High Systolic Blood Pressure Variability Research Articles

Higher Long-Term Visit-to-Visit Blood Pressure Variability Is Associated With Severe Cerebral Small Vessel Disease in the General Population.

Long-term visit-to-visit blood pressure (BP) variability is linked to various diseases, but its impact on cerebral small vessel disease (cSVD) burden, and its features remains uncertain. We analyzed 1284 participants from the Kailuan cohort (2006-2022). Visit-to-visit systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) variability were categorized into tertiles (low, middle, high). Magnetic resonance imaging identified white matter hyperintensities (WMH), lacunae of presumed vascular origin (LA), cerebral microbleeds (CMBs), and visible perivascular spaces (PVS). Total cSVD burden was classified as none (0), mild (1), moderate (2), or severe (3-4) based on the presence of these features. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). High SBP variability was associated with moderate cSVD burden (OR = 1.89, 95% CI: 1.09-3.29) and PVS (OR = 1.62, 95% CI: 1.10-2.39). High DBP variability was associated with LA (OR = 1.74, 95% CI: 1.06-2.84). High PP variability showed a significant risk for severe cSVD burden (OR = 2.49, 95% CI: 1.34-4.63). These associations were modified by age and hypertension status. Among young adults (age < 60 years), high PP variability was associated with severe cSVD burden (OR = 3.33, 95% CI: 1.31-8.44), LA (OR = 3.02, 95% CI: 1.31-6.93), and PVS (OR = 1.86, 95% CI: 1.20-2.88). The risk effects of SBP and PP variability on cSVD burden were significant only in participants with hypertension. High long-term visit-to-visit BP variability (BPV), particularly in combination with hypertension, is a significant risk factor for total cSVD. Special attention should be given to PP variability in younger adults.

Blood pressure variability assessed by office, home, and ambulatory measurements before and during antihypertensive drug treatment: a sub-analysis of the REVERENT randomized trial.

Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP), or ambulatory BP (ABP) measurements. This analysis investigated the association and agreement between OBP, HBP, and ABP measurements for BPV assessment at baseline and 10 weeks after initiating antihypertensive drug therapy. Untreated hypertensive patients with elevated BPV were randomized to receive an angiotensin-converting enzyme inhibitor (ramipril) or a calcium channel blocker (nifedipine GITS) in a 10-week, open-label, blinded-end point study. BPV was assessed using standard deviation (SD) and coefficient of variation (CV) (reading-to-reading analyses). Data from 146 participants from three research centers (Athens/Greece; Milan/Italy; Shanghai/China) were analyzed [mean age 53 ± 10 (SD) years, male individuals 60%, baseline systolic OBP, HBP, and 24 h ABP 144 ± 9, 138 ± 10, and 143 ± 10 mmHg, respectively]. Post-treatment minus pre-treatment systolic CV difference was: OBP: 0.3%, P = 0.28; HBP: -0.2%, P = 0.20; 24 h ABP: 1.1%, P < 0.001. Home and ambulatory (not office) BPV indices presented weak-to-moderate correlation, both before and during treatment (range of coefficients 0.04-0.33). The correlation coefficient between systolic HBP and awake ABP CV was 0.21 and 0.28 before and during treatment, respectively ( P < 0.05/< 0.001, respectively). Home and ambulatory (not office) BPV indices presented slight-to-fair agreement (range 64-73%) in detecting participants with high systolic BPV (top quartile of respective distributions) both before and during treatment (kappa range 0.04-0.27). These data showed a weak-to-moderate association between out-of-office (but not office) BPV indices both before and during BP-lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar and consistent BPV information than office measurements.

Associations of variability in blood glucose and systolic blood pressure with mortality in patients with coronary artery disease: A retrospective cohort study from the MIMIC-IV database

AimsVariability of metabolic parameters, such as glycemic variability (GV) and systolic blood pressure variability (SBPV), are associated with adverse cardiovascular outcomes. However, whether these parameters have additive effects on mortality in patients with coronary artery disease (CAD) hospitalized in the intensive care unit (ICU) remains unclear. MethodsWe retrospectively enrolled patients with CAD from the Medical Information Mart for Intensive Care-IV database. The highest tertile of variability was defined as high variability. A variability scoring system was established, which assigned 0 points to tertile 1, 1 point to tertile 2, and 2 points to tertile 3 for GV and SBPV. ResultsAmong 4237 patients with CAD, 400 patients died in hospital, and 967 patients died during 1-year follow-up. High GV and high SBPV were associated with an increased risk of mortality. The effects of GV and SBPV on in-hospital mortality were partially mediated by ventricular arrhythmias (18.0 % and 6.6 %, respectively). The risk of mortality gradually increased with the number of high-variability parameters and increasing variability scores. ConclusionsGV and SBPV have additive effects on the risk of mortality in patients with CAD hospitalized in the ICU. Ventricular arrhythmias partially mediate the effects of GV and SBPV on in-hospital mortality.

