Effect Of Blood Pressure Variability Research Articles

Effect of the early diastolic blood pressure response to the head-up tilt test on the recurrence of benign paroxysmal positional vertigo.

Otolith organ acts complementarily with the autonomic nervous system to maintain blood pressure. However, the effect of blood pressure variability in the autonomic nervous system on otolith organ has not yet been determined. This study aimed to verify the hypothesis that blood pressure variability in the autonomic nervous system affects the recurrence of benign paroxysmal positional vertigo (BPPV), which is the most common disease of the vestibular organs, by using the head-up tilt test (HUTT). This study included 432 patients diagnosed with idiopathic BPPV. The follow-up period for all patients was 12 months. Age, sex, hypertension, diabetes and recurrence were analyzed. The HUTT parameters were divided into a group of patients whose average diastolic blood pressure increased in the upright position compared to supine position during the HUTT (DBP1) and a group of patients whose average diastolic blood pressure decreased in the upright position compared to supine position during the HUTT (DBP2). Model selection, general loglinear analysis, and logit loglinear analysis were performed using a hierarchically progressing loglinear analysis. In summary, the group with increased average diastolic blood pressure (DBP1) showed a higher tendency for BPPV recurrence compared to the group with decreased diastolic blood pressure (DBP2) in the upright position during the HUTT, although the difference was not statistically significant (p = 0.080). However, in males, the DBP1 group demonstrated a significantly higher recurrence rate of BPPV than the DBP2 group during the HUTT (95% CI, -20.021 to -16.200; p < 0.001). It is presumed that poor autonomic nervous system response through vestibulosympathetic reflex maintains elevated diastolic blood pressure in the upright position during the HUTT. This variability is assumed to affect the recurrence of BPPV.

Effects of blood pressure variability and its association with dementia and cognitive impairment: A systematic review

Effects of blood pressure variability and its association with dementia and cognitive impairment: A systematic review

Effect of blood pressure variability on hypertensive retinopathy

ABSTRACT Purpose This study intends to investigate the correlation between blood pressure variability (BPV) levels and the use of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to measure retinal microvasculature in hypertensive patients. Methods All individuals in the study had 24-hour ambulatory blood pressure monitoring and bilateral OCT and OCTA exams, and only data from the right eye were analyzed statistically. Results The study included 170 individuals, with 60 in the control group. The experimental group was separated into two groups based on the average real variability (ARV) median, with 55 in the low ARV group and 55 in the high ARV group. The mean thicknesses of the Retinal Nerve Fiber Layer (RNFL), internal limiting membrane-retinal pigment epithelial cell layer (ILM-RPE), vessel density (VD), and perfusion density (PD) in the high-ARV group were substantially lower in the low-ARV and control groups (p＜0.05). Multiple linear regression analysis revealed that disease duration, age, and 24 h diastolic standard deviation all affected RNFL mean thickness (p＜0.05). VD and PD were influenced by disease duration, systolic-ARV, daytime systolic blood pressure, intraocular pressure(IOP), and best-corrected visual acuity (BCVA) (p＜0.05). And the change in VD was connected to best-corrected visual acuity. Conclusion Hypertensive retinopathy is related to BPV. In clinical practice, we can assess the degree of BPV and retinopathy in hypertensive patients to track the progression of hypertension-mediated organ damage (HMOD). Correction of BPV may help treat or postpone the progression of HOMD.

The effect of blood pressure variability on the prognosis of patients with acute cerebral hemorrhage: Possible mechanism

