Indices Of Blood Pressure Variability Research Articles

Актуальні аспекти варіабельності артеріального тиску при артеріальній гіпертензії

Ця стаття є оглядом даних літератури про клінічне значення варіабельності артеріального тиску в пацієнтів з артеріальною гіпертензією. Наведено найбільш часто аналізовані показники варіабельності артеріального тиску, особливості класифікації. Подані результати досліджень, присвячених взаємозв’язку показників варіабельності артеріального тиску та стратифікації серцево-судинних ризиків. Наводиться огляд даних про особливості лікування пацієнтів з артеріальною гіпертензією з урахуванням варіабельності артеріального тиску.

Day-by-day blood pressure variability in hospitalized patients with COVID-19.

In a retrospective analysis, the authors investigated day‐by‐day blood pressure variability (BPV) and its association with clinical outcomes (critical vs. severe and discharged) in hospitalized patients with COVID‐19. The study participants were hospitalized in Tongji Hospital, Guanggu Branch, Wuhan, China, between February 1 and April 1, 2020. BPV was assessed as standard derivation (SD), coefficient of variation (CV), and variability independent of mean (VIM). The 79 participants included 60 (75.9%) severe patients discharged from the hospital after up to 47 days of hospitalization, and 19 (24.1%) critically ill patients transferred to other hospitals for further treatment (n = 13), admitted to ICU (n = 3) or died (n=3). Despite similar use of antihypertensive medication (47.4% vs. 41.7%) and mean levels of systolic/diastolic blood pressure (131.3/75.2 vs. 125.4/77.3 mmHg), critically ill patients, compared with severe and discharged patients, had a significantly (p ≤ .04) greater variability of systolic (SD 14.92 vs. 10.84 mmHg, CV 11.39% vs. 8.56%, and VIM 15.15 vs. 10.75 units) and diastolic blood pressure (SD 9.38 vs. 7.50 mmHg, CV 12.66% vs. 9.80%, and VIM 9.33 vs. 7.50 units). After adjustment for confounding factors, the odds ratios for critical versus severe and discharged patients for systolic BPV were 3.41 (95% confidence interval [CI] 1.20‐9.66, p = .02), 4.09 (95% CI 1.14‐14.67, p = .03), and 2.81 (95% CI 1.12‐7.05, p = .03) for each 5‐mmHg increment in SD, 5% increment in CV, and 5‐unit increment in VIM, respectively. Similar trends were observed for diastolic BPV indices (p ≤ .08). In conclusion, in patients with COVID‐19, BPV was greater and associated with worse clinical outcomes.

MO642DAPAGLIFLOZIN HAS NO IMPACT ON SHORT-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH TYPE-2 DIABETES MELLITUS

Abstract Background and Aims Increased blood-pressure-variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM. Method This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM (NCT02887677). Subjects were randomized to oral dapagliflozin 10mg once daily or placebo for 12 weeks. All participants underwent 24-h ambulatory blood pressure (BP) monitoring with the Mobil-O-Graph NG device at baseline and study-end. Standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), average real variability (ARV) and variation independent of mean (VIM) were calculated with validated formulae for the 24-h and the daytime and nighttime periods. Results Dapagliflozin reduced 24-h brachial BP compared to placebo. From baseline to study-end 24-h brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51±3.45 vs 11.05±3.35; p=0.326, SBP-wSD: 13.59±3.60 vs 13.48±3.33; p=0.811) or placebo (SBP-ARV: 11.47±3.63 vs 11.05±3.00; p=0.388, SBP-wSD: 13.85±4.38 vs 13.97±3.87; p=0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no differences between the groups were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between-groups (SBP-wSD: dapagliflozin: -0.11±3.05 vs placebo: 0.12±4.20; p=0.227). Conclusion This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in patients with T2DM, showing no effect on dapagliflozin on all BPV indexes studied.