Abstract 148: Increased Systolic Blood Pressure Variability During the First 24-hours of Hospitalization Associates With Poor 90-day Outcome After Intracerebral Hemorrhage

Introduction: Prospective studies and secondary analyses from clinical trials have identified increased systolic blood pressure variability (SBPV) as a risk factor for poor outcomes. Evidence of this association in real-world intracerebral hemorrhage (ICH) hospitalization is lacking, however. Methods: Data for adult (≥18) patients with primary ICH were retrieved from the REINAH cerebrovascular research database. Systolic blood pressure measurements from the first 24 hours of admission were retrieved and SBPV was calculated as the Coefficient of Variation (CV) = (standard deviation/mean)*100. Socioeconomic deprivation was assessed using the state Area Deprivation Index (ADI), with high deprivation assessed at ADI ≥ 8. The primary outcome was severe disability or death (SDD; modified Rankin Scale ≥4) at 90-days after discharge. Differences in SBPV across SDD were assessed using the Mann-Whitney U test. Associations between SBPV and SDD were assessed using multivariable logistic regression models adjusted for patient characteristics. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Final cohort included 807 patients (median [IQR]: 66 [54-77], 45.6% female), with an ethno-racial distribution of 41.9% White, 25.9% Black, 23.9% Hispanic, 5.7% Asian, and 2.6% Other. The median CV was 12.07 [9.50-15.59] and 485 (60.1%) patients experienced SDD. Patients with SDD showed significantly higher SBPV than non-SDD patients (12.90 [10.33-17.11] vs 10.99 [8.72-13.72]; p&lt;0.001). Patients with 24-hour SBPV in the 3 rd (1.86 [1.16-2.96]) and 4 th quartile (3.10 [1.89-5.09]) had higher independent odds of SDD (vs. 1 st quartile) (Figure 1). Discussion: Patients with high SBPV during the first 24 hours of admission have higher odds of severe disability or death at 90-days after discharge.

Abstract TP152: Systolic Blood Pressure Variability Characteristics Increase With Severity Among Intracerebral Hemorrhage Patients

Introduction: Selected studies link high systolic blood pressure variability (SBPV) to poor patient outcome after intracerebral hemorrhage (ICH). SBPV levels during real-world ICH admission remain unknown, however. We profile SBPV across ICH patient characteristics. Methods: Clinical data for adult patients (≥18) with primary non-traumatic ICH were retrieved from the electronic medical records. Patient SBPV was calculated as the Coefficient of Variation (CV; CV = (Standard Deviation/Mean)*100) during the first 24 hours of admission and across whole hospitalization. Hemorrhage characteristics and cerebral small vessel disease burden (CSVD; STRIVE 2.0 criteria) were assessed from neuroimaging during admission. Severe CSVD was assessed at summary scores ≥3. Cerebral Amyloid Angiopathy (CAA) was graded via Modified Boston Criteria. Descriptive statistics are provided for SBPV during first 24 hours of admission and whole-stay. Population differences are assessed using Mann Whitney Rank Sum and Kruskal Wallis tests of hypothesis. Results: Patient cohort included 2,020 primary ICH patients (median age: 67, IQR: [55-77]; 45.2% female), with an ethno-racial distribution of 43.6% White, 23.3% Black, 22.5% Hispanic, 8.2% Asian, and 2.5% Other. Median hemorrhage volume was 12.1 [1.9-36.3] cm 3 ; SBPVs over the first 24-hours and whole-stay were 12.6 [9.9-16.2] (Mean: 13.7; Skewness: 1.9; Kurtosis; 11.3) and 12.5 [10.7-15.0] (Mean: 13.4; Skewness: 3.05; Kurtosis; 21.3), respectively. SBPV significantly increased with female sex, worsening discharge disposition, increasing Glasgow Coma Scale severity, hemorrhage volume, intraventricular hemorrhage presence, and severe CSVD. Increasing CAA tiers showed reductions in SBPV. (Figure 1) Discussion: Levels of SBPV during ICH vary across patient characteristics and are elevated in those with more severe hemorrhage characteristics and worse hospital outcomes.