Antihypertensive therapy in the acute phase of intracerebral hemorrhage (ICH) can reduce hematoma expansion. Numerous studies have demonstrated that blood pressure variability secondary to antihypertensive therapy has adverse effects on neurological outcomes, but the conclusions are diverse, and the mechanism of this occurrence is unknown. The aim of this research was to analyze the impact of blood pressure variability after antihypertensive treatment on the prognosis of patients with acute ICH, along with the possible mechanism. A total of 120 patients within 20 h of onset of ICH were divided into a good prognosis group (mRS ≤ 2 points) and a poor prognosis group (mRS ≥ 3 points) according to their 90-day mRS scores. The basic patient information, NIHSS score, GCS score, mRS score at 90 days after admission, head CT examination at admission and 24 h and CTP examination at 24 h were collected from some patients. The blood pressure values of patients were collected within 24 h, and multiple blood pressure variation (BPV) parameters within 1 and 24 h were calculated. (1) After excluding confounding factors such as age, whether the hematoma ruptured into the ventricle, confounding signs, amount of bleeding, edema around the hematoma, NIHSS on admission, operation or non-operation, and 24-h hematoma increment, the fourth quartile systolic blood pressure (SBP) maximum and minimum difference within 1 h [OR: 5.069, CI (1.036-24.813) P = 0.045] and coefficient of continuous variation (SV) within 24 h [OR: 2.912 CI (1.818-71.728) P = 0.009] were still independent factors affecting the 90-day mRS in ICH patients. (2) There was a negative correlation between SBP SV and CBF in terms of the difference between the contralateral side and the perihematomal region at 24 h (Rs = -0.692, P = 0.013). Blood pressure variability after antihypertensive therapy in acute ICH is one of the influencing factors for 90-day mRS in patients. A 1-h dramatic drop in SBP and 24-h SBP SV may affect the long-term prognosis of patients by reducing whole cerebral perfusion.

Effect of blood pressure variability on weakness during maintenance hemodialysis.

Effect of blood pressure variability on weakness during maintenance hemodialysis.

Effect of blood pressure variability in the randomized controlled BP TARGET trial.

The Blood Pressure Target in Acute Ischemic Stroke to Reduce Hemorrhage After Endovascular Therapy (BP TARGET) trial evaluated whether an intensive systolic blood pressure (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful endovascular therapy (EVT) but did not assess the effect of blood pressure variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BP TARGET trial. We performed a post hoc analysis of the BP TARGET trial and included patients with at least 50% of blood pressure (BP) recordings during the first 24 h after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum (max-min), successive variation (SV), and time rate. The primary outcome was favorable functional outcome (3-month modified Rankin Scale between 0 and 2); the secondary outcome was the rate of ICH at 24h. We included 290 patients (mean number of BP measures = 30.4, SD=8.0). BPV parameters (SBPSD , SBPmax-min , SBPCV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBPSD , DBPmax-min , DBPCV , and DBPSV ), but not after adjustment. Higher SBPmax-min was associated with worse functional outcomes in Thrombolysis in Cerebral Infarction 2B patients (odds ratio [OR]=0.62, 95% confidence interval [CI] = 0.38-1.02), but not in patients with complete reperfusion (OR=1.27, 95% CI = 0.80-2.02, p for heterogeneity (phet =0.037). None of the BPV parameters was associated with ICH, regardless of the randomization group or the reperfusion grade. BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.

Effect of Blood Pressure Variability During the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes

Ascanio, Luis C MD; Enriquez-Marulanda, Alejandro MD; Maragkos, Georgios A MD; Salem, Mohamed M MD; Alturki, Abdulrahman Y MBBS, MSc, FRCSC; Ravindran, Krishnan BS; Fehnel, Corey R MD, MPH; Hanafy, Khalid MD, PhD; Ogilvy, Christopher S MD; Thomas, Ajith J MD; Moore, Justin M MD, PhD

Lifestyle modification factors in hypertensive patients: impact on blood pressure variability

Current guidelines do not suggest considering blood pressure variability in the management of hypertensive patients. At the same time, a sufficient evidence base has been accumulated on the relationship of blood pressure variability with damage to target organs, the development of stroke, myocardial infarction, cardiovascular mortality, and kidney disease. In general, assessing the effect of blood pressure variability on the course of arterial hypertension, it can be assumed that it is not as significant as the absolute values of blood pressure, but this effect has been proven, regardless of the degree of hypertension. And if a practitioner finds an increased variability in blood pressure in his patient, he should know what recommendations should be given to him.&#x0D; Not all traditional lifestyle modification factors that are suggested for hypertensive patients affect blood pressure variability in the same way as blood pressure readings. Thus, we were unable to find evidence of the influence of increased consumption of table salt, physical activity, «chronic psychological stress» on the variability of blood pressure in the general population. At the same time, dietary habits, alcohol abuse, smoking status affect the level of blood pressure, blood pressure variability in both healthy individuals and patients with arterial hypertension. The same effect is exerted by the relative intake of minerals with food, toxic agents (lead). If in individuals of the general population an increase in body weight leads to an increase in blood pressure, then in patients with arterial hypertension such an effect is nonlinear, depending on the type of obesity. It should be emphasized once again that the presence of psychoemotional disorders symptoms of anxiety, depression – in patients with arterial hypertension contributes both to an increase in the level of blood pressure, but also to its variability.

Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage.

IntroductionPatients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients’ hospital stay.MethodsWe retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes.ResultsWe analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 (14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBPSD), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005–1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15–0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients’ likelihood to be discharged home.ConclusionOur study suggests that greater SBPSD during patients’ ED stay is associated with higher likelihood of AKI, while starting nicardipine infusion is associated with lower odds of in-hospital mortality. Further studies about interventions and outcomes of patients with sICH in the ED are needed to confirm our observations.

Effect of Blood Pressure Variability During the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes.

The association of blood pressure variation with poor outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is unknown. To evaluate the association of systolic blood pressure (SBP) variation and clinical outcomes in aSAH. We conducted a retrospective chart review of all aSAH patients treated at an academic institution between 2007 and 2016. Patient demographics, aSAH characteristics, and blood pressure observations for the first 24 h of admission in 4-h intervals were obtained. SBP variability metrics assessed were mean, standard deviation, maximum, minimum, peak, trough, coefficient of variation, and successive variation. The primary outcome was a composite of the modified Rankin scale as good (0-2) or poor (3-6) at last follow-up. Comparisons between outcome groups were performed. Logistic regression models for each significant SBP metric controlling for potential confounders were constructed. The study population was 202 patients. The mean age was 57 yr; 66% were female. The median follow-up time was 18 mo; 57 (29%) patients had a poor outcome. Patients with poor outcomes had higher standard deviation (17.1 vs 14.7 mmHg, P=.01), peak (23.5 vs 20.0 mmHg, P=.02), trough (22.6 vs 19.2 mmHg, P<.01), coefficient of variation (13.9 vs 11.8 mmHg, P<.01), and lower minimum SBP (101.4 vs 108.4, P<.01). The logistic regression showed that every 1-mmHg increase in the minimum SBP increased the odds of good outcomes (odds ratio=1.03; 95% CI=1.001-1.064; P=.04). Models including other SBP metrics were not significant. Hypotension was found to be independently associated with poor outcomes in patients with aSAH.

Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT.

Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management. Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials. In ACCORD, CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: hazard ratio [HR] 1.15, P = 0.01; CV-DBP: HR 1.18, P = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR 1.16, P = 0.001; CV-DBP: HR 1.09, P = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP. Effects of blood pressure variability were related to dips, not elevations, in blood pressure. Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes.

Acute in-hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno-occlusive arterial disease.

It is generally known that acute minor stroke and transient ischemic attack (TIA) seem to be benign. However, their occurrence in patients with steno-occlusive arterial disease may result in early neurological deterioration (END). We aimed to elucidate the effect of blood pressure variability (BPV) on the development of END. Consecutive acute minor stroke and TIA patients within 24hours of onset were prospectively recruited from the Affiliated Hospital of Yangzhou University between Aug 2015 and Feb 2019. END was defined as an NIHSS score increased ≥1 during the first 72hours compared with the initial NIHSS score. During this period, the mean, maximum (max), the difference between the maximum and minimum (max-min), the SD, and coefficient of variation of BP (BPCV ) were calculated. Of the 160 total patients enrolled in the study (mean age, 68.01±9.33years; 50.6% female), 52 (32.5%) patients occurred END during the first 72h after admission. To express the BPV as a categorical variable, we classified the subjects into one of four groups, representing four quartiles of BPV. In the multivariable analyses, the lowest quartiles were considered as reference groups. The results showed that patients who fell in the fourth quartile (SBPmax-min :OR=3.289, 95% CI 1.147-9.430; SBPSD :OR=3.313, 95% CI 1.041-10.547; SBPCV :OR=3.425, 95% CI 1.164-10.077; DBPSD :OR=3.124, 95% CI 1.065-9.158) had a significantly higher risk of END after adjusting the variables (age, female, diabetes mellitus, atrial fibrillation, and CRP with P values <.1 in univariate analyses). Our study demonstrated that the acute in-hospital BPV was associated with the development of END in acute minor stroke and TIA with steno-occlusive arterial disease.

