Blood Pressure Variability In Patients Research Articles

P1651Combination of valsartan/amlodipine is more effective than bisoprolol/hydrochlorothiazide on reduction of blood pressure variability in patients with moderate or severe hypertension after control

P1651Combination of valsartan/amlodipine is more effective than bisoprolol/hydrochlorothiazide on reduction of blood pressure variability in patients with moderate or severe hypertension after control

Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism.

Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire primary hyperparathyroidism patients group (P = 0.04, P = 0.02; respectively). Systolic blood pressure variability is increased in normotensive patients with primary hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.

Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study

BackgroundSevere sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients.MethodsWe prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter. We analyzed SBP variability on the first 5-min window immediately following ICU admission. We performed principal component analysis of multidimensional complexity, and used the first principal component (PC1) as input for Firth logistic regression, controlling for mean systolic pressure (SBP) in the primary analyses, and Acute Physiology and Chronic Health Evaluation (APACHE) II score or NEE dose in the ancillary analyses. Prespecified outcomes were vasopressor independence at 24 h (primary), and 28-day mortality (secondary).ResultsWe studied 51 patients, 51% of whom achieved vasopressor independence at 24 h. Ten percent died at 28 days. PC1 represented 26% of the variance in complexity measures. PC1 was not associated with vasopressor independence on Firth logistic regression (OR 1.04; 95% CI: 0.93–1.16; p = 0.54), but was associated with 28-day mortality (OR 1.16, 95% CI: 1.01–1.35, p = 0.040).ConclusionsEarly SBP variability appears to be associated with 28-day mortality in patients with severe sepsis and septic shock.

Association of blood pressure variability with orthostatic intolerance symptoms.

The short-term blood pressure variability (BPV) reflects autonomic regulatory mechanisms. However, the influence of BPV in orthostatic intolerance (OI) is unknown. Herein, we assessed BPV profiles in patients with OI and determined their association with orthostatic symptoms. In this cross-sectional study, we prospectively enrolled 126 patients presenting with OI at the Seoul National University Hospital from December 2014 to August 2016. Among them, those with other neurological diseases (n = 8) and insufficient BP measurements (n = 15) were excluded. The degree of OI symptoms were measured using the self-administered orthostatic intolerance questionnaire (OIQ). All patients underwent ambulatory BP monitoring and we calculated the standard deviation and coefficient of variation as a measure of BPV. The mean age was 48.6 years and the average of the total OIQ score was 11.6. The severe OI group had higher BPV values than the mild group, although mean BP profiles did not differ significantly. Correlation analysis demonstrated that the orthostatic symptoms were positively correlated with diastolic BPV for the total and awake periods. Multiple linear regression analysis revealed that diastolic BPV (B = 0.46, p = 0.031) and current smoking (B = 4.687, p = 0.018) were independent factors for higher OI symptom scores after adjusting for covariates. The results of the current study demonstrated that a positive correlation exists between BPV and OI symptoms. Further studies are required to confirm the present findings and understand the neural mechanisms contributing to the excessive BPV in patients with OI.

Predictors of visit-to-visit blood pressure variability in patients with hypertension: an analysis of trials with an amlodipine treatment arm

We conducted a post hoc analysis of blood pressure (BP) data from long-term antihypertensive trials to identify predictors of visit-to-visit BP variability (BPV). BPV was defined as the within-subject coefficient of variation in systolic BP from week 12 onward. BP data from the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis, NY92011, and R-0510 trials were pooled and dichotomized into top 25th and bottom 75th percentiles because of positive skew. Significant (P < .001) predictors of BPV within the top 25th percentile were identified using logistic regression. The baseline characteristics of the pooled cohort (n = 47,558) were similar between patients who received amlodipine (n = 17,499) versus other antihypertensive drugs (n = 29,491). BPV in the top 25th percentile was lower with amlodipine versus other treatments (13.7 ± 3.2 vs. 14.3 ± 3.5), with single-study analyses of Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, and Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis all showing BPV was the lowest with amlodipine. Baseline diastolic BP, estimated glomerular filtration rate, and smoking were predictors of BPV, with significant two-way interactions between smoking and both age and body mass index and between systolic BP or diastolic BP and being randomized to treatment other than amlodipine. In conclusion, analysis of BPV required transformation of BP data. After transformation, a number of baseline variables and combinations of variables were predictors of BPV.