Visit-to-visit variability in blood pressure and the risk of open-angle glaucoma in individuals without systemic hypertension: a nationwide population-based cohort study.

We aimed to evaluate the effect of visit-to-visit variability in blood pressure (BP) on the risk of open-angle glaucoma (OAG) in individuals without systemic hypertension using a population-based retrospective cohort study design. The Korean National Health Insurance Service-National Health Screening Cohort database, which collected data of 209,226 individuals between 2002 and 2015, was used to analyze the data of 140,910 eligible participants. The mean follow-up duration was 8.3 years. Visit-to-visit BP variability was assessed using standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM). Participants were categorized into four groups according to BP variability quartiles. We verified the effect of BP variability by comparing participants of the first to third quartiles of BP variability groups with those belonging to the fourth quartile group. A Cox proportional hazards model was used to determine the hazard ratio (HR) of BP variability in cases of newly diagnosed OAG. Moreover, we conducted subgroup analyses using baseline characteristics. In the multivariable analyses, BP variability did not significantly increase the risk of OAG development. However, subgroup analyses revealed significant interactions between age and systolic BP variability in the development of OAG (CV: p = 0.008; SD: p = 0.007). For participants aged <60 years, the risk of OAG development significantly increased with high systolic BP variability (CV: HR, 1.18; 95% confidence interval [CI], 1.00-1.39; p = 0.049). We observed a similar trend using the SD and VIM as the parameters for systolic BP variability. Higher visit-to-visit systolic BP variability was associated with an increased risk of OAG development in participants younger than 60 years of age without systemic hypertension. These results suggest that BP variability can be the considerable factor when assessing the risk of OAG, especially in relatively young people without systemic hypertension.

Impact of Long-Term Blood Pressure Variability on Survival Rate in Elderly Maintenance Hemodialysis Patients: A 46-Month Follow-Up Study of 245 Patients.

BACKGROUND At present, there are few blood pressure variability (BPV)-related studies of elderly maintenance hemodialysis (MHD) patients. This study aimed to compare the effects of long-term BPV on the 46-month survival rate of MHD patients aged <75 years and ≥75 years between 2000 and 2014, with follow-up until 2018. MATERIAL AND METHODS According to systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV), patients were divided into 4 groups: a low SBPV group (n=121), a high SBPV group (n=122), a low DBPV group (n=114), and a high DBPV group (n=112). RESULTS We included 243 patients in the study. All the patients were followed up for 46 months, and 59 patients (28 males) died during follow-up. The survival rate of patients in the high SBPV group was significantly lower than that of the low SBPV group (log rank P=0.049). No significant differences were observed between the high DBPV group and low DBPV group (log rank P=0.167). There were no significant differences in survival rates between the high SBPV group and low SBPV group among patients aged <75 years (log rank P=0.656), and among patients ≥75 years, the survival rate of the high SBPV group was significantly lower than that of the low SBPV group (log rank P=0.041). CONCLUSIONS Increased long-term SBPV in MHD patients is associated with a decrease in long-term survival rate, and patients ≥75 years are more susceptible to it.

Cognitive Disorders in Patients with Hypertension: Are There Gender Differences?

Background: Given the profound differences between women and men, there is a need to study gender as a vital variable and factor in blood pressure regulation, control, and treatment. The level of anxiety and depression, which significantly affect the psychological characteristics and patients' quality of life, and the status of the autonomic nervous system represent a rather significant layer of hypertension problems due to its specificity, accumulating its medical, social, gender, and humanitarian aspects, which are related to sexual characteristics.&#x0D; Material and Methods: The study results are based on the data of a comprehensive examination of 185 working patients with controlled hypertension (H) stage II. According to the neuro-psychological testing on MMSE, МоСА and Life Quality scales, 157 people with various severity cognitive disorders (CD) were found. There were 87 (55.4 %) women and 70 (44.6 %) men among them, and the average age [M(SD)] was 52.3 (8.2) years; the average duration of H was 10 (8-12 years). The comparison and control groups were adequate for the purpose. The standard methods of parametric and non-parametric statistics processed the obtained data. &#x0D; Results: As a result of the study, significant differences were found in patients with hypertension and CD of both sexes compared with healthy individuals and patients with hypertension without cognitive impairment in relation to the daily blood pressure profile (VAR SBP, VAR DBP) both during the day and at night. The females, even middle-aged, with controlled hypertension but high systolic blood pressure variability, have a substantial risk of developing CD. Male patients with hypertension, even in the absence of CD, are more prone to depression, according to the HADS scale. In the presence of hypertension with CD, they are characterized by significantly worse personal-role physical and emotional functioning compared to female patients on the life quality scale. The often irresponsible attitude of men to the doctor's advice and regular antihypertensive treatment probably plays a significant role in the formation of gender differences in the quality of life of patients with hypertension and CD.&#x0D; Conclusion: It is necessary to ensure early diagnosis and monitoring of CD as a marker of brain damage due to hypertension and determine the level of anxiety and depression, which significantly affect the psychological characteristics and quality of life even of patients with controlled hypertension, regardless of gender. However, middle-aged women, even with controlled hypertension but high SBP variability, have a priority risk of CD development.