INFLUENCE OF BLOOD PRESSURE VARIABILITY ON COGNITIVE FUNCTION IN PATIENTS WITH DYSCIRCULATORY ENCEPHALOPATHY (LITERATURE REVIEW)

Goal. To review the literature on the problem of the influence of variability of blood pressure on the cognitive function of patients with dyscirculatory encephalopathy after suffering ischemic stroke on the background of hypertension.&#x0D; Research Methods: Bibliosemantic, Comparative and Systemic Results. In the Recommendations of the European Society of Cardiologists / European Society for Hypertension (European Approach).&#x0D; Society for Cardiology / European Society of Hypertension - ESC / ESH) 2018 for the treatment of hypertension emphasized that the study of cognitive function (CF) should be mandatory in the list of methods of examination of patients to detect the damage of target organs caused by hypertension, in order refinement of stratification of risk of cardiovascular events, namely stroke (Williams B. et al., 2018). Cognitive impairment in patients with cardiovascular disease is known to be one of the earliest and most sensitive indicators of cerebral vascular injury and is a consequence of chronic cerebral ischemia and / or recurrent acute cerebral circulation disorders. It is proved that the variability of blood pressure has a negative effect on cerebral circulation, is a predictor of chronic brain ischemia, which can result in the appearance or deepening of cognitive impairment. In the ASCOT study on the prognostic significance of variability in daily monitoring of blood pressure, intracutaneous variability, and long-term variability, it was found that visit-to-visit variability is a strong predictor of stroke and coronary events, not independent of the level.&#x0D; Conclusions. Analysis of the literature on this problem has shown the negative effect of blood pressure variability on the course of chronic brain ischemia, which exacerbates cognitive and emotional-volitional disorders in patients with hypertensive dyscirculatory encephalopathy. The peculiarities of the effect of blood pressure variability on CF in patients with brain stroke are poorly understood and need further investigation.

Blood pressure variability in the management of hypertensive emergency: A narrative review.

Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta-analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage.This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.

The effect of blood pressure variability on the prognosis of hypertensive patients.

Objective:Our study aims to compare the effects of blood pressure variability (BPV) during ambulatory blood pressure measurement (ABPM) and visit-to-visit measurements to predict future cardiovascular complications among hypertensive patients.Methods:This is a retrospective case-control study of patients with hypertension over 10 years. All adult patients with at least one recorded ABPM, and at least three recorded visit measurements were included. Patients with incomplete ABPM readings, a history of a tested outcome, or the occurrence of any of the tested outcomes within the measurement period were excluded. The outcome was the development of any of the following: acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), or stroke.Results:Of the 305 cases reviewed, 152 were included. The mean follow-up was 6.6±2.3 years. The mean age was 53.5±14.3 years. Eighty-two (53.9%) patients were male, while 70 (46.1%) were female. Risk factors included diabetes mellitus (53.9%), dyslipidemia (39.5%), obesity (16.4%), and smoking (8.6%). Comorbidities included stroke (2%), ACS (8.6%), IHD (20.4%), HF (2.6%), and renal failure (1.3%). One or more complications were seen in 22.4 % of the included patients. The variation of the daytime systolic ABP had been found to predict the future risk of developing IHD (OR=1.94; 95% CI=1.09–3.45; p=0.025). Moreover, IHD was associated with night-time systolic standard deviation (SD) in ABPM (OR=1.23; 95% CI=1.00–1.51; p=0.048). On the other side, ACS was found to be associated with systolic SD in visit-to-visit measurement (OR=1.10; 95% CI=1.01–1.21; p=0.04).Conclusion:Hypertensive patients with high variability of daytime and night-time SD in ABPM are more likely to have IHD. Whereas, having high variability in systolic SD in visit-to-visit measurements is associated with developing ACS.

