ROC curve of the prediction model was 0.837. There was a positive correlation between salt sensitivity and blood pressure variability, which has predictive value for cardiovascular events in patients with essential hypertension.

Augmented resting beat-to-beat blood pressure variability in patients with chronic kidney disease.

Our aim was to test the hypothesis that patients with chronic kidney disease (CKD) would exhibit augmented resting beat-to-beat blood pressure variability (BPV) that is associated with poor clinical outcomes independent of mean blood pressure (BP). In addition, since the arterial baroreflex plays a critical role in beat-to-beat BP regulation, we further hypothesized that an impaired baroreflex control would be associated with an augmented resting beat-to-beat BPV. In 25 sedentary patients with CKD stages III-IV (62 ± 9years) and 20 controls (57 ± 10years), resting beat-to-beat BP (finger photoplethysmography) and heart rate (electrocardiography) were continuously measured for 10min. We calculated the standard deviation (SD), average real variability (ARV) and other indices of BPV. The sequence technique was used to estimate spontaneous cardiac baroreflex sensitivity. Compared with controls (CON), the CKD group had significantly increased resting BPV. The ARV (2.2 ± 0.6 versus 1.6 ± 0.5mmHg, P < 0.001; 1.6 ± 0.7 versus 1.3 ± 0.3mmHg, P = 0.039; 1.4 ± 0.5 versus 1.0 ± 0.2mmHg, P < 0.001) of systolic, diastolic and mean BP, respectively, was increased in CKD versus controls. Other traditional measures of variability showed similar results. The cardiac baroreflex sensitivity was lower in CKD compared with controls (CKD: 8.4 ± 4.5ms/mmHg versus CON: 14.0 ± 8.2ms/mmHg, P = 0.008). In addition, cardiac baroreflex sensitivity was negatively associated with BPV [systolic blood pressure (SBP) ARV; r = -0.44, P = 0.003]. In summary, our data demonstrate that patients with CKD have augmented beat-to-beat BPV and lower cardiac baroreflex sensitivity. BPV and cardiac baroreflex sensitivity were negatively correlated in this cohort. These findings may further our understanding about cardiovascular dysregulation observed in patients with CKD.

Blood Pressure Variability: Marker or Predictor of Cardiovascular Risk?

Background: Regardless of the mean blood pressure value, short-term and long-term BP variability (BPV) are associated with the development and progression of target organ damage and predictors of cardiovascular complications and mortality. The purpose of the present study was to evaluate the prognostic significance of increased BPV in patients with arterial hypertension (AH). Methods and Results: The study consisted of two stages. In the first stage, a retrospective analysis of 365 ABPM results was carried out. As a result of the analysis, 271 patients aged 56.1±10.0 years with uncontrolled AH Grades 1-3 (ESC/ESH, 2018) were included in this study. Depending on the values of BPV, AH patients were divided into two groups: Group 1 consisted of patients with normal BPV (n=145), and Group 2 consisted of patients with increased BPV (n=126). The second stage included 91 patients with uncontrolled hypertension without permanent antihypertensive therapy who had increased BPV. We found statistically significant differences in BP between the AH patients with normal BPV and increased BPV. Thus, in the group with normal BPV, compared with increased BPV, the parameters of the average 24-h systolic BP (SBP), daytime SBP, and nighttime SBP were statistically lower (141±14.6 vs. 147.2±20.2 mmHg, P&lt;0.004; 142.8±15.1 vs. 148.4±20.7 mmHg, P&lt;0.01; and 136.2±15.5 vs. 143.8±21.4 mmHg, P&lt;0.001; respectively). A statistically significant moderate direct correlation was found between the average 24-h SBP and the average 24-h and daytime SBP variability (SBPV) (rs=0.49 and rs=0.40 respectively, P&lt;0.001 in all cases). A statistically significant moderate to weak direct correlation also was found between the average daytime SBP, and the average 24-h and daytime SBPV (rs=0.45 and rs=0.37, respectively, P&lt;0.001 in all cases). A moderate direct correlation was found between nighttime SBP and 24-hour SBPV (rs=0.52, P&lt;0.001) and between nighttime SBP and daytime SBPV (rs=0.42, P&lt;0.001). Weak direct correlations were found between the average 24-h SBPV and central SBP (SBPc) (rs=0.34, P&lt;0.001), as well as between the average 24-h and daytime SBPV and central pulse pressure (PPc) (rs=0.33 and rs=0.32, respectively, P&lt;0.001 in all cases). A weak direct correlation was found between carotid intima-media thickness (CIMT) and the average 24-h and daytime SBPV (rs=0.37 [P&lt;0.001] and rs=0.3 [P=0.04]). Conclusion: The increased BPV is associated with impaired diurnal blood pressure profile (DBPP) and structural and functional changes in blood vessels, in particular, an increase in SBPc and PP in the aorta, and CIMT thickening, which characterizes increased BPV as a predictor of vascular remodeling in patients with uncontrolled AH.