Sex Differences in Blood Pressure Variability in response to Sodium and Potassium Diets

It is well established that Americans consume more salt than recommended by the Dietary Guidelines for Americans. High sodium diets have been shown to increase blood pressure (BP) while dietary potassium is known for its BP lowering properties. Elevated BP variability (BPV), as indicated by spontaneous fluctuations in BP, is associated with cardiovascular morbidity and mortality. Although no recommendations exist for targeting elevated BPV, understanding how different dietary components affect BPV could be important to reduce CVD. Limited literature from rodent and human studies suggests a relation between a high sodium diet and an increased BPV. Additionally, mechanisms regulating BP between men and women differ which may lead to the hypothesis that BPV differs as well. Thus, the interactive effects of dietary sodium and potassium on BPV in humans are unknown as well as whether potential sex differences exist. The purpose of this study was to compare BP and BPV responses to varying dietary levels of sodium and potassium in salt-resistant, healthy, normotensive young adults. Twenty women (27±1 yrs. old; SBP: 112±3 mmHg; DBP: 71±1 mmHg; BMI: 24.1±0.7 kg/m2) and 17 men (26±1 yrs. old; SBP: 117±3 mmHg; DBP: 75±2 mmHg; BMI: 24.4±0.7 kg/m2) completed 7 days each of the following diets: moderate potassium/low sodium diet (65 mmol potassium/50 mmol sodium; MK/LS), a moderate potassium/high sodium diet (65 mmol potassium/300 mmol sodium; MK/HS) and a high potassium/high sodium (120 mmol potassium/300 mmol sodium; HK/HS) in random order. BP and BPV were calculated from 24 h ambulatory BP monitoring on day 6 of each diet. Average Real Variability (ARV) was used as an index of BPV. A mixed-model ANOVA was performed with a Tukey post hoc test with diet as a within subject factor and sex as a between subject factor to determine whether differences existed between men and women on each diet. For 24 h SBP, the main effect of sex was significant (p=0.01) and the sex*diet interaction was significant (p=0.03) such that men had a higher 24 h SBP than women on the HK/HS diet (117±2 mmHg vs 112±1 mmHg, p=0.02). On the MK/LS and MK/HS diets, 24 h SBP was not different between men and women (p>0.05). For 24 h DBP, the main effect of diet was significant (p=0.009) such that 24 h DBP was higher on the MK/LS diet vs HK/HS diet (69±1 mmHg vs 67±1 mmHg, p=0.01) and higher on MK/LS diet compared to MK/HS diet regardless of sex (69±1 mmHg vs 68±1 mm Hg, p=0.02). For 24 h SBP ARV, the main effects of diet and sex and the interaction of sex*diet were not significant (all p>0.05). For 24 h DBP ARV, the main effect of sex was significant (p=0.006) such that men had higher variability regardless of diet (9±0.2 mmHg vs 7±0.2 mm Hg). Our results suggest that in the context of a high sodium diet, potassium may help lower BP in women but not in men. In addition, men tended to have a higher BPV compared to women regardless of the diet. Future studies are warranted to further study the differential response of men and women to the effectiveness of dietary interventions for reducing CVD risk.

Sugar‐Sweetened Soft Drink Consumption Acutely Modifies Cardiovascular Control in Healthy Adults

