Blood Pressure Variability Parameters Research Articles

Association between blood pressure variability and the short-term outcome in patients with acute spontaneous subarachnoid hemorrhage.

The association between the fluctuation in blood pressure (BP) and the early outcomes of patients with subarachnoid hemorrhage (SAH) remains unclear. Our study aimed to evaluate the value of blood pressure variability (BPV) for predicting the short-term outcomes of patients with acute spontaneous SAH. We collected data from 303 patients hospitalized for acute spontaneous SAH. BP values were recorded at admission and subsequently every 2 h during the initial 24 h of hospitalization. BPV was determined as the standard deviation (SD), the difference between the maximum and the minimum (ΔBP), the coefficient of variation (CV), and successive variation (SV). The outcome at discharge was assessed according to the Glasgow Outcome Scale (GOS). The association between BPV and the outcome was identified by multivariable analysis. The findings showed that the parameters of systolic BPV were independently associated with the outcome in a graded fashion. The odds ratios (OR) for the highest tertiles were as follows: SD 13.9 (95% confidence interval [CI], 4.8-40.4), ΔBP 4.4 (95% CI, 1.6-11.9), CV 16.4 (95% CI, 5.6-48.8), SV 15.8 (95% CI, 5.3-46.9). However, there was no association between a poor outcome and diastolic BPV (all p > 0.05). In conclusion, systolic BPV within the first 24 h after admission was independently associated with the outcomes in SAH patients; the greater the variability was, the worse the outcome.

Postreperfusion Blood Pressure Variability After Endovascular Thrombectomy Affects Outcomes in Acute Ischemic Stroke Patients With Poor Collateral Circulation.

Background and Purpose: We evaluated the effect of 24 h blood pressure variability (BPV) on clinical outcomes in acute ischemic stroke patients with successful recanalization after endovascular recanalization therapy (ERT).Methods: Patients with anterior circulation occlusion were evaluated if they underwent ERT based on multiphase computed tomography angiography and achieved successful recanalization (≥thrombolysis in cerebral ischemia 2b). Collateral degrees were dichotomized based on the pial arterial filling score, with a score of 0–3 defined as a poor collateral status. BPV parameters include mean, standard deviation, coefficient of variation, and variation independent of the mean (VIM) for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure, and pulse rate (PR). These parameters were measured for 24 h after ERT and were analyzed according to occlusion sites and stroke mechanisms. Associations of BPV parameters with clinical outcomes were investigated with stratification based on the baseline collateral status.Results: BPV was significantly different according to the occlusion sites and stroke mechanisms, and higher BPV was observed in patients with internal carotid artery occlusion or cardioembolic occlusion. After adjustment for confounders, most BPV parameters remained significant to predict functional outcomes at 3 months in patients with poor collateral circulation. However, no significant association was found between BPV parameters and clinical outcomes in patients with good collateral circulation.Conclusion: Postreperfusion BP management by decreasing BPV may have influence on improving clinical outcome in cases of poor collateral circulation among patients achieving successful recanalization after ERT.

The Relationship between Blood Pressure Variability, Recanalization Degree, and Clinical Outcome in Large Vessel Occlusive Stroke after an Intra-Arterial Thrombectomy

Background: Blood pressure variability (BPV) is associated with target organ damage progression and increased cardiovascular events, including stroke. The aim of this study was to evaluate the associations between short-term BPV during acute periods and recanalization degree, early neurological deterioration (END) occurrence, and functional outcomes in acute ischemic stroke patients who had undergone intra-arterial thrombectomy (IAT). Methods: We retrospectively analyzed 303 patients with large vessel occlusive stroke who underwent IAT. The following BPV parameters, measured over 24 and 48 h after IAT, were compared: the mean, SD, coefficient of variation (CV), variation independent of the mean (VIM) for both the systolic BP (SBP) and diastolic BP, and the proportion of nocturnal SBP risers. Results: BPV parameters decreased with higher recanalization degree. The mean SBP (SBP_mean) over 24 and 48 h after IAT, and the SD of SBP (SBP_SD), CV of SBP (SBP_CV), and VIM of SBP (SBP_VIM) during the 48 h following the procedure had significant associations with recanalization degree. Patients with END had higher BPV than that of those without END, and the difference was more evident for incomplete recanalization. Increased BPV was associated with a shift toward poor functional outcome at 3 months after adjustment, including recanalization degree (OR range for significant parameters, 1.26–1.64, p = 0.006 for 48 h SBP_mean, p = 0.003 for 48 h SBP_CV, otherwise p < 0.002). Conclusions: Short-term BPV over 24 and 48 h after IAT in acute ischemic stroke patients was related to recanalization degree, and END occurrence, and may be an independent predictor of clinical outcome.