Association between within-visit blood pressure variability, stroke, coronary heart disease, and cardiovascular mortality.

Long-term variability in systolic blood pressure (SBP) is associated with a higher risk of cardiovascular events. Little is known about any association between within-visit SBP variability, stroke, coronary heart disease (CHD), and cardiovascular (CV) death. Participants included adults ≥ 18 years who participated in the US National Health and Nutrition Examination Surveys from 1999 to 2012 linked to the national death index in 2012. Stroke was self-reported. SBP was obtained up to four times by a physician, using a manual sphygmomanometer according to standard procedures. Within-visit SBP variability was defined as the standard deviation of the BP measurements, stratified into quartiles. We evaluated the relationship between within-visit SBP variability and the odds of stroke or CHD using multivariable logistic regression, and with CV mortality, using multivariable Cox regression. Of the 27,987 adults, 16.4% were aged ≥ 65 years, 51.3% were female, 71.2% were white, and 10.7% were black. Factors associated with higher mean SBP variability included older age, hypertension, chronic kidney disease, peripheral artery disease, and smoking (all p < 0.05). The prevalence of stroke significantly increased across SBP variability quartiles, from 2.1% for quartile 1 to 3.7% for quartile 4 (p < 0.001). High SBP variability was associated with higher odds of stroke [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.2], coronary heart disease (OR 2.0, 95% CI 1.6-2.4), and increased risk of CV mortality [hazard ratio (HR) 2.7, 95% CI 2.3-3.1]. The relationships were not observed after adjusting for covariables. Within-visit variability in SBP is associated with increased risks of stroke, coronary heart disease, and cardiovascular mortality, but the relationship is confounded by age and covariates.

Blood pressure variability and short-term outcomes after mechanical thrombectomy in patients with acute ischemic stroke

ObjectivesThere is limited data evaluating effects of post-mechanical thrombectomy (MT) blood pressure (BP) control on short-term clinical outcomes in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). We aim to investigate the association of BP variations, after MT, with stroke early outcomes. Materials and methodsA retrospective study was conducted on AIS patients with LVO undergoing MT at a tertiary center over 3.5 years. Hourly BP data was recorded within the first 24- and 48-hours post-MT. BP variability was expressed as the interquartile range (IQR) of BP distribution. Short-term favorable outcome was defined as modified Rankin scale (mRS) 0-3, discharge to home or inpatient rehabilitation facility (IRF). ResultsOf the 95 enrolled subjects, 37(38.9%) had favorable outcomes at discharge and 8 (8.4%) died. After adjustment for confounders, an increase in IQR of systolic blood pressure (SBP) within the first 24 hours after MT revealed a significant inverse association with favorable outcomes (OR 0.43, 95% CI [0.19, 0.96], p = 0.039). Increased median MAP within the first 24 hours after MT correlated with favorable outcomes (OR 1.75, 95% CI [1.09, 2.83], p = 0.021). Subgroup analysis redemonstrated significant inverse association between increased SBP IQR and favorable outcomes (OR 0.48, 95% CI [0.21, 0.97], p = 0.042) among patients with successful revascularization. ConclusionsPost-MT high SBP variability was associated with worse short-term outcomes in AIS patients with LVO regardless of recanalization status. MAP values may be used as indicators for functional prognosis.