Long-term consumption of sugar-sweetened soft drinks is associated with an increased prevalence of cardiometabolic diseases. Previous reports demonstrate that consuming a bolus of fructose-sweetened water acutely increases blood pressure variability (BPV) and decreases spontaneous cardiovagal baroreflex sensitivity (cBRS) and heart rate variability (HRV). If caffeinated soft drinks containing high levels of fructose elicit similar responses is unknown. Objective Test the hypothesis that high-fructose corn syrup (HFCS) sweetened soft drink consumption increases BPV and decreases cBRS and HRV compared to water and artificially-sweetened (Diet) and sucrose-sweetened (Sucrose) soft drinks. Methods Twelve subjects (2 females; age 24 ± 4 y; body mass index: 24.1 ± 3.1 kg/m2) completed four randomized, double-blinded trials in which they drank 500 mL of water or commercially available soft drinks matched for taste and caffeine content (~77 mg). Subjects were not naïve to caffeine and consumed 346 ± 481 mL of soft drinks per week. We continuously measured beat-to-beat blood pressure (finger photoplethysmography) and R-R interval (ECG) before and 30 minutes after drink consumption during supine rest for 5 minutes during spontaneous and paced breathing (frequency of 15 breathes/minute). BPV was evaluated using standard deviation, average real variability, and successive variation methods for systolic and diastolic blood pressure. cBRS was assessed using the sequence method for up and down sequences. Overall cBRS was calculated as the average of up and down sequences. HRV was evaluated using the root mean square of successive differences in R-R interval (RMSSD) and the high frequency power component following power spectral density analysis (HF). Due to variation at baseline, data were analyzed as the magnitude of change (∆) from pre-drink consumption using a mixed-effects model with post hoc Sidak's test comparisons. Data are reported as mean ± SD. Results There were no differences between conditions for indices of BPV in standard deviation, average real variability, and successive variation during spontaneous and paced breathing (P≥0.07). Overall cBRS during spontaneous breathing was reduced in the HFCS (-3 ± 5 ms/mmHg) and Sucrose (-3 ± 5 ms/mmHg) trials compared to Water (+1 ± 5 ms/mmHg, P<0.03). Sucrose also elicited greater reductions in overall cBRS during spontaneous breathing compared to Diet (+1 ± 4 ms/mmHg, P=0.01) and HFCS was reduced during down sequences compared to Diet (-3 ± 5 vs. +2 ± 3 ms/mmHg, P=0.057). HFCS evoked greater reductions in RMSSD during paced breathing compared to Water (-26 ± 34 vs. +2 ± 26 ms, P<0.01), but not Diet (-11 ± 26 ms, P=0.43) nor Sucrose (-12 ± 11 ms, P=0.51). There were no differences in HF during paced breathing between HFCS and the other trials (Water: -408 ± 1178; Diet: -62 ± 1270; Sucrose: -871 ± 1549; HFCS: -155 ± 1505 ms2, P≥0.13). Conclusion These findings suggest that in healthy young adults, sugar-sweetened soft drink consumption acutely reduces cBRS and HRV but does not alter BPV.

ASSOCIATION OF SHORT-TERM AND MID-TERM BLOOD PRESSURE VARIABILITY INDICES WITH LEFT VENTICULAR MASS INDEX IN CHRONIC KIDNEY DISEASE PATIENTS

Objective: Several studies have demonstrated that increased blood pressure (BP) variability is associated with target-organ damage development in hypertensive patients. However, the impact of BP variability (BPV) indices on target-organ damage in chronic kidney disease patients (CKD) is unclear. Aim of the study was to evaluate the association between short-term and mid-term BPV indices with left ventricular mass index (LVMI) in chronic kidney disease patients. Design and method: A total of 131 CKD patients, referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory BP monitoring, home BP monitoring and echocardiographic measurements. Short-term BPV was expressed by standard deviation (SD), time rate (TR) of BP variation and coefficient of variation (CV) of systolic and diastolic BP for both 24-h, daytime and nighttime intervals. Mid-term BPV was expressed by SD and CV of systolic and diastolic BP for morning and evening BP measurements. Statistical analysis was performed by means of bivariate correlations, simple and multiple linear regression analysis. Results: All home BPV indices did not correlated significantly with LVMI. Regarding short-term BPV, only 24-h systolic TR (r = 0.320, p &lt; 0.001) and daytime systolic TR of BP variation (r = 0.310, p &lt; 0.001) significantly correlated with LVMI. The multivariate analysis revealed that 24-h systolic TR of BP variation was the only variable that was significantly and independently associated with LVMI (B = 12.016 95%CI 4.981–19.052, p &lt; 0.001). The association remained significant after adjustment for baseline characteristics and risk factors. Conclusions: Short-term BPV indices such as 24-h and daytime systolic TR of BP variation were significantly associated with LVMI in CKD patients. In contrast, no significant association was observed between mid-term BPV indices and LVMI.