Damaged cardiovascular autonomic control in wheelchair-using children and adolescents with myelomeningocele: a case–control study

BackgroundCardiovascular autonomic dysfunction is associated with the development of cardiovascular diseases, but little is known about it in children and adolescents with myelomeningocele. ObjectiveThis study investigated the cardiovascular autonomic function in wheelchair-using children and adolescents with myelomeningocele. MethodsTwenty-two participants were assigned to one of two groups: myelomeningocele group (n=11) and Control group (n=11). Heart rate variability and systolic blood pressure variability were collected in supine resting position using spectral analyses. Spontaneous baroreflex sensitivity was collected by time-domain through the sequence method. ResultsAt rest, heart rate was higher in myelomeningocele group when compared to Control group (mean difference 22.1, 95% CI 4.82–39.40; p=0.01). The heart rate and systolic blood pressure variability parameters did not show differences between groups. However, myelomeningocele showed lower gain mean in baroreflex sensitivity (mean difference −4.5, 95% CI −8.47 to −0.60; p=0.02), when compared to Control. ConclusionWheelchair-using children and adolescents with myelomeningocele presented differences in the autonomic cardiovascular function. This may be associated with hypomobility due to wheelchair dependence, and venous muscle pump insufficiency due to paraplegia.

BLOOD PRESSURE VARIABILITY AND CLINICAL CHARACTERISTICS OF PATIENTS HOSPITALIZED FOR ACUTE MYOCARDIAL INFARCTION

Objective: The aim of the present study was to assess blood pressure variability (BPV) in patients hospitalized for acute myocardial infarction. Design and method: We studied 75 patients (76% males, age 65 ± 13 years) who were hospitalized because of ST-elevation myocardial infarction (STEMI) and Non ST–elevation myocardial infarction (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Additionally, BPV was estimated based on double daily measurements of BP during hospitalization and with 24-hour ambulatory BP monitoring during the third day of hospital stay. The parameters of BPV analyzed were: a) standard deviation (SD) of systolic BP (24-h, daytime and nighttime), b) SD of diastolic BP (24-h, daytime and nighttime) and c) the coefficient of variation (CV) of systolic BP (24-h, daytime) and d) the average real variability (ARV) of systolic and diastolic BP across 24-h. Results: From the total population, 20% had family history of cardiovascular events, 72% were hypertensives, 32% had diabetes, 51% were smokers and 32% had previous history of coronary artery disease. Regarding the type of myocardial infarction, 37% were admitted for STEMI and 55% had coronary revascularization. Focusing on the mean systolic and diastolic BP and their SD the values were 72 ± 6.1mmHg, 127 ± 11.4mmHg and 74.5 ± 6.5mmHg, respectively. From the ambulatory BP the daytime, nighttime and total SD of systolic BP was 11.3 ± 2.8mmHg, 9.8 ± 3.1mmHg and 11.7 ± 2.9mmHg, respectively. Moreover, ARV was 9.31 ± 2.1mmHg while CV was 10.21 ± 26 %. The type of MI (STEMI and NSTEMI) was significantly related to systolic and diastolic ARV (r = 0.29, p = 0.012 and r = 0.28, p = 0.014, respectively). Conclusions: In patients admitted for acute myocardial infarction there is a relationship between the ARV and the type of myocardial infarction. These findings suggest differential impact of hemodynamic load on the cardiovascular system in patients with STEMI and NSTEMI.

Autonomic dysregulation in colon cancer patients

To the best of our knowledge, only two studies analyzed the relationship between HRV and carcinoembryonic antigen (CEA) in colon cancer patients. The aim of this study was to analyze changes in the autonomic activity of colon cancer patients using heart rate variability (HRV) and blood pressure variability (BPV) measures, and to verify if HRV and BPV parameters correlate with hemodynamic indices in this group and the plasma levels of CEA. Presence of colon cancer is associated with changes in autonomic activity, namely parasympathetic-sympathetic imbalance in form of sympathetic overdrive. Cancer-related autonomic dysfunction may contribute to impairment of gastrointestinal motility.