Effects of chlorthalidone plus amiloride compared with amlodipine on short-term blood pressure variability in individuals with hypertension and obstructive sleep apnea: a randomized controlled trial.

To compare the effects of chlortalidone plus amiloride and amlodipine on blood pressure (BP) variability in patients with hypertension and obstructive sleep apnea syndrome (OSA). A randomized, controlled, double-blind trial enrolled men and women aged 40 years or older with a diagnosis of OSA (apnea-hypopnea index 10-40 apneas/h of sleep) confirmed by overnight laboratory polysomnography and systolic BP 140-159 mmHg or diastolic BP 90-99 mmHg. Participants were randomized to receive chlortalidone 25 mg plus amiloride 5 mg daily or amlodipine 10 mg daily for 8 weeks. BP variability was calculated from 24-hour ambulatory BP monitoring at baseline and follow-up using the following indices: SD, coefficient of variation, average real variability (ARV), time-rate index, and variability independent of the mean (VIM). The study included 65 patients, with 33 assigned to the chlortalidone plus amiloride group and 32 to the amlodipine group. Participants in both groups had similar baseline characteristics. Short-term BP variability decreased within groups for SD and ARV indexes for 24-hour systolic BP and daytime systolic BP, but statistically significant time*group interactions were found for sleep systolic SD and VIM, with greater reduction in patients treated with amlodipine. In brief, our study has shown that the use of chlorthalidone in combination with amiloride and amlodipine produces comparable effects on short-term BP variability in patients with hypertension and OSA. Therefore, our findings suggest that BP variability may not be a significant factor when choosing between these medications for the treatment of hypertension and OSA.

Hipertensión arterial y riñón

Hypertension (HT) is the main cause of death in the world. It is maintained thanks to the dysfunction of different organs and systems that normally take part in controlling blood pressure (BP) to ensure adequate perfusion of the tissues. The kidneys are the main regulators of BP over the long-term. A strict balance between the production and metabolism of vasoactive substance that regulate the excretion of water and sodium through the renin-angiotensin-aldosterone system (RAAS) modulates BP. Nevertheless, new mechanisms described in the last decade could also explain the variability of BP in patients. The overexpression of sodium cotransporters at renal level seems to escape from the regulatory effect of the RAAS. Moreover, the immune system and intestinal microbiota seem to play an important and newly discovered role. The production of certain inflammatory cytokines promotes the tubular reabsorption of sodium and the intrarenal over-activation of the RAAS. The proliferation of fermicutes, proteobacterias and Prevotella in subjects with salt-sensitive HT predisposes them to more difficult control of BP. Studying these new mechanisms may not only discover new treatment targets, as it may also explain why the improvement in BP control was not enough to reduce the comorbidities and cardiovascular risk associated with HT.

The role of stress and sleep disorders in the development of cardiovascular complications in patients with arterial hypertension: what is important for an internist to know? A review

This publication discusses the mechanisms underlying the development of arterial hypertension on the background of stress, discusses the current problems of blood pressure control in patients with stress-induced sleep disorders, the clinical features of patients with hypersympathicotonia as the main mechanism for the development of arterial hypertension and blood pressure variability in patients with comorbid pathology, a diagnostic algorithm, as well as presenting current recommendations in the strategy for choosing the optimal antihypertensive therapy with the possibility of personalized choice in various clinical situations.