AMBULATORY BLOOD PRESSURE PROFILE AND BLOOD PRESSURE VARIABILITY IN PERITONEAL DIALYSIS COMPARED TO HEMODIALYSIS AND CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension in ESRD patients is highly prevalent and poorly controlled. Data on ambulatory blood pressure (BP) profile and BP variability (BPV) in peritoneal dialysis (PD) patients are absent. This study examined the BP profile and BPV of patients undergoing PD in comparison to hemodialysis (HD) and pre-dialysis CKD patients. Design and method: Thirty-eight PD patients were matched for age, gender and dialysis vintage with 76 HD patients and for age and gender with 38 patients with CKD stage 2–4. Patients under PD and HD underwent 48-hour and CKD patients 24-hour ambulatory BP monitoring. BP levels and BPV indexes were compared for the 48hour, 1st and 2nd 24hour, daytime and nighttime periods. Two-way mixed ANOVA analysis for repeated measurements was used to evaluate the effect of dialysis modality and time on ambulatory BP in PD and HD. Results: During all periods studied, SBP and DBP were numerically higher but not statistically different in PD than in HD patients. Systolic BP was significantly higher in PD or HD compared with predialysis CKD (PD:138.38 ± 20.97; HD:133.75 ± 15.5; CKD:125.52 ± 13.4, p = 0.003), a difference evident also during daytime and night-time periods. Repeated-measurements analysis showed no effect of dialysis modality on ambulatory BP during all periods studied. All BPV indexes studied were similar between PD and HD patients and higher than CKD individuals (1st-24hour systolic-ARV: PD: 11.86 ± 3.19; HD:11.23 ± 3.45; CKD:9.81 ± 2.49, p = 0.016). Conclusions: Average BP levels and BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. The dialysis modality has no effect on ambulatory BP profile. These results suggest that PD is no better than HD with regards to overall BP control or BP fluctuations over time.

Visit-to-Visit Blood Pressure Variability and Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.

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Dapagliflozin Does Not Affect Short-Term Blood Pressure Variability in Patients With Type 2 Diabetes Mellitus.

Increased blood pressure variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type-2 diabetes mellitus (T2DM). Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM. This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM. Subjects were randomized to dapagliflozin 10 mg/day or placebo for 12 weeks. All participants underwent 24-hour ambulatory blood pressure (BP) monitoring with Mobil-O-Graph-NG device at baseline and study-end. SD, weighted SD (wSD), coefficient of variation, average real variability (ARV), and variation independent of mean were calculated for the 24-hour, daytime and nighttime periods. Dapagliflozin reduced 24-hour brachial BP compared with placebo. From baseline to study-end 24-hour brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51 ± 3.45 vs. 11.05 ± 3.35; P = 0.326, SBP-wSD: 13.59 ± 3.60 vs. 13.48 ± 3.33; P = 0.811) or placebo (SBP-ARV: 11.47 ± 3.63 vs. 11.05 ± 3.00; P = 0.388, SBP-wSD: 13.85 ± 4.38 vs. 13.97 ± 3.87; P = 0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no between-group differences were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between groups (SBP-wSD: dapagliflozin: -0.11 ± 3.05 vs. placebo: 0.12 ± 4.20; P = 0.227). This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in T2DM, showing no effect of dapagliflozin on all BPV indexes studied. Trial Number NCT02887677.

Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study

BackgroundWhether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). MethodsThis case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. ResultsCSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1−3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r2 = 0.308−0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804−0.943; P = .001), with r2 = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489−47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709−196.660; P = .001) having the highest risks of CSVD (r2 = 0.413). ConclusionsLower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.

Psychological stress and long-term blood pressure variability of military young males: The cardiorespiratory fitness and hospitalization events in armed forces study.