27 The Effect of Blood Pressure Variability on Time to First Coronary Artery Disease Onset

27 The Effect of Blood Pressure Variability on Time to First Coronary Artery Disease Onset

Effect of blood pressure variability on early neurological deterioration in single small subcortical infarction with parental arterial disease.

Background and purposeEarly neurological deterioration (END) is not uncommon in acute single small subcortical infarct (SSSI), especially in those with parental arterial disease (PAD). The purpose of this study was to elucidate the effect of BP variability on the development of END as well as functional outcome at 90 days in SSSI and to determine whether the effect is linked to the status of parent artery.MethodsConsecutive patients with acute SSSI were prospectively recruited from the First People's Hospital of Yangzhou between Aug 2013 and Jul 2016. END was defined as an NIHSS score increased ≥ 2 during the first 72 h compared with the initial NIHSS score. Functional outcome at 90 days after onset was assessed using the modified Rankin Score (mRS) and dichotomized as good (0–2) and poor (≥ 3). During this period, the parameters of BP variability such as BPmax–min, BPSD, and BPCV (equal to [SD × 100] / mean) were calculated.ResultsA total of 296 patients were included in the analysis. Of these, 30 (38.5%) SSSI associated with PAD and 53 (24.3%) without developed END respectively. Logistic regression analysis demonstrated that SBPmax (OR 1.036, 95% CI 1.005–1.069), SBPSD (OR 1.177, 95% CI 1.021–1.356), SBPcv (OR 1.306, 95% CI 1.049–1.626), DBPmax (OR 1.141, 95% CI 1.042–1.250), DBPmax–min (OR 1.085, 95% CI 1.015–1.160), DBPSD (OR 1.369, 95% CI 1.032–1.816), and DBPCV (OR 1.281, 95% CI 1.028–1.597) were all the independent predictors of END after acute SSSI associated with PAD. However, for those without PAD, none of the BP parameters was found significantly associated with END. Also, BP parameters were not related to the poor outcome at 90 days after onset.ConclusionsOur study demonstrated that the acute in-hospital BP variability was associated with the development of END in patients with acute SSSI. However, its impact varies depending on the status of parent artery.

The effect of blood pressure variability on renal functional reserve at essential arterial hypertension І stage

The article presents the results of the investigation impact of variability in blood pressure (BP) on renal functional reserve (RFR) in patients with essential hyper tension (EH) I stage.The objective: to determine the effect of the blood pressure variability on kidney function at EH І stage.Patients and methods. The study involved 50 patients. The study group included 30 patients with diagnosed essential hypertension I satge diagnosed according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health of Ukraine (May, 24, 2012 No.384) (mean duration of EH 3,5±0,5 years, women – 12 (40%), men – 18 (60%), average age – 44,6±1,78 years); 20 healthy individ uals as the control group (women – 11 (55%), men – 9 (45%), average age – 41,1±1,96 years). Non – inclusion criteria were: symptomatic hypertension, valvular heart disease, arrhythmias, congestive heart failure, chronic kidney disease, diabetes, coronary heart disease. Patients of the main group were not taking antihypertensive therapy. All patients underwent following tests: clinical examination, general clinical blood and urine tests, urine albumin/creatinine ratio, biochemical blood tests (total protein, urea, creatinine, glucose, lipid profile); ambulatory blood pressure monitoring (ABPM) , ECG, EchO KG and ultrasound of the carotid arteries ), ophthalmoscopy; renal function reserve (RFR) was determined by water and salt load method (under patent Ukraine 42,860). ABPM performed on the monitor ABPM 50 (UK, 2015). The results were analyzed by the soft ware ABPM50.Results. Рatients of the main group had shown increased BP variability compared to the results of control group: SBP and DBP were significantly higher in EAG patheints (in 74,34% (p<0,001) and 76,74% (p<0,001), respectivel. Analyze of the night BP level has demonstrated that most of patients in main group had abnormal BP reaction: 12 (40%) persons were «non dipper», 3 (10%) – «night peaker», 9 (30%) – «over dipper»; normal circadian rhythm («dipper») was found in only 6 persons (20%). All persons from control group demonstrated «dipper» profile of the night BP. The mean RFR was signifi cantly lower in the main group (14,16±3,86%) than in the control group (34,04±10,63%; p<0,05). The lowest rate of RFR in study patients was determined in «night picker» and «non dipper» subgroups; and in patients with maximum degree of BP variability.Conclusions. 1. In hypertensive patients RFR is significantly reduced compared with healthy persons (14,16±3,86%) and (34,04±10,63%; p<0,001).2. Adverse nocturnal blood pressure profile («non dipper», «night peaker») observed in 50% of patients with EH I stage.3. The maximum reduction in RFR develops in «non dipper» (9,42±3,87%) and «night peaker» (5,56 ± 3,24%) subgroups .4. Maximal variability in SBP and DBP in EH I stage patients leads to decreased RFR/