CKD patients have augmented beat-to-beat BP variability that is not improved with 12 weeks of cycling exercise

Increased blood pressure (BP) variability is a powerful predictor of cardiovascular events and end-organ damage and is associated with sympathetic overactivity. Given the heightened cardiovascular (CV) risk in patients with chronic kidney disease (CKD), we hypothesized that patients with CKD would exhibit augmented resting beat-to-beat BP variability. Additionally, since aerobic exercise training exerts CV protective effects and has been shown to reduce resting sympathetic activity, we hypothesized that twelve weeks of aerobic exercise training would improve resting beat-to-beat BP variability in patients with CKD. In 25 sedentary patients with CKD stages III-IV [19 male/6 female, age: 62 ± 10 yr, 23 Black/2 White, systolic/diastolic BP: 130 ± 12/73 ± 9 mmHg, BMI: 31 ±7 kg/m 2 ] and 15 controls [11 male/4 female, age: 56 ± 11 yr, 13 Black/2 White, systolic/diastolic BP: 129 ± 12/83 ± 8 mmHg, BMI: 29 ± 3 kg/m 2 ], resting beat-to-beat blood pressure (finger photoplethysmography) was continuously measured for 5–10 min. Next, a subset of patients with CKD (n = 13) underwent 12 weeks of aerobic cycling exercise (spinning at 85% of maximal heart rate reserve). Exercise training was performed 45 minutes/session 3 days/week. All measurements were performed at baseline (n=40) and following the 12-week intervention (n=13). We calculated the standard deviation (SD), the coefficient of variation [CV (SD/mean)×100], and the average real variability (AVR) as indices of BP variability. Compared with controls, patients with CKD had significantly increased BP variability. The systolic SD BP (6.0 ± 2.1 vs. 3.9 ± 1.8 mmHg, P = 0.002) and the mean SD BP (3.9 ± 1 vs. 2.8 ± 1 mmHg, P = 0.006) were increased in CKD vs. Controls, but there were no differences in diastolic SD BP between groups (3.3 ± 1 vs. 2.6 ± 1 mmHg, P = 0.065). Similar results were found using AVR (Systolic AVR 2.0 ± 0.5 vs. 1.1 ± 0.5 mmHg, P &gt; 0.001 and, Mean AVR, 1.3 ± 0.5 vs. 1.0 ± 0.3 mmHg, P = 0.010 for patients with CKD and controls respectively). Contrary to our hypothesis, we observed no significant change in resting beat-to-beat BP variability after 12 weeks of exercise in patients with CKD (SD SBP 6.3 ± 2.1 vs. 5.7 ± 2.0 mmHg, P = 0.893 and, AVR 1.9 ± 0.5 vs. 1.9 ± 0.6 mmHg, P = 0.970). In summary, our data demonstrate that patients with CKD have augmented beat-to-beat BP variability, and 12 weeks of cycling exercise did not reduce resting beat-to-beat BP variability in CKD patients. This work was supported by National Institutes of Health Grants R01HL135183 and R61AT010457 (J.P). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Beat-to-beat resting blood pressure variability in patients with type 2 diabetes: effect of statin therapy

Type 2 diabetes (T2D) is a major health concern affecting more than 30 million people in the United States alone. Approximately two-thirds of patients with T2D develop hypertension, a major risk factor for cardiovascular disease. In addition to higher resting absolute blood pressure (BP), increased variability in BP has also been related to greater cardiovascular disease risk. However, whether patients with T2D display greater beat-to-beat BP variability remains unknown. Herein, we hypothesized that patients with T2D would exhibit greater beat-to-beat BP variability than age and body-weight-matched control subjects. In addition, since previous literature has shown that statins lower cardiovascular disease risk through favorable pleiotropic mechanisms, we further hypothesized that patients with T2D taking statins (T2D+statin) would have a lower beat-to-beat BP variability compared to patients with T2D not taking statins (T2D-statin). Beat-to-beat BP (finger photoplethysmography) and heart rate (ECG) were continuously measured, and absolute BP (automated sphygmomanometer) was measured periodically in patients with T2D (N=23; T2D+statin: N=10, T2D-statin: N=13) and age and body weight-matched control subjects (N=17). Measurements were made over the course of a quiet resting baseline period (9.5±1.3 minutes) with subjects in a supine position. Beat-to-beat BP variability was quantified as standard deviation (SD), range, and average real variability (average change in BP from one heartbeat to the next). Data are presented as mean ± standard deviation. Resting absolute systolic BP, diastolic BP, and mean arterial pressure (MAP) were not different between control subjects and T2D patients (P&gt;0.05 for all). There was also no difference in beat-to-beat systolic BP, diastolic BP, or MAP variability between the groups (e.g., MAP SD: control: 4.5±1.3 mmHg, T2D: 4.7±1.1 mmHg, P=0.763). When comparing T2D patients taking statins and those not taking statins, no difference was observed in absolute resting BP (P&gt;0.05). Likewise, systolic BP variability was not different between groups (SD: T2D-statin: 7.0±2.2 mmHg, T2D+statin: 6.3±1.4 mmHg, P=0.369). However, diastolic BP variability was significantly higher in T2D-statin patients (SD: T2D-statin: 4.1±1.1 mmHg, T2D+statin: 3.1±0.6 mmHg, P=0.013) and MAP variability tended to be higher (SD: T2D-statin: 5.2±1.4 mmHg, T2D+statin: 4.3±0.7 mmHg, P=0.061). Similar results were found for BP range and average real variability. These preliminary findings suggest that statin therapy may have a beneficial effect in lowering BP variability in patients with T2D. Supported by American Heart Association (AHA) - Institutional Award for Undergraduate Student Training - #915555. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Circadian blood pressure variability and asymmetric dimethylarginine in patients with glaucoma: cross-sectional study of The LIGHT cohort.