BACKGROUNDAcute stress might increase short-term heart rate variability and blood pressure variability (BPV); however, chronic stress would not alter short-term BPV in animal models.AIMTo examine the association of psychological stress with long-term BPV in young male humans.METHODSWe prospectively examined the association of chronic psychological stress with long-term BPV in 1112 healthy military males, averaged 32.2 years from the cardiorespiratory fitness and hospitalization events in armed forces study in Taiwan. Psychological stress was quantitatively evaluated with the Brief Symptom Rating Scale (BSRS-5), from the least symptom of 0 to the most severe of 20, and the five components of anxiety, insomnia, depression, interpersonal sensitivity, and hostility (the severity score in each component from 0 to 4). Long-term BPV was assessed by standard deviation (SD) for systolic and diastolic blood pressure (SBP and DBP), and average real variability (ARV), defined as the average absolute difference between successive measurements of SBP or DBP, across four visits in the study period from 2012 to 2018 (2012-14, 2014-15, 2015-16, and 2016-18).RESULTSThe results of multivariable linear regressions showed that there were no correlations of the BSRS-5 score with SDSBP, SDDBP, ARVSBP, and ARVDBP after adjusting for all the covariates [β(SE): -0.022 (0.024), -0.023 (0.026), -0.001 (0.018), and 0.001 (0.020), respectively; P > 0.05 for all]. In addition, there were also no correlations between each component of the BSRS score and the long-term BPV indexes.CONCLUSIONOur findings suggest that chronic psychological stress might not be associated with long-term BPV in military young male humans.

Isoflavone Supplementation Does Not Potentiate the Effect of Combined Exercise Training on Resting and Ambulatory Blood Pressure in Non-Obese Postmenopausal Women: A Randomized Double-Blind Controlled Trial-A Pilot Study.

Physical exercise and isoflavone supplementation are potential strategies to prevent and treat cardiovascular diseases in postmenopausal women. The aim of this study was to investigate whether there are additive effects of isoflavone supplementation when associated with combined aerobic and resistance exercise on resting and ambulatory blood pressure monitoring (ABPM) and in blood pressure variability (BPV). Thirty-one non-obese postmenopausal women were randomly allocated into two groups: placebo and exercise (Placebo n = 19); and isoflavone supplementation (100 mg/day) and exercise (isoflavone n = 19). ABPM and BPV were evaluated before and after 10 weeks of moderate combined (aerobic and resistance) exercise training. Generalized Estimating Equation (GEE) with Bonferroni correction and intention-to-treat analysis was used to compare the effects of interventions on resting BP, ABPM and BPV. Combined exercise training decreased resting systolic (SBP) and diastolic blood pressure (DBP) and reduced 24 h and awake ambulatory SBP, DBP and mean blood pressure over time, with no additional effects of isoflavone supplementation. No changes were observed in sleep period, or in BPV indexes (Standard Deviation of 24 h (SD), daytime and nighttime interval (SDdn) and average real variability (ARV) in both groups. We conclude that isoflavone supplementation does not potentiate the effects of combined training on resting and ambulatorial systolic and diastolic blood pressure in non-obese postmenopausal women.

Short-Term but not Long-Term Blood Pressure Variability Is a Predictor of Adverse Cardiovascular Outcomes in Young Untreated Hypertensives.

Whether blood pressure variability (BPV) measured with ambulatory monitoring (short-term BPV) or computed from office visits (long-term BPV) are related to each other and carry similar prognostic information is not well known. We investigated the independent determinants of short-term and long-term BPVs and their predictive capacity for the development of major adverse cardiovascular and renal events (MACEs) in a cohort of young hypertensive participants. Long-term BPV was calculated as visit-to-visit SD and average real variability from office blood pressure (BP) measured during 7 visits, within 1 year. Short-term BPV was calculated as weighted 24-hour SD and coefficient of variation. Hazard ratios (HRs) for risk of MACE were computed from multivariable Cox regressions. 1,167 participants were examined; mean age was 33.1 ± 8.5 years. Variables independently associated with 24-hour systolic SD were 24-hour systolic BP, low physical activity, smoking, baseline office pulse pressure, systolic BP dipping, and diastolic white coat effect, while those associated with long-term BPV were mean systolic BP, age, female gender, and baseline office heart rate. During a median follow-up of 17.4 years 75 MACEs occurred. In Cox analysis only short-term BPV resulted a significant predictor of MACE (HR, 1.31 (1.07-1.59); P = 0.0086), while no index of long-term BPV was independently associated with outcome. In young hypertensive subjects only short-term BPV resulted a significant predictor of MACE on top of traditional ambulatory BP monitoring parameters. Whether reduction of short-term BPV with therapy may reduce the cardiovascular risk independently from the effects on 24-hour BP is a matter for future research.