Exaggerated blood pressure variability is associated with memory impairment in very elderly patients.

We investigated the association between working memory (WM) impairment and blood pressure variability (BPV) in very elderly patients. Japanese outpatients ≥80years who engaged in normal activities of daily living were the study cohort. WM function was evaluated by a simple visual WM test consisting of 3 figures. We considered the number of figures recalled by the patient his/her test score. We defined the patients with a score of 0 or 1 as those with WM impairment and those with scores of 2 or 3 as those without. To investigate the relative risk of WM impairment, we evaluated each patient's 24hour ambulatory systolic blood pressure (SBP) and its weighted standard deviation (SDSBP ), office SBP, and the visit-to-visit SDSBP during the 1year period from the patient's enrollment. A total of 66 patients (mean 84±3.6years) showed WM impairment, and 431 patients (mean 83±3.1years) showed no WM impairment. There were no significant differences in 24hour ambulatory SBP or office SBP between these two groups. However, the WM impairment patients showed significantly higher weighted SDSBP and visit-to-visit SDSBP values compared to the no-impairment group even after adjusting for age. Among these ≥80-year-old patients, those with the highest quartile of both weighted SDSBP (≥21.4mmHg) and visit-to-visit SDSBP (≥14.5mmHg) showed the highest relative risk (odds ratio 3.52, 95% confidence interval 1.42-8.72) for WM impairment. Exaggerated blood pressure variability parameters were significantly associated with working memory impairment in very elderly individuals.

Association Between Hyperacute Stage Blood Pressure Variability and Outcome in Patients With Spontaneous Intracerebral Hemorrhage.

Increased blood pressure (BP) variability, in addition to high BP, may contribute to adverse outcome in intracerebral hemorrhage. However, degree and association with outcome of BP variability (BPV) in the hyperacute period, 15 minutes to 5 hours after onset, have not been delineated. Among consecutive patients with intracerebral hemorrhage enrolled in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium), BPs were recorded by paramedics in the field and during the first 24 hours of hospital course. BP was analyzed in the hyperacute period, from 0 to 4-6 hours, and in the acute period, from 0 to 24-26 hours after onset. BPV was analyzed by SD, coefficient of variation, and successive variation. Among 386 patients with intracerebral hemorrhage, first systolic BP at median 23 minutes (interquartile range, 14-38.5) after onset was median 176 mm Hg, second systolic BP on emergency department arrival at 57 minutes (interquartile range, 45-75) after onset was 178 mm Hg, and systolic BP 24 hours after arrival was 138 mm Hg. Unfavorable outcome at 3 months (modified Rankin Scale, 3-6) occurred in 270 (69.9%). Neither mean nor maximum systolic BP was associated with outcome in multivariable analysis. However, all 3 parameters of BPV, in both the hyperacute and the acute stages, were associated with poor outcome. In the hyperacute phase, BPV was associated with poor outcome with adjusted odds ratios of 3.73 for the highest quintile of SD, 4.78 for the highest quintile of coefficient of variation, and 3.39 for the highest quintile of successive variation. BPV during the hyperacute first minutes and hours after onset in patients with intracerebral hemorrhage was independently associated with poor functional outcome. Stabilization of BPV during this vulnerable period, in the pre-hospital and early emergency department course, is a potential therapeutic target for future clinical trials. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.

PP.29.27] EXAGGERATED BLOOD PRESSURE VARIABILITY IN BOTH OFFICE AND AMBULATORY BLOOD PRESSURE MONITORING ARE ASSOCIATED WITH COGNITIVE DYSFUNCTION IN EXTREMELY ELDERLY PATIENTS