Glaucoma is reportedly associated with asymmetric dimethylarginine (ADMA) and circadian blood pressure (BP) variability, including night-time SBP. We determined whether ADMA level is associated with night-time SBP in patients with glaucoma. In this cross-sectional study, we measured the serum ADMA level and ambulatory BP of 163 patients with glaucoma and 705 participants without glaucoma. Based on the tertiles of serum ADMA level, the patients were divided into three groups: low, intermediate, and high-ADMA. Night-time SBP was determined based on ambulatory BP measured every 30 min for 48 h. The nondipper BP pattern was defined as having a night-time mean SBP decline of less than 10% relative to the mean daytime SBP. In the glaucoma group, the night-time SBP in the high-ADMA group was significantly higher than in the low-ADMA group (123.0 and 114.4 mmHg, respectively; P = 0.003). Multivariable analysis adjusted for the potential confounders showed the night-time SBP, and the odds ratio for nondipper in the high-ADMA group were also significantly higher than in the low-ADMA group ( P = 0.030 and P = 0.021, respectively). Significant associations between continuous serum ADMA levels with night-time SBP and nondipper were also found ( P = 0.002 and 0.006, respectively). In the control group, however, no significant associations were found between serum ADMA levels and night-time SBP and nondipper. A significant interaction effect of the serum ADMA levels and glaucoma on nondipper was found ( P = 0.004). Serum ADMA level was significantly associated with the disturbance of circadian BP variability in patients with glaucoma.

Variability of blood pressure and risk of postoperative acute kidney injury in patients undergoing surgery for acute aortic dissection: A 11-year single-center study.

In patients receiving surgery, increased blood pressure variability may contribute to the onset of acute kidney injury (AKI). However, the extent and significance of blood pressure variability in patients undergoing aortic dissection surgery have yet to be determined. The authors analyzed all patients operated for aortic dissection at Peking University Shenzhen Hospital from January 1, 2011 to December 31, 2021. Preoperative blood pressure variability was expressed as standard deviation, coefficient of variation (CV), and range. The primary outcome was postoperative AKI. After multivariate analysis, systolic blood pressure variability was found to be independently associated with AKI after aortic dissection surgery. The odds ratios and 95% confidence intervals for standard deviation, CV, and systolic blood pressure range were 1.232 (1.011-1.500), 1.451 (1.058-1.991), and 1.138 (0.986-1.288) for postoperative AKI, respectively. However, there was no significant relationship between diastolic blood pressure variability and AKI after aortic dissection surgery. Finally, in patients undergoing surgery for aortic dissection, the variability of systolic blood pressure is actually an important factor in the development of AKI.

Relationship between left atrial functions and ambulatory blood pressure variability in patients with heart failure and preserved ejection fraction.