Association of home and ambulatory blood pressure variability with left ventricular mass index in chronic kidney disease patients.

Increased blood pressure (BP) variability is associated with the development of target organ damage. However, the optimal type and index of BP variability (BPV) regarding their prognostic significance is unclear. The aim of our study was to compare the association of ambulatory and home BPV with the left ventricular mass index (LVMI) in patients with chronic kidney disease (CKD). From a total of 1560 consecutive subjects, 137 hypertensive patients with CKD underwent home and ambulatory BP monitoring and echocardiographic measurements. The variability of home BP monitoring was quantified by using the standard deviation (SD), coefficient of variation (CV), and morning minus evening BP values. Ambulatory BPV was quantified using the SD, CV, and the time rate (TR) of BP variation. The univariate analysis demonstrated that day-to-day systolic SD and the 24-h TR of systolic BP (SBP) variation were significantly associated with the LVMI. The multivariate linear regression analysis showed a significant and independent association of the LVMI with the 24-h TR of SBP variation (B = 9.204, 95% CI: 1.735-16.672; p = 0.016). A 0.1-mmHg/min increase in the 24-h TR of SBP variation was associated with an increment of 9.204 g/m2 in the LVMI, even after adjustment for BP and other vascular risk factors. In conclusion, ambulatory BPV but not home BPV was associated with the LVMI in CKD patients. The 24-h TR of SBP variation was the only BPV index associated with the LVMI, independent of average BP values.

Some features of blood pressure variability in patients with arterial hypertension in various modes of antihypertensive therapy

Aim. The study objective was to compare different timing modes of hypertension medications dosing in patients with arterial hypertension in relation to blood pressure level and variability.Materials and methods. The study included 103 subjects with previously diagnosed AH in whom 24h ambulatory blood pressure monitoring records of adequate quality were obtained. Participants were stratified to three groups based on timing of hypertension medications dosing – morning dosing (group 1), bedtime dosing (group 2), and as needed (group 3). The last one included patients with low compliance of prescribed medications and irregular antihypertensive drugs intake. The systolic and diastolic blood pressure variability indices – standard deviation (VAR1) and root-mean-square value of the difference between consecutive blood pressure measurements (VAR2) were calculated. The Kruskal-Wallis ANOVA or χ2-test, as appropriate, was used to compare the groups. A two-sided P value &lt;0.05 was considered statistically significant. Analysis of data included corrections for multiple comparisons.Results. Statistically significant differences were found in mean 24-h diastolic blood pressure values between groups 1 and 3, 2 and 3 (P = 0.02), awake mean diastolic blood pressure values between groups 1 and 3 (P = 0.03) and for VAR1 night-time systolic blood pressure between groups 1 and 3, 2 and 3 (P &lt; 0.05). There were no significant differences between any of the studied parameters between the groups with the morning and evening dosing of antihypertensive drugs.Conclusions. Treatment mode does not significantly affect the short-term variability of blood pressure, determined by the standard deviation from the mean blood pressure and the root-mean-square value of the difference between consecutive blood pressure measurements for a given time period.

Increased Arterial Stiffness Amplifies the Association Between Home Blood Pressure Variability and Cardiac Overload: The J-HOP Study.