Abstract WP245: Hyperacute Blood Pressure Variability is Associated with Early Neurological Deterioration

Background: Increased blood pressure variability (BPV) has been associated with worse outcomes in acute stroke. The effect of hyperacute (&lt;4 hours) BPV on early neurologic deterioration (END) has not been described. Objective: To investigate whether BPV in the first hours after stroke onset is associated with END from prehospital evaluation to presentation at the emergency department Methods: All patients enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial were included. FAST-MAG was a multicenter, randomized, double-blind, placebo-controlled study looking at whether initiation of magnesium sulfate (20 grams/24 hours) in the prehospital setting of acute stroke would reduce disability. Study agent was initiated prior to hospital arrival &lt; 2 hours from symptom onset. BPV was defined as the standard deviation of systolic blood pressure of all readings obtained by 4 hours after initiation of study agent. END was diagnosed as Glasgow Coma Scale (GCS) decrease by ≥ 2 points between the prehospital evaluation and post-emergency department arrival assessment by a study nurse. Results: There were 1,700 cases evaluated by paramedics 24 minutes (15-45 IQR), and by study nurses 150 minutes (120-180) after symptom onset with a median of 6 (IQR 5-6) BP readings. The mean (±SD) age was 69±13 years, 42.6% were women, and the median prehospital GCS was 15 (IQR 14-15). The final diagnosis was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. END was seen in 202 (12%) of subjects, with higher rates noted in those with intracerebral hemorrhage (ICH) compared to cerebral ischemia (31% vs 6%). Overall, there was greater BPV in patients with END (23mmHg vs 15mmHg, p&lt;0.001). Blood pressure variability was greater in cases of cerebral ischemia with END (N=1,245, 18mmHg vs 15mmHg, p=0.004) and in ICH cases with END (N=387, 23mmHg vs 15mmHg, p&lt;0.001). Conclusion: Greater blood pressure variability is associated with early neurologic deterioration in patients with cerebral ischemia and ICH evaluated &lt;2 hours from symptom onset.

Olmesartan with azelnidipine versus with trichlormethiazide on home blood pressure variability in patients with type II diabetes mellitus

The aim of the present study was to compare the effects of olmesartan combined with azelnidipine versus olmesartan combined with trichlormethiazide, on home blood pressure (BP) and pressure variability in type II diabetes mellitus patients using home BP telemonitoring system. We performed an open-label cross-over pilot study of 28 patients with type II diabetes mellitus. Patients received combination treatment with either olmesartan 20 mg plus azelnidipine 16 mg or olmesartan 20 mg plus trichlormethiazide 1 mg for more than 6 weeks each in a cross-over method. The coefficient of morning systolic BP variability in the olmesartan plus azelnidipine group was significantly lower than that in the olmesartan plus trichlormethiazide group (6.4 ± 1.9 vs. 7.5 ± 2.6, P = .004). There were no significant differences in mean morning systolic BP between the two groups. Using home BP telemonitoring for hypertensive patients with type II diabetes, this study revealed for the first time that the olmesartan with azelnidipine combination is superior to the olmesartan with trichlormethiazide combination in reducing home BP variability. The protocol is registered in the trial registry system, and the trial identification number is UMIN000018581.

PS 02-68 THE RELATIONSHIP BETWEEN VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CLIMATE IN JEJU

Objective: In Korea, Jeju Island is a region where monthly mean temperature does not drop below 0 degrees Celsius. The purpose of this study is to find out the relationship between visit-to-visit blood pressure variability (BPV) and the warm climate. Design and Method: From Jan. 2013 to Dec. 2015, 596 patients who take antihypertensive medication were analyzed in our hospital. 70 patients were excluded: 24 paid no visit more than 3 times, 31 had no blood pressure records, and 15 had atrial fibrillation. The measurement of the BPV is standard deviation. The high variability group was defined as the increased medication or the more than 15mmHg of standard deviation (more than 75 percentile) without decreased medication. Results: An inverse correlations were observed between the monthly mean BP, monthly mean temperature (r = −0.847, p < 0.001; Figure1). In high variability group, which were significantly different compared to the normal variability group (130.7 ± 8.5 mmHg vs. 136.1 ± 11.8 mmHg, p < 0.001; 16.5 ± 1.4oC vs.16.2 ± 1.4oC, p = 0.008). In multivariable analysis, higher monthly mean systolic blood pressure (B = 0.058, odds ratio [OR] = 1.06, p < 0.001, 95% CI = 1.04 – 1.08) and lower monthly mean temperature (B = -0.214, odds ratio [OR] = 0.81, p = 0.003, 95% CI = 0.70 – 0.93) were associated with the high variability group. Conclusions: Even in Jeju, a relatively warm region, blood pressure changed according to the temperature. Blood pressure variability in patients who are taking antihypertensive medication had an association with monthly high mean systolic blood pressure and monthly mean temperature.