Aim The aim of this study was to investigate the relationship between left atrial (LA) abnormalities and ambulatory blood pressure variability (BPV) in heart failure with preserved ejection fraction (HFpEF) patients.Material and methods In this single-center, prospective study, we included 187 patients with HFpEF. Eighteen patients with poor image quality were excluded from the study. BPV was evaluated using 24-h ambulatory blood pressure (BP) monitoring. The standard deviation of systolic BP (SBP-SD) was calculated to assess BPV. The patients were classified into two groups according to median SBP-SD (10.5 mm Hg).Results Overall, 169 HFpEF patients (69.2% women, mean age 69.2±11 yrs) were evaluated. There were 98 patients (57.9%) with a SBP-SD greater than 10.5 mm Hg. Patients with higher SPB-SD had significantly higher left atrial stiffness (LASt) and lower LA reservoir strain (LASr) than those with low SPB-SD. LASt was correlated with 24 hr SBP-SD in both sinus rhythm (r= 0.35, p= 0.015) and atrial fibrillation patients (r= 0.32, p= 0.005). There were significant correlations between night-time SBP-SD and LASr (r=-0.23, p=0.045) in HFpEF with sinus rhythm. For all HFpEF patients, multiple regression analyses showed that 24-hr SBP-SD was correlated with LASt (coeff.=0.40, 95%CI= 0.52-5.25, P= 0.017).Conclusions High BPV is associated with impaired LA function, especially for LASt and LASr. This study may provide insight for larger multicenter studies to evaluate the effects on outcomes in HFpEF.

Understanding the Position of Beta-blockers in the Management of Hypertension among Patients with Different Clinical Comorbidities: An Expert Opinion of Cardiologists from India

Abstract Background: Elevated blood pressure (BP) increases the risk of cardiovascular mortality, underscoring the vital importance of effective management in individuals with hypertension (HTN) and cardiovascular disease. However, lack of clear guidance on the utilization of the new beta-blockers has caused hesitation among doctors in using them effectively. The objective of this expert opinion was to understand the role and current position of beta-blockers in the management of patients with HTN and different clinical comorbidities. Methods: A collective of 828 cardiologists throughout India were invited to participate in an online survey and virtual meetings. Their clinical insights were gathered on approaches in managing these patients and their understanding of the role of beta-blockers. Results: The panel of experts recommended that in patients with HTN and angina, the BP target should be 130/80 mmHg (40.70%), and the use of a combination of telmisartan and cardio-selective beta-blockers should be used to lower BP (63.29%). A combination of telmisartan and a beta-1 blocker was recommended for effective BP control and structural regression of left ventricular hypertrophy (52.78%). For intensive BP control, combination therapy of telmisartan and beta-blockers should be used in patients with HTN and atrial fibrillation (59.18%). The panel of experts opined (60.02%) that different BP targets should be considered for different stroke subtypes. Telmisartan (44.44%) and selective beta-1 blockers (29.35%) are recommended to manage BP variability in patients with HTN and recurrent stroke. Conclusion: In patients with HTN and cardiovascular disease, individualized decision-making is necessary for beta-blocker use in HTN management. Selective beta-blockers should be considered first-line therapy or combined with telmisartan when indicated.

Characteristics of Month-by-Month Blood Pressure Variability in Patients on Hemodialysis

Introduction: Poor prognosis in hemodialysis (HD) patients is due to the increased prevalence of cardiovascular diseases among them. We previously reported that higher visit-by-visit blood pressure variability is associated with increased cardiovascular mortality in HD patients. This present study aimed to investigate the characteristics of month-by-month blood pressure variability (MMBPV) in these patients. Methods: A total of 324 maintenance HD patients, who could be followed up for 60 months, were recruited. We used standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) in pre- and post-dialysis systolic blood pressure (pre- and post-SD, pre- and post-CV, and pre- and post-VIM) as an index of MMBPV. We investigated (1) the reproducibility of MMBPV, (2) relationship between these values and background factors, and (3) association between these values and mortality. Results: MMBPV (pre- and post-SD, pre- and post-CV, and pre- and post-VIM) showed significant reproducibility (intraclass correlation, 0.483 [p p p p p p p = 0.028). Conclusion: These data suggested that pre- and post-VIM in HD patients are reproducible and associated with various background factors, and especially post-VIM is independently correlated with cardiovascular mortality. Further studies are necessary to confirm the mechanism of increased post-VIM and clarify whether reducing post-VIM can improve the prognosis of HD patients.