Increased blood pressure (BP) variability, an index of hemodynamic stress, leads to cardiac overload and worse cardiovascular prognosis. The association between day-by-day home BP variability and NT-proBNP (N-terminal pro-B-type natriuretic peptide) as an index of cardiac overload may be amplified by increased arterial stiffness as assessed by brachial-ankle pulse wave velocity (baPWV). J-HOP (Japan Morning Surge-Home Blood Pressure) Study participants who were selected from a practitioner-based population with at least one cardiovascular risk factor underwent home BP monitoring, and their BP levels and SD, coefficient of variation, and average real variability as indexes of systolic BP variability were assessed. We analyzed 2115 individuals without prevalent heart failure and divided them into lower (<1800 cm/s, n=1464) and higher (≥1800 cm/s, n=651) baPWV groups. The higher baPWV group had significantly higher SDSBP, CVSBP, ARVSBP values, and NT-proBNP levels than the lower baPWV group (all P<0.001). In the higher baPWV group, a multiple linear regression analysis revealed that the SDSBP was associated with the NT-proBNP level after adjustment for traditional cardiovascular risk factors including the average home systolic BP (coefficient per 1 SD increase, 0.049 [95% CI, 0.018-0.081]; P=0.002). Similar trends were found for CVSBP (P=0.003) and ARVSBP (P=0.004). However, these associations were not found in the lower baPWV group. There was an interaction between all indexes of systolic BP variability and the NT-proBNP level according to lower or higher baPWV group (all P<0.05). Arterial stiffness amplified the association between home BP variability and cardiac overload.

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

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

Reduced Postpartum Cognitive Function in Young Women with a History of Preeclampsia: Association with Blood Pressure Variability

Preeclampsia is a disorder of pregnancy characterized by de novo hypertension and multi‐organ dysfunction in mid to late gestation. After pregnancy, women with a history of preeclampsia (hxPE) are at a two‐ and fourfold increased risk of incident stroke and chronic hypertension respectively. Excessive 24‐hour blood pressure variability (BPV) is exaggerated in age‐related hypertension and associated with the progression of ischemic damage to the cerebral microstructure and cognitive decline independent of average blood pressure (BP). Young women with hxPE exhibit signs of cerebral microvascular damage early after pregnancy, but the degree to which cognitive function is altered remains unknown. Furthermore, the relation between elevated BPV and cognitive function has not been assessed in women with hxPE. Therefore, the purpose of this study was to 1) establish whether cognitive function is reduced early postpartum women with hxPE compared with healthy pregnancy, and 2) determine the extent to which BPV is associated with cognitive function in women with hxPE. Women with hxPE (n=24; 32 ± 1 yrs) and healthy pregnancy controls (n=20; 33 ± 1 yrs) were assessed between 1–3 years postpartum. Participants wore an automated, portable brachial cuff for 24‐hour ambulatory blood pressure monitoring. BPV was expressed as the standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24‐hour ambulatory BP values. Cognitive function was assessed in domains of memory, processing speed, and executive function. Women with hxPE had reduced executive function (−0.26 ± 0.1 vs. 0.32±0.1 Z‐score; F(1,41) = 4.486, p=0.04) and slower processing speed (−0.28 ± 0.2 vs. 0.34 ± 0.2 Z‐score; F(1,41) = 4.135, p=0.050) compared with controls independent of educational attainment. Memory performance did not differ between groups. Women with hxPE had higher 24‐hour systolic BP (121 ± 2 vs. 116 ± 2 mmHg; p=0.052) and diastolic BP (78 ± 1 vs. 74 ± 1 mmHg; p=0.055) compared with controls. However, no indices of systolic or diastolic BPV differed between groups. Greater 24‐hour diastolic BPV was associated with reductions in executive function independent of average diastolic BP, age, body mass index, and education among women with hxPE (SD: r = −0.54, p=0.03; CV: r = −0.52, p=0.04) but not among controls (SD: r = 0.12, p =0.67; CV: r = 0.16, p=0.56). The relation between diastolic ARV and executive function among women with hxPE (r = −0.51, p=0.03) was lost with adjustment for education. Systolic BPV was not associated with cognitive function. Postpartum executive function was reduced and processing speed was slower among young women with hxPE compared with healthy pregnancy. Although BPV did not differ between groups, BPV was associated with reduced executive function only among women with hxPE. These preliminary findings suggest that select cognitive domains early postpartum among young women with hxPE may be more sensitive to 24 hour fluctuations in diastolic BP compared with controls. The physiologic or environmental mechanisms leading to this finding warrant further study.Support or Funding InformationAHA grant 18SCG34350001 and 15SFRN23760002