PP.01.30] PSYCHOLOGICAL STATUS SCORES RELATED WITH LEFT VENTRICULAR MASS INDEX AND MEAN AMBULATORY BLOOD PRESSURE VARIABLES IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Objective: The aim of our study was to determine correlations between psychological status and quality of life scores with left ventricular mass index and mean ambulatory blood pressure variables in patients with arterial hypertension (AH). Design and method: We analyzed 76 ambulatory blood pressure monitoring (ABPM) data of AH patients. ABPM monitor (Spacelabs 90207) was applied after the washout period. After ABPM session patients completed the QL questionnaire “General Well-Being Questionnaire” (J.Siegrist et al.). Left ventricular mass index (LVMI) (L. Teichholtz et all., 1976) was measured using echocardiography (Acuson 128XP). We assessed the following QL scale scores: I - physical well-being, II - physical performance, III - positive psychological well-being, IV - negative psychological well-being, V - psychological performance, VI - social well-being, VII - social performance. Also, patients completed the psychological questionnaire “Minnesota Multiphasis Personality Inventory” (MMPI). We analyzed the following MMPI scales: L – lie scale, F – aggravation scale, K – correction scale, 1 (Hs) – hypochondria, 2 (D) – depression, 3 (Hy) – hysteria, 4 (Pd) – psychopathy, 6 (Pa) – rigidity of affect, 7 (Pt) – psychasthenia, 8 (Sc) – schrizothemia, 9 (Ma) – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The mean ambulatory systolic BP (SBP) was 136.1 ± 11.2; diastolic (DBP) - 89.1 ± 9.0 mmHg (M ± SD). LVMI – 122,1 ± 24,9 g/m2. We found the following correlations: 1) 9 MMPI scale scores (energy, optimism, good mood) were negatively correlated with LVMI (r = -0.33, p < 0.05); 2) 9 MMPI scale scores had the negative relationships with clinical and ambulatory SBP levels (r = -0.23, r = -0.24 respectively, p < 0.05) and with SBP load variables (r = -0.25, p < 0.05). There were no significant links between QL scales scores and LVMI, ambulatory BP indices. Thus, energy, optimism, good mood (9 MMPI scale scores) had a negative correlation with LVMI, also to SBP indices. Conclusions: It was identified inverse correlation between energy, optimism, good mood and LVMI indices, and also with clinical and ambulatory SBP variables of AH patients. There were no links between QL scores and LVMI, ambulatory BP indices.