Objective: The objective of this study is to assess the association between cognitive dysfunction and blood pressure (BP) variability in extremely elderly patients, over 80 years. Design and method: This cross-sectional study were performed on 520 extremely very elderly outpatients (mean age: 83.2 ± 3.2 years, 44.0% male). These patients had normal activities of daily living. We evaluated cognitive function, office BP values during 1 year and BP values measured by 24-hour ambulatory BP monitoring. Cognitive function was evaluated by a visual working memory test consisted of three figures. The number of figures recalled was counted as the test score. We divided patients into two groups, 0 or 1 score as group 1, and 2 or 3 score as group 2. We used standard deviation (SD), coefficient of variation (CV), weighted SD, average real variability (ARV) and the maximum and minimum BP difference (MMD) to assess the BP variability. Results: A total of 70 patients (mean age: 84.0 ± 3.6 years, 35.7% male) constituted group 1, while the remaining 450 patients (mean age: 83.0 ± 3.1 years, 45.3% male) constituted group 2. There were no significant differences in office and 24-hour ambulatory systolic/diastolic BP levels between two groups. However, visit-to-visit systolic BP variability and all 24-hour ambulatory systolic/diastolic BP variability parameters in group 1 were significantly higher than those in group 2 even after adjusting for age (Table 1). Conclusions: Exaggerated visit-to-visit BP variability and 24-hour ambulatory BP variability were related to cognitive dysfunction in extremely elderly patients.

The relationship between the autonomic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension

ABSTRACTObjective: This study investigated the relationship between autonomic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension (EH). Design: A total of 223 elderly patients with mild-to-moderate EH were enrolled. Urinary albumin excretion (UAE) and urinary creatinine (UCr) were measured in all elderly patients with mild-to-moderate EH, and urinary albumin to creatinine ratio (ACR) was calculated (ACR = UAE/UCr × 0.113). All patients were divided into two groups such as ACR normal group (109 cases) and abnormal ACR group (114 cases) according to the results of ACR. Synchronic 24-hour ambulatory blood pressure monitoring and 24-hour ambulatory electrocardiogram were detected for all patients to simultaneously monitor heart rate variability (HRV) and blood pressure variability (BPV). Results: The level of 24-hour SSD, dSSD, and nSSD and 24-hour PP (parameters of BPV) increased significantly (P < 0.028, P < 0.023, P < 0.027 and P < 0.019, respectively), while the level of RMSSD, pNN50, SDNN, and SDANN (parameters of HRV) decreased significantly(P < 0.048, P < 0.029, P < 0.025 and P < 0.022, respectively) in abnormal ACR group than in normal ACR group. Multiple logistic regression analysis showed that ACR was closely correlated with 24-hour SSD, 24-hour PP, SDANN, and SDNN (ß = 1.261, P = 0.000; ß = 1.121, P = 0.003; ß = −1.741, P = 0.000 and ß = −1.231, P = 0.002, respectively). Conclusions: HRV (SDANN, SDNN) and BPV (24-hour SSD, dSSD, nSSD) were significantly correlated to ACR in patients with mild-to-moderate EH. This result suggested that sympathetic activation was closely related with early renal dysfunction in elderly patients with mild-to-moderate EH.

Increased nocturnal blood pressure variability is associated with renal arteriolar hyalinosis in normotensive patients with IgA nephropathy

Abnormal blood pressure (BP) variability (BPV), occurring as beat-to-beat, 24 h, and day-to-day fluctuations, is related to target organ damage. However, the associations between abnormal BPV and renal structural changes have not been clearly investigated. We evaluated the day time and night time BP s.d. and average real variability (ARV), which reflected short-term BPV, the night time to day time (N/D) ratio of systolic BP (SBP), and the 7-day BPV, in 29 normotensive IgA nephropathy (IgAN) patients. We further compared the results with renal structural changes. The degree of arteriosclerosis was positively correlated with age, s.d. of night time SBP and the N/D ratio of SBP, and was negatively correlated with the estimated glomerular filtration rate (eGFR). The degree of arteriolar hyalinosis was positively correlated with age, night time SBP, s.d. of day time and night time SBP, day time and night time ARV, the N/D ratio of SBP and 7-day SBP, and was negatively correlated with the eGFR. A multiple linear regression analysis revealed that the level of arteriolar hyalinosis, but not arteriosclerosis, was associated with the s.d. of night time SBP (β=0.63, P<0.01) or night time ARV (β=0.61, P<0.01) after adjustment for age, sex, body mass index, the eGFR and night time SBP. Multiple linear regression analyses indicated no significant correlation between the degree of arteriolar hyalinosis and the N/D ratio of SBP or 7-day SBP s.d. or between the degree of arteriosclerosis and any of the BPV parameters. In conclusion, short-term night time BPV was found to be associated with arteriolar hyalinosis in normotensive IgAN patients.

Plasma levels of natriuretic peptides and year-by-year blood pressure variability: a population-based study.