PS-C12-8: BLOOD PRESSURE VARIABILITY IN PREVIOUSLY UNTREATED HYPERTENSIVE PATIENTS RANDOMIZED TO NIFEDIPINE GITS OR RAMIPRIL. REVERENT STUDY

Blood pressure (BP) variability (BPV) independently predicts adverse outcomes, making it a potential target for treatment. Preliminary data indicate that dihydropyridine calcium channel blockers (CCB) may reduce BPV more than other antihypertensives. Aim of Reverent: (Reducing blood pressure Variability in Essential hypertension with Ramipril vErsus Nifedipine GITS) Trial was to compare changes in either short-, mid- and long-term BPV in patients treated with a CCB (nifedipine GITS) or an ACE inhibitor (ramipril) in a randomised fashion. Methods: Untreated (treatment-naïve or after treatment washout) patients with mild to moderate essential hypertension and elevated basal BPV, were randomized to open label treatment with nifedipine GITS 30 mg or ramipril 10 mg once daily. BPV after 10 weeks and 12 months of treatment was assessed based on home (primary endpoint; validated AND UA-651BLE monitor), 24-hour ambulatory (A&amp;D TM 2430) and office (AND UA-651BLE) measurements and expressed as standard deviation [SD] of obtained readings. Results: 156 patients were included in the intention-to-treat analysis of the main study (10 weeks, primary analysis) and 138 of the extension study (12 months, exploratory analysis). No significant differences were observed between groups at baseline. Patient characteristics, BP and BPV values after 10 weeks of treatment are reported in the table. No significant differences between groups were observed in home and office BPV at the end of main study, also after adjusting for mean BP reduction. 24-hour weighted SD of systolic BP after 10 weeks of treatment was lower in the nifedipine GITS group (p = 0.032). Exploratory analysis also revealed lower office BPV after 12 months of treatment in nifedipine GITS group (7.15 ± 3.79 vs 9.00 ± 5.28 mmHg, p = 0.026). Conclusions: The study did not identify differences between nifedipine GITS and ramipril in reducing home BPV, while significant differences in favour of nifedipine GITS were observed in 24-hour BPV and in office BPV after 12 months. Clinical impact of these findings remains to be evaluated in outcome studies.

PS-BPC04-1: CHARACTERISTICS OF MONTH-BY-MONTH BLOOD PRESSURE VARIABILITY IN HEMODIALYSIS PATIENTS

Objectives: It is well known that blood pressure (BP) exhibits BP variation in patients with hemodialysis (HD). We have previously reported that high visit-to-visit blood pressure variability is independently correlated with cardiovascular mortality in maintenance HD patients. However, the characteristics of long-term BP variability remains to be elucidated in these patients. The present study, therefore aimed to investigate the characteristics of month-by-month blood pressure variability, as an indicator of long-term blood pressure variability, and the relationship between month-by-month blood pressure variability and cardiovascular mortality in these patients. Design and method: A total of 324 maintenance HD patients, who could be followed for 60 months, were recruited. We used variation independent of the mean (VIM), which was estimated using systolic BP (SBP) in pre-dialysis and post-dialysis at the beginning of the month in 12 consecutive months (pre-VIM-SBP and post-VIM-SBP), as an index of month-by-month BP variability. We also estimated the average of 12 values of differences between the highest and lowest SBP values during a dialysis session (average Δ SBP) and the difference between SBP in January and February and SBP in July and August (seasonal variability of SBP). We investigated (1) the reproducibility of these values, (2) the relationship between these values and background factors, and (3) the association between these values and mortality. Results: (1) Pre-VIM-SBP and post-VIM-SBP showed significant reproducibility (intraclass correlation, 0.456 (P &lt; 0.001) and 0.522 (P &lt; 0.001), respectively]. Seasonal variability of pre-SBP and Δ SBP was observed both at beginning / after 12 months [5.0 (-5.0–19.0) / 5.3 ± 18.3, 7.2 ± 16.7 / 5.0 ± 12.8, respectively]. (2) Higher pre-VIM-SBP was associated with higher interdialytic weight gain and poor nutritional status. Higher post-VIM-SBP was associated with glucose intolerance, higher interdialytic weight gain and poor nutritional status. Higher Δ SBP was associated with glucose intolerance and higher interdialytic weight gain. (3) Higher post-VIM-SBP was associated with a higher rate of cardiovascular deaths independent of other factors (hazard ratio: 1.104, 95% confidence interval: 1.011–1.207, P = 0.028). Conclusions: Month-by-month blood pressure variability in HD patients is reproducible and associated with various background factors. Month-by-month blood pressure variability in post-dialysis SBP is independently correlated with cardiovascular mortality. Further studies are necessary to confirm the mechanism of increased month-by-month blood pressure variability and to clarify whether reducing month-by-month blood pressure variability will improve the prognosis for HD patients.