PP.15.01] VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN UNCOMPLICATED AND COMPLICATED ARTERIAL HYPERTENSION

Objective: Visit-to-visit blood pressure variability (BPV) is associated with adverse cardiovascular outcomes in different patients’ populations. Mechanisms of visit-to-visit BPV in different groups of patients have not been determined yet. The aim of our study was to assess visit-to-visit systolic BPV in patients with uncomplicated controlled arterial hypertension (AH) and patients with controlled AH and stable coronary heart disease (CHD) or heart failure (HF) with reduced ejection fraction. Design and method: In retrospective study we assessed 3 groups of patients with controlled AH. Group 1 included 52 patients with uncomplicated AH (20 men, age 58,9 ± 9,0 yrs) who achieved target BP on RAAS-inhibitor/amlodipine combination. Group 2 included 40 pts with stable CHD (28 men, age 69,2 ± 5,9 yrs). Group 3 included 100 pts with HF with reduced EF (80 men, age 64,4 ± 9,3yrs, mean EF 32,3 ± 4,3%). Pts in groups 2 and 3 received stable therapy for CHD and HF. BP was measured with a validated oscillometric device. Visit-to-visit BPV was calculated as SD for 5–7 visits during 8–18 months of stable therapy. p < 0,05 was considered significant. Results: At first evaluated visit BP in group 1 was 126,4 ± 7,6/76,7 ± 7,2 mmHg, in group 2 - 125,5 ± 7,5/75,2 ± 8,8 mmHg, in group 3 - 127,6 ± 15,1/77,9 ± 8,3 mmHg. At final evaluated visit BP was 123,7 ± 9,7/76,8 ± 6,7mmHg, 124,2 ± 13,4/72 ± 8,5 mmHg and 123,6 ± 13,6/74,8 ± 8,9 mmHg, respectively. Despite stable levels of BP, BPV on stable therapy varied in wide range in all groups: 1,8–16,8 mmHg, 0,7–23,3 mmHg, 2,3–20,0 mmHg for systolic BPV, respectively and 1,0–11,4 mmHg, 0–17,9 mmHg and 1,5–13,1 mmHg for diastolic BPV, respectively. Despite similar levels of final BP, there were significant differences in mean BPV between groups: systolic BPV in group 1 was 7,2 ± 3,6 mmHg vs 7,8 ± 6,6 mmHg in group 2 and 10,2 ± 3,8 mmHg in group 3; diastolic BPV – 4,8 ± 2,7 mmHg vs 7,0 ± 4,4 mmHg and 7,3 ± 2,2 mmHg, respectively (p < 0,01 for trend). No predictors of BPV were found in all groups. Conclusions: Despite similar BP levels HF with reduced EF is associated with the highest visit-to-visit BPV compared to uncomplicated AH and stable CHD. Thus high visit-to-visit BPV may be a marker of the severity of cardiovascular disease.

PP.28.08] LONG- AND SHORT-TERM BLOOD PRESSURE VARIABILITIES IN PATIENTS WITH CONTROLLED ARTERIAL HYPERTENSION ARE NOT INTERCHANGEABLE

Objective: Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular disease risk. In view of the inconvenience of obtaining blood pressure at multiple visits to calculate visit-to-visit BPV, substituting BP variability from calculating short-term variability (intravisit and 24-hours) may be a practical alternative. The aim of the study was to evaluate the associations between long-term (visit-to-visit) and short-term (intravisit and 24-hours) BPV in patients with uncomplicated controlled arterial hypertension (AH). Design and method: 52 pts (20 men, age 58,9 ± 9,0 yrs; 4 smokers; 6 diabetics) with AH without HF were treated to target BP<140/90 mmHg with combination of RAAS-inhibitor and amlodipine for 14mo. Visit-to-visit BPV was calculated as SD for 5 visits during 8 months after target BP achievement. Intravisit BPV was calculated as SD of 3 BP values at each visit. ABPM was performed before treatment and at the end of the study.p < 0,05 was considered significant. Results: Baseline BP was 163,4 ± 8,1/100,9 ± 4,2 mmHg; achieved-123,7 ± 9,7/76,8 ± 6,7 mmHg. Intravisit SBPV varied from 0,8 to 7,0 mmHg (mean 3,1 ± 1,1 mmHg), DBPV – from 0,8 to 4,2 mmHg (mean 2,3 ± 0,7 mmHg). Daytime SBPV varied from 6 to 29 mmHg, daytime DBPV varied from 5 to 31 mmHg. Nighttime SBPV varied from 5 to 18 mmHg, nighttime DBPV – from 4 to 23 mmHg. Visit-to-visit SBPV after achievement of target BP varied from 1,79 mmHg to 16,79 mmHg (mean 7,2 ± 3,6 mmHg); (tertile I < 5,38;II 5,38 - 7,78;III > 7,78 mmHg). The groups were similar by age (I 56,6 ± 8,94, II 59,4 ± 9, III 60,7 ± 9,1 yrs, p > 0,05), gender, metabolic risk factors, baseline and achieved BP. Groups were also similar by intravisit SBPV (3,0 ± 1,0 vs 3,4 ± 1,2 vs 3,0 ± 1,2 mmHg, respectively), intravisit DBPV (2,1 ± 0,8 vs 2,1 ± 0,4 vs 2,5 ± 0,9 mmHg, respectively); daytime SBPV (13,5 ± 3,8 vs 15,6 ± 2,9 vs 14,9 ± 5,1 mmHg), daytime DBPV (14,0 ± 6,1 vs 13,6 ± 3,3 vs 12,3 ± 4,7 mmHg), nighttime SBPV (10,7 ± 2,9 vs 11,6 ± 3,1 vs 11,4 ± 3,1 mmHg) and nighttime DBPV (8,2 ± 2,5 vs 10,2 ± 3,5vs 9,9 ± 4,0 mmHg). No correlation was found between visit-to-visit BPV and short-term variability. Conclusions: Absence of association between visit-to-visit blood pressure variability and short-term variability underlines the importance of its separate calculation in patients with uncomplicated controlled AH without HF.