Augmented blood pressure (BP) variability over various time periods has been recognized as a risk factor for cardiovascular diseases. Both atrial and B-type natriuretic peptides (ANP and BNP) are secreted in response to volume or pressure overload to the heart, exerting natriuretic and vasodilator actions. In this study, we examined the relationships between year-by-year BP variability and plasma levels of ANP and BNP in the general population. Study subjects were local residents receiving an annual heath checkup, who had an estimated glomerular filtration rate of >30 ml min-1 per 1.73 m2 and no history of heart disease. Of those, we selected 314 subjects that received checkups at least five times over the past 6 years. BP variability year-by-year was retrospectively evaluated by s.d., coefficient of variation, average real variability and variation independent of the mean of BP values of 6 or 7 time points. The four parameters of BP variability were each found to significantly correlate with logarithmically transformed ANP and BNP levels by simple regression. When classified by quartiles of s.d. of systolic BP, the highest quartile group showed significantly higher levels of the natriuretic peptides compared with other groups. Multivariate analyses revealed that BP variability was an independent determinant for the ANP and BNP levels. In conclusion, augmented year-by-year BP variability over the past 6 years was associated with elevation of plasma levels of ANP and BNP, suggesting a possible relationship between the BP variability and cardiac load, in the general population.

Эффективность комбинированной с психотропными препаратами антигипертензивной фармакотерапии у больных с артериальной гипертонией и аффективными расстройствами

To compare effects of isolated antihypertensive therapy (AHT) and AHT combined with anxiolytic and antidepressant on parameters of 24‑hour blood pressure (BP) profile, severity of affective disorders, and quality of life (QL) in patients with uncontrolled arterial hypertension (AH) and anxiety or depressive disorders. We randomized 140 patients (age 48.6±5.9 year, 72 women) into 2 groups. During 1 year patients of each group received 2 variants of pharmacotherapy: isolated AHT and AHT combined with psychotropic medication (PM) - anxiolytic for persons with anxiety disorder and antidepressant for persons with depressive disorder (AHT+PM). Patients of group I received AHT for first 6 months and AHT+PM for remaining 6 months. Group II patients started with AHT+PM and after 6 months switched to AHT. In each group we selected subgroups of patients with prevailing anxiety (I‑A, II‑A) and prevailing depression (I-D, II-D). In the end of each 6 months period we compared parameters of 24‑hour BP monitoring, severity of affective disorders, and QL in subgroups IA vs. II‑A and ID vs. IID. Same comparisons were done for each subgroup in the end of the first and second stages of treatment. Starting with combination AHT provided more rapid achievement of low values of average diurnal and nocturnal systolic (S) and diastolic (D) BP, lower parameters of BP variability. In patients with comorbid depression it led to lowering of magnitude and velocity of morning increment of SBP and DBP. Only combination AHT demonstrated adequate reduction of affective disorders. Both combination and isolated AHT in 6 months resulted in significant improvement of QL, however combination AHT provided significantly better estimates of QL. In patients with AH and anxiety or depressive disorders effectiveness of AHT combined with anxiolytic or antidepressant was higher compared with isolated AHT.

THE EFFICACY OF ANTIHYPERTENSIVE TREATMENT COMBINATION WITH ANXIOLYTICS IN HYPERTENSIVES WITH ANXIETY DISORDER

Aim. To compare the influence of the simple and combined with anxiolytic drug tofisopam (AT) antihypertesion therapy (AHT) on the 24-hour blood pressure (BP) profile, anxiety level and life quality of patients with uncontrolled arterial hypertension and anxiety spectrum disorder. Material and methods. Sixty-nine patients (mean age 48,5±5,3 y. o., 35 women) were randomized to 2 groups. Each group consequently during 1 year study received two types of medicines for 6 months each with cross-replacement: isolated AHT and combination AHT with AT (AHT+A). Group 1 (35 persons) for the 1st half year took AHT, and then following half year AHT+A; group 2 (34 persons) — in back order. At the end of every period the following parameters were controlled: ambulatory blood pressure monitoring, prominence of trait and reactive anxiety, and life quality. Also, the same comparisons were done for every group separately at the end of the first and second stages of treatment. Results. The initiation of combination AHT+A led to faster decrease of BP, achievement of lower mean daily and mean nocturnal systolic and diastolic BP, lower BP variability parameters. Only combination AHT+A showed adequate reducement of reactive anxiety. Combination and simple AHT in 6 months led to significant improvement of life quality, however combination AHT showed more significant values. Conclusion. Efficacy of combination AHT+A in hypertensive persons with anxiety disorder is higher comparing to simple AHT.