THE RELATIONSHIP BETWEEN BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR REMODELING IN HYPERTENSION DEVELOPED IN THE ELDERLY

Background. The prevalence of arterial hypertension (HTN) increases with age, but the causes of HTN in elderly and young age are different. The contribution of the specific parameters of high blood pressure (BP) in the pathogenesis of organ damage in the elderly has not been studied enough. Objective. We assessed the effect of BP variability (BPV) on left ventricular (LV) remodeling and vascular stiffness in patients with HTN developed at age before and over 65 years. design and methods. Altogether 122 elderly patients were enrolled and divided into 3 groups: group 1–45 patients with newly diagnosed HTN 1–2 degree at the age over 65 years (21 males, 24 females, the average age — 71,7 ± 2,6 years), group 2–39 subjects with newly diagnosed HTN 1–2 degree under 65 years old (18 males, 21 females, the average age — 68,4 ± 2,4 years). The 3rd control group, comprised 38 elderly subjects without HTN (20 males, 18 females, the average age — 67,5 ± 2,0 years). At baseline, none of the patients achieved target BP. At admission to the hospital, two-component antihypertensive therapy was prescribed to all patients, it included a blocker of the renin-angiotensine-aldosterone system (RAAS) — an angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist) and calcium channel blocker (amlodipine in all cases). Short-term BPV was assessed by ambulatory BP monitoring (ABPM), medium-term BPV — based on the BP monitoring for 7 days, and long-term BPV — based on the 3-month self-monitoring of BP. Central aortic pressure was also measured. LV myocardial mass index and LV relative wall thickness (2T/DD) were assessed by 2D-echocardiography, and early diastolic flow velocities E, A and the ratio E/A were evaluated by spectral Doppler. Pulse wave velocity, cardio-ankle vascular index (R-CAVI and L–CAVI), ankle-brachial index (ABI) and the biological arterial age were assessed by sphygmomanometry. Results. Increased BPV seems to be an indicator in elderly, as elderly patients without HTN show increased SBP and DBP short-term variability. However, the maximum rate of BPV increase was found in patients with the HTN development in the age over 65 years. In the same group, the correlation between BPV and LV and vascular remodeling was the most severe. The increase in visit-to-visit DBP variability had the greatest impact on the arterial wall stiffness, while visit-tovisit SBP variability affected LV remodeling. The increase in the mediumand long-term BPV was found to be a more powerful predictor of cardiovascular remodeling compared to the increase in short-term BPV assessed by ABPM. Thus, arterial stiffness may be an important factor leading to the increase in both short-term and longterm BPV. Conclusions. BPV measurement should be widely implemented for the assessment of cardiovascular risk and the overall effectiveness of antihypertensive therapy.

GW25-e3131 Effect of Blood Pressure Variability on Cardiovascular Outcome in Diabetic and Nondiabetic Patients with Stroke

GW25-e3131 Effect of Blood Pressure Variability on Cardiovascular Outcome in Diabetic and Nondiabetic Patients with Stroke