Cardiac surgical outcome prediction by blood pressure variability indices Poincar\xe9 plot and coefficient of variation: a retrospective study

BackgroundRecent literature suggests a significant association between blood pressure variability (BPV) and postoperative outcomes after cardiac surgery. However, its outcome prediction ability remains unclear. Current prediction models use static preoperative patient factors. We explored the ability of Poincaré plots and coefficient of variation (CV) by measuring intraoperative BPV in predicting adverse outcomes.MethodsIn this retrospective, observational, cohort study, 3687 adult patients (> 18 years) undergoing cardiac surgery requiring cardio-pulmonary bypass from 2008 to 2014 were included. Blood pressure variability was computed by Poincare plots and CV. Standard descriptors (SD) SD1, SD2 were measured with Poincare plots by ellipse fitting technique. The outcomes analyzed were the 30-day mortality and postoperative renal failure. Logistic regression models adjusted for preoperative and surgical factors were constructed to evaluate the association between BPV parameters and outcomes. C-statistics were used to analyse the predictive ability.ResultsAnalysis found that, 99 (2.7%) patients died within 30 days and 105 (2.8%) patients suffered from in-hospital renal failure. Logistic regression models including BPV parameters (standard descriptors from Poincare plots and CV) performed poorly in predicting postoperative 30-day mortality and renal failure [Concordance(C)-Statistic around 0.5]. They did not add any significant value to the standard STS risk score [C-statistic: STS alone 0.7, STS + BPV parmeters 0.7].ConclusionsIn conclusion, BP variability computed from Poincare plots and CV were not predictive of mortality and renal failure in cardiac surgical patients. Patient comorbid conditions and other preoperative factors are still the gold standard for outcome prediction. Future directions include analysis of dynamic parameters such as complexity of physiological signals in identifying high risk patients and tailoring management accordingly.

Blood pressure and heart rate variability and baroreflex sensitivity in white-coat, masked, and sustained hypertension.

We investigated blood pressure (BP) and heart rate variability and baroreflex sensitivity (BRS) in white-coat, masked and sustained hypertension in untreated patients (n = 645). Normotension and white-coat, masked, and sustained hypertension were defined according to the clinic (cutoff 140/90 mmHg) and 24-h ambulatory (130/80 mmHg) BPs. The Finometer device recorded beat-to-beat finger BP and electrocardiograms in the supine and standing positions for the computation of frequency-domain power-spectral BP and heart rate variability indexes and BRS. In multivariate analysis, BP variability indexes in the supine position differed significantly (P < 0.0001) for both low-frequency (LF) and high-frequency (HF) components and the LF/HF ratio, with the lowest LF and HF power and highest LF/HF ratio in white-coat hypertension (n = 28), the highest LF and HF power and lowest LF/HF ratio in sustained hypertension (n = 198), and intermediate values in normotension (n = 189) and masked hypertension (n = 230). These differences diminished in the standing position, being significant (P < 0.0001) only for the LF component variability. The LF/HF ratio in BP in the supine position decreased with advancing age in normotension and sustained hypertension (P ≤ 0.03) but not white-coat or masked hypertension (P ≥ 0.12). For heart rate variability, a significant difference was observed only for the LF component in the supine position (P = 0.0005), which was lowest in white-coat hypertension. BRS in masked and sustained hypertension was significantly (P ≤ 0.0001) lower than that in normotension in both supine and standing positions and decreased with advancing age (P ≤ 0.0001). In conclusion, masked, but not white-coat, hypertension showed similar patterns of, but slightly less severe, changes in BP and heart rate variability and BRS to sustained hypertension.