Effect of Continuous Positive Airway Pressure on Blood Pressure Variability in Patients With Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common risk factor for cardiovascular disease. Continuous positive airway pressure (CPAP) improves OSA symptoms and blood pressure (BP) control. The effect of CPAP on BP variability (BPV) in patients with and without hypertension treated with autotitrating CPAP (APAP) for 2 weeks was studied. A total of 78 participants (76.9% men, 49% hypertensive, mean body mass index 36.2 [6.9] kg/m2 , age 49.0 [12.9] years) underwent 2 weeks of APAP therapy. Office BP, BPV (standard deviation of three BP measurements), and pulse rate were measured before and after treatment. Systolic BPV (5.3±4.9 vs 4.2±3.4 mm Hg, P=.047) and pulse rate (78.0±14.5 vs 75.5±15.8 beats per minute, P=.032) decreased after treatment, particularly in hypertensive participants. Mask leak was independently associated with reduced changes in systolic BPV (r=-0.237, P=.048). Short-term APAP treatment reduced BPV and pulse rate, particularly in hypertensive patients with OSA.

Nocturnal Blood Pressure Variability in Patients with Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea (OSA) is a common respiratory disorder associated with hypertension and cardiovascular complications. Blood pressure variability may be a sign of risk of cardiovascular events. The aim of this study was to investigate the hypothesis that severe OSA syndrome is associated with increased blood pressure variability. Based on respiratory polygraphy, 58 patients were categorized into two groups: severe OSA with apnea/hypopnea index (AHI) greater than 29 episodes per hour (mean 52.2 ± 19.0/h) and mild-to-moderate OSA with AHI between 5 and 30 episodes per hour (mean 20.2 ± 7.8/h). A 24-h noninvasive blood pressure monitoring was performed. The standard deviation of mean blood pressure was used as the indicator of blood pressure variability. In patients with severe, compared with mild-to-moderate OSA, a higher mean nocturnal systolic blood pressure (133.2 ± 17.4mmHg vs. 117.7 ± 31.2mmHg, p < 0.05) and diastolic blood pressure (80.9 ± 13.1mmHg vs. 73.8 ± 9.2, p < 0.01), nocturnal systolic blood pressure variability (12.1 ± 6.0 vs. 7.6 ± 4.3, p < 0.01) and diastolic blood pressure variability (10.5 ± 6.1 vs. 7.3 ± 4.0 p < 0.05), nocturnal mean blood pressure variability (9.1 ± 4.9 mmHg vs. 6.8 ± 3.5 mmHg) were detected. The findings of the study point to increased nocturnal systolic and diastolic arterial blood pressure and blood pressure variability as risk factors of cardiovascular complications in patients with severe OSA.

Blood Pressure Self-Measurement.

Blood pressure self-measurement has been used extensively as part of several clinical processes including in the home monitoring setting for mitigating white coat effect and gaining more detailed insights into the blood pressure variability of patients over time. Self-measurement of BP is also being used as part of telemonitoring and telemedicine processes, as well as in the waiting rooms and self-measurement rooms of general practice clinics, specialized hospital department's outpatient clinics, and in other types of care facilitates and institutions.The aim of this review is to provide an overview of where, when, and how blood pressure self-measurement is being used, which official clinical guidelines and procedures are available for its implementation, as well as the opportunities and challenges that are related to its use.

Blood pressure variability after catheter-based renal sympathetic denervation in patients with resistant hypertension.