P1270Effects of blood pressure variability on layer-specific longitudinal strain in hypertensionP1271 Left atrial dynamics and diastolic function in hypertensive patientsP1272Echocardiographic evaluation of right ventricular function in patients with chronic obstructive pulmonary disease in comparison with healthy groupP1273The impact of preeclampsia on myocardial recovery in women with peripartum cardiomyopahty - speckle tracking studyP1274Diagnostic accuracy of bedside lung ultrasonography in emergency (BLUE)

Our previous study showed sub-epicardial longitudinal strain (EpiLS) was an independent prognostic factor for worse outcome in regular treated hypertension but not global longitudinal strain (GLS) and sub-endocardial longitudinal strain (EndLS). Increased blood pressure variability (BPV) has been found associated with target organ damage in hypertension. However, effects of BPV on layer-specific longitudinal strain have not been well studied. The aim of this study was to investigate the effects of different blood pressure parameters on layer-specific longitudinal strain in hypertension. This study included 95 patients (57 men, age 65 ± 12 years) with uncomplicated hypertension who have been regularly treated for more than 1 year. Speckle tracking echocardiography was used for measurement of longitudinal deformation from 3 apical views of left ventricle. GLS was measured by automated function imaging (AFI). We further divided into sub-endocardial and sub-epicardial myocardium and measured their longitudinal strain by manual click-and-draw method and averaged from 3 apical views. Blood pressure parameters included office systolic blood pressure (SBP), office diastolic blood pressure (DBP), central SBP and DBP by tonometry, average 24-hour SBP and DBP, and BPV parameters by ambulatory blood pressure monitor. BPV parameters included standard deviation of daytime SBP (DSSD), standard deviation of nighttime SBP (NSSD), standard deviation of daytime DBP (DDSD), and standard deviation of nighttime DBP (NDSD). We divided subjects into low and high group according to median level of each strain. No blood pressure parameters were different between low and high EndLS group except week difference in NDSD (9.0 ± 3.4 vs. 7.8 ± 2.0 mmHg, p = 0.051). NSSD (11.2 ± 4.6 vs. 9.3 ± 2.9 mmHg, p = 0.027) and NDSD (9.1 ± 3.4 vs. 7.7 ± 2.0 mmHg, p = 0.031) were significant increased in low GLS group but not other parameters. DDSD (10.3 ± 3.0 vs. 9.0 ± 2.5 mmHg, p = 0.034), NSSD (11.4 ± 4.4 vs. 9.1 ± 3.1 mmHg, p = 0.006), and NDSD (9.2 ± 3.2 vs. 7.6 ± 2.2 mmHg, p = 0.012) were significantly increased in low EpiLS group. Only BPV parameters were associated with decreased longitudinal strain in hypertension. Effects of BPV were majorly noted in EpiLS.

The Association between Obesity, Blood Pressure Variability, and Right Ventricular Function and Mechanics in Hypertensive Patients

The purpose of this investigation was to evaluate the association between blood pressure (BP) variability and right ventricular (RV) mechanical function in normal-weight, overweight, and obese untreated patients with hypertension. This retrospective cross-sectional study included 127 untreated subjects with hypertension who underwent 24-hour ambulatory BP monitoring and complete two-dimensional and three-dimensional echocardiographic examination. All participants were divided into three groups according to body mass index (BMI): normal-weight patients (BMI<25kg/m(2)), overweight patients (25≤BMI<30kg/m(2)), and obese patients (BMI≥30kg/m(2)). Daytime, nighttime, and 24-hour BP variability parameters were higher in overweight and obese subjectswith hypertension than in lean subjects. Two-dimensional RV longitudinal strain and systolic strain rate were significantly lower in obese patients with hypertension than in normal-weight patients (-24.1±3% vs -23.3±3.2% vs -21.7±3.3%, P=.004). Three-dimensional echocardiographic RV volumes indexed to body surface area were lower in lean and overweight subjects than in obese participants with hypertension(mean RV end-diastolic volume index, 65±6 vs 67±7 vs 71±8mL/m(2), P=.001), while three-dimensional RV ejection fraction decreased in the same direction (60±4% vs 58±3% vs 57±3%, P<.001). Nighttime BP variability indices, more than daytime BP variability parameters, correlated with two-dimensional RV global longitudinal strain and three-dimensional echocardiographic RV volumes. BP variability and RV structure, function, and mechanics are significantly affected by obesity in patients with untreated hypertension. BP variability is significantly associated with RV remodeling in patients with hypertension.