Renal denervation (RDN) reduces sympathetic activity and blood pressure (BP) in patients with resistant hypertension. Increased 24-h BP variability is associated with adverse cardiovascular outcomes and related to sympathetic activation. This multicenter study investigated the effect of RDN on BP variability in 84 patients with uncontrolled hypertension (office systolic BP ≥140 mmHg) despite treatment with greater than three antihypertensive agents. BP variability was assessed by means of standard deviation, coefficient of variation (standard deviation/mean), and average real variability of 24-h ambulatory SBP at 3-month and 6-month follow-up. RDN significantly reduced office BP by 17/6 mmHg at 3-month and 19/7 mmHg at 6-month follow-up (P < 0.001 for all) and 24-h ambulatory BP by 9/5 mmHg (P < 0.001/P = 0.001) after 3 months and 12/7 mmHg (P < 0.001/P < 0.001) after 6 months. Standard deviation significantly decreased from 17.1 to 14.9 mmHg (P = 0.008) and 15.3 mmHg (P = 0.037), consistent with a reduction of coefficient of variation from 0.116 to 0.103 (P = 0.035) and 0.104 (P = 0.071) and average real variability from 12.3 to 10.9 (P = 0.029) and 11.0 (P = 0.054) after 3-month and 6-month, respectively. Interestingly, also BP nonresponders (change in office systolic BP < 10 mmHg after 6 months) showed a significant reduction of standard deviation after 3 months (P = 0.041, n = 26) and a borderline significant reduction at 6-month (P = 0.057, n = 28). RDN reduces office and ambulatory BP and BP variability in patients with resistant hypertension. Improvement in BP variability was also documented in patients characterized as office BP nonresponders after 6 months.

Assessment of Short-term Blood Pressure Variability in Patients With Ascending Aortic Dilatation.

Blood pressure variability (BPV) is a novel parameter related to adverse cardiovascular findings and events, especially in hypertensive patients. The aim of the present study was to investigate the relationship between short-term BPV and ascending aortic dilatation (AAD). Hypertensive patients with AAD may exhibit higher short-term BPV compared to hypertensive patients with normal diameter ascending aorta and BPV may be correlated with aortic sizes. Seventy-six hypertensive patients with AAD and 181 hypertensive patients with a normal-diameter ascending aorta were retrospectively enrolled in the study. Clinical data, echocardiographic characteristics, and 24-hour ambulatory blood pressure monitoring characteristics were compared between the 2 groups. Standard deviation (SD) and Δ of BP were used as parameters of BPV. Although 24-hour mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar between the 2 groups, the SD of SBP and SD of DBP values were significantly higher in AAD patients (17.2 ± 6.8 vs 13.8 ± 3.5, P < 0.01; and 12.1 ± 5.1 vs 10.7 ± 3.1, P = 0.02, respectively). Daytime SD of SBP values were higher in AAD patients, whereas nighttime SD of SBP values did not differ between groups. In multivariate linear regression analysis, 24-hour SD of SBP, 24-hour Δ SBP, daytime SD of SBP, daytime Δ SBP, and left ventricular mass index were independently correlated with aortic size index. Our study revealed higher levels of short-term BPV in hypertensive patients with AAD. This conclusion warrants further study.

Association among epicardial fat, heart rate recovery and circadian blood pressure variability in patients with hypertension.