The interaction between blood pressure variability, obesity, and left ventricular mechanics: findings from the hypertensive population.

The aim of this study was to determine the relationship between blood pressure (BP) variability and left ventricular (LV) mechanical function in untreated normal-weight, overweight, and obese hypertensive patients. This cross-sectional study included 144 untreated hypertensive study participants who underwent 24-h ambulatory BP monitoring and complete two (2DE) and three-dimensional echocardiography (3DE). All the patients were divided into three groups according to their BMI: normal-weight patients (BMI < 25 kg/m), overweight patients (25 ≤ BMI < 30 kg/m), and obese patients (BMI ≥ 30 kg/m). Daytime, night-time, and 24-h BP variability progressively increased from normal-weight, throughout overweight, to obese hypertensive study participants. 2DE and 3DE LV longitudinal, circumferential and radial strains, as well as 3DE area strain, were significantly lower in obese hypertensive patients than in normal-weight and overweight study participants. 3DE LV volumes indexed for BSA did not differ significantly among the three observed groups. Night-time and 24 h BP variability indices, more than daytime BP variability parameters, were associated with 2DE and 3DE longitudinal and circumferential strains independent of BMI, LV mass index, and average 24-h SBP and DBP values. BP variability and LV deformation are significantly affected by obesity in untreated hypertensive patients. BP variability is associated with 2DE and 3DE LV mechanics independently of main clinical and echocardiographic characteristics.

The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population

We sought to investigate the relationship between blood pressure (BP) variability and left atrial (LA) phasic function assessed by volumetric and speckle tracking method in normal-weight, overweight and obese hypertensive patients. This cross-sectional study included 164 untreated hypertensive subjects who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). All the patients were separated into three groups according to their body mass index (BMI): normal-weight patients (BMI<25kg/m(2)), overweight patients (25≤BMI<30kg/m(2)), and obese patients (BMI≥30kg/m(2)). Daytime, nighttime and 24h BP variability indices were higher in obese hypertensive subjects than in lean patients. Maximum and minimum LA volumes and volume indexes gradually and significantly increased, whereas pre-A LAV decreased, from normal-weight to obese subjects. Total and passive LA emptying fractions, representing LA reservoir and conduit function, gradually reduced from lean to obese individuals. Active LA EF, the parameter of LA booster pump function, increased in the same direction. Similar results were obtained by 2DE strain analysis. BP variability parameters were associated with structural, functional and mechanical parameters of LA remodeling in the whole study population. The parameters of LA reservoir function were negatively related with BP variability indices, whereas the parameters of LA pump function were positively related with BP variability indices. Obesity significantly impacts BP variability and LA phasic function in untreated hypertensive subjects. BP variability is associated with LA remodeling independent of BP, left ventricular systolic and diastolic function.

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.

Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke.

Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke. We studied association between blood pressure (BP) variability and development of END. In this retrospective observational study, we studied a consecutive series of patients hospitalized for acute ischemic stroke within 24 h of onset. The primary outcome of interest was the development of END according to predefined criteria within the first 72 h of stroke onset. During this period, the mean, maximum (max), and minimum (min) values for the SBP and DBP were measured. The following parameters of BP variability were calculated for the SBP and DBP: the difference between the maximum and minimum (max-min), the SD, and the coefficient of variation. Of the 1161 patients enrolled in the study (mean age, 67.5 ± 13.3 years; 59.6% men), 210 (18.1%) developed END. All of the BP variability parameters were linearly associated with END independent of mean BP and potential clinical variables (P values < 0.05 on likelihood ratio tests for trend), except for SBPmax-min. Among the other BP parameters, SBPmean, SBPmax, DBPmax, and DBPmin were independently associated with END. After adjustments for potential confounders, the odds for END increased 14-21% with each increase of one standard deviation in the BP variability parameter. BP variability is independently and linearly associated with the development of neurologic deterioration in acute stage of ischemic stroke.