BackgroundEpicardial fat tissue is known to have an unique endocrine function which affect the cardiac autonomic system. Heart rate recovery (HRR) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We aimed to investigate the association among epicardial fat thickness (EFT), HRR and circadian blood pressure (BP) variation in patients with hypertension.MethodsA total of 358 consecutive patients who underwent both 24-hour ambulatory BP monitoring (ABPM) and a treadmill test were enrolled. Echocardiographic EFT and HRR, defined as peak heart rate minus heart rate after a 1-min recovery time, were measured. Patients were classified according to the ABPM; 147 patients with hypertension with a dipping pattern at night (dippers), 140 patients with hypertension with a non-dipping pattern at night (non-dippers) and 71 normotensive controls.ResultsEFT was significantly higher in hypertensive patients, especially in the non-dipper group, compared to the controls (non-dippers, 7.5 ± 2.9 mm; dippers, 6.6 ± 1.6 mm; controls, 5.5 ± 2.1 mm; p < 0.001). HRR was significantly lower in both hypertensive groups as compared to the control group and was the lowest in the non-dipper group (non-dipper, 26.6 ± 18.6; dipper, 29.5 ± 21.5; control, 71.4 ± 19.8; p < 0.001). EFT was significantly correlated with age, body mass index, 24-hour mean systolic BP and 24 h mean BP variability, whereas exercise duration, metabolic equivalents (METs) and HRR were inversely correlated with EFT. Furthermore, EFT > 6.7 mm was associated with a blunted HRR with 76 % sensitivity and 61 % specificity (ROC area under curve: 0.71, 95 % confidence interval, CI = 0.65–0.76, p < 0.001). In a multivariate analysis, EFT (odds ratio, OR = 3.53, 95 % CI = 1.20–10.37, p = 0.022) and 24-hour mean BP variability (OR = 1.09, 95 % CI = 1.03–1.16, p = 0.005) were independent predictors of a blunted HRR defined as HRR ≤ 12 beats (n = 63) in patients with hypertension.ConclusionEFT and HRR were significantly correlated with circadian BP variability in patients with hypertension. EFT and circadian BP variability were independent predictors of blunted HRR, which suggests a link between epicardial fat and autonomic dysregulation in hypertension.

Abstract 16891: Beat-to-beat Systolic as Well as Diastolic Blood Pressure Variability is High in Atrial Fibrillation

Background: Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, beyond thromboembolism. The underlying mechanisms for this association are not fully understood but may involve effects on artery walls and endothelial function. High blood pressure (BP) incurs an increased risk of cardiovascular events. The interplay between AF and BP is insufficiently studied. Material and methods: We studied 33 patients, 21 in AF and 13 in sinus rhythm (SR), during coronary angiography. After catheterization of the radial artery invasive BP was recorded four times at three locations (radial artery, brachial artery (twice) and ascending aorta). BP was recorded for a minimum of 15 consecutive beats. BP variability defined as mean beat-to-beat BP difference was calculated for systolic and diastolic BP at each site. Results: There was a significant difference (p&lt;0.001) in mean systolic and diastolic beat-to-beat BP variability between the AF and SR groups at all locations, see figures. No significant difference in BP variability was seen between locations. RA = Radial Artery; BA = Brachial Artery; AA = Ascending Aorta Conclusions: Beat-to-beat BP variability in patients with AF is substantially higher than in patients with SR. Systolic BP variability was almost twice as high and diastolic BP variability was almost seven times as high in AF as compared to SR. Hemodynamic effects of this beat-to-beat variation in BP may have negative effects on vascular structure and function, possibly contributing to the disproportionate increase in cardiovascular morbidity and mortality seen in AF patients.

Multidisciplinary Treatment of the Metabolic Syndrome Lowers Blood Pressure Variability Independent of Blood Pressure Control.

Blood pressure (BP) variability (BPV) contributes to target organ damage independent of BP. The authors examined the effect of a 1-year multidisciplinary intervention on BPV in patients with the metabolic syndrome (MetS) as defined by criteria from the Third Report of the Adult Treatment Panel. Forty-four nondiabetic patients underwent clinical and biochemical profiling, 24-hour ambulatory BP monitoring (ABPM), body composition, carotid intima-media thickness, and carotid-femoral pulse wave velocity (PWV). The intervention targeted all MetS components. BPV was assessed by the standard deviation of daytime systolic BP derived from ABPM. Patients with low and high BPV (lower or higher than the median daytime standard deviation of 11.6 mm Hg) did not differ in regards to systolic and diastolic BP, age, fasting glucose, glycated hemoglobin, and body mass index, but the high-variability group had higher values of low-density lipoprotein and leg fat. The 1-year intervention resulted in weight reduction but not BP-lowering. BPV declined in the high-variability group in association with lowering of PWV, C-reactive protein, glycated hemoglobin, alanine aminotransferase, asymmetric dimethylarginine, and increased high-density lipoprotein cholesterol. A multidisciplinary intervention independent of BP-lowering normalized BPV, lowered PWV, and enhanced metabolic control.

P-160 Estimation of autonomic nervous system activity by heart rate and blood pressure variability in patients with gastric and colorectal cancer. Preliminary study

P-160 Estimation of autonomic nervous system activity by heart rate and blood pressure variability in patients with gastric and colorectal cancer. Preliminary study