Correlation Between Short-Term Blood Pressure Variability After Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Patients With ST Segment Elevation Myocardial Infarction

Abstract Background To investigate the relationship between short-term blood pressure variability (BPV) after primary percutaneous coronary intervention (PPCI) and adverse cardiovascular outcomes 1 year after operation in patients with acute ST segment elevation myocardial infarction (STEMI). Methods The clinical and prognostic data of 331 patients with STEMI who underwent PPCI and drug-eluting stent implantation were collected retrospectively from 2016 to 2019. The correlation between BPV within 4 days and adverse cardiovascular outcome 1 year after operation was analyzed. Blood pressure SD was used to evaluate individual systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV). The high SBPV and DBPV groups were defined as SD ≥11.42 and ≥8.49 mm Hg, respectively. Multivariate bivariate logistic regression model was used to explore the correlation between SBPV, DBPV, and major adverse cardiovascular events (MACE) 1 year after operation. Results The incidence of heart failure in the high SBPV group (21.1% vs. 10.3%) was significantly higher than the low SBPV group. Also, the incidence of heart failure (23.5% vs. 7.9%) and the cumulative incidence of MACE (29.5% vs. 13.9%) in the high DBPV group were higher than those in the low DBPV group (all P &amp;lt; 0.05). After adjusting for age, sex, body mass index, antihypertensive drugs, left ventricular ejection fraction, Gensini score, and other influencing factors, multivariate binary logistic regression analysis showed that high SBPV was a risk factor for heart failure (odds ratio [OR] = 3.462, 95% confidence interval [CI] 1.476–8.117, P = 0.004), and high DBPV was a risk factor for heart failure and cumulative MACE (OR = 4.535, 95% CI 1.725–11.926, P = 0.002; OR = 3.412, 95% CI 1.627–7.152, P = 0.001, respectively) and in the subgroup hypertensives using oral antihypertensive drugs (OR = 4.328, 95% CI 1.619–11.572, P = 0.004), as well as high DBPV for heart failure and cumulative MACE (OR = 4.600, 95% CI 1.518–13.934, P = 0.007; OR = 4.942, 95% CI 1.851–13.198, P = 0.001, respectively). Conclusions High BPV within 4 days after PPCI and drug-eluting stent implantation in STEMI patients is a cardiovascular risk factor within 1 year after operation.

Association of 24 h Blood Pressure on Functional Outcome in Patients with Acute Ischemic Stroke Post Intravenous Thrombolysis

Introduction: Elevated admission blood pressure (BP) and BP variability have been shown to be associated with poor outcomes in most studies, while few studies have not found such an association. We investigated the association of various BP parameters with 3-month functional outcomes, mortality, and symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT). Methods: Patients with AIS who received IVT between January 2012 and March 2020 were analyzed. Admission BP, 24 h mean BP, and BP variability were noted for all patients. Outcomes assessed were 3-month modified Rankin Scale (mRS), mortality, and sICH. Results: Of the 237 patients, 161 were males. The mean admission systolic BP (SBP), 24 h mean SBP, and BP variability were 158.1 mm Hg (SD 30.25), 138 mm Hg (SD 16.78), 19.42 (SD 12.79), respectively. At 3 months, 147 (62%) patients had a good outcome (mRS 0–2). Multivariate analysis showed prior stroke, NIHSS >15, mean SBP ≥160 mm Hg, and SBP variability >45 to be significant predictors of poor outcome (mRS > 2) at 3 months. Eleven patients (4.6%) developed sICH. Age more than 60 years, presence of atrial fibrillation, admission blood sugar ≥180 mg/Dl, and SBP variability >45 predicted sICH. None of the above factors were predictive of 3-month mortality. Conclusion: An elevated mean SBP and greater SBP variability were predictive of poor functional outcomes, whereas a high SBP variability predicted sICH. Our study emphasizes the need for BP control and minimizing large fluctuations to achieve good poststroke outcomes.

Left ventricular global function index and peculiarities of daily blood pressure profile in patients with arterial hypertension

BACKGROUND: The left ventricular global function index (LVGFI), determined using transthoracic echocardiography, is a simple clinical marker of left ventricular dysfunction and has superior prognostic value to the standard ejection fraction-based assessment of cardiac pump function. The methodology for calculating this index was proposed in 2019. Currently, the clinical factors that influence the state of left ventricular global functions are not examined.&#x0D; AIM: This study aimed to assess the association of LVGFI with the peculiarities of daily blood pressure (BP) profile in patients with arterial hypertension (AH).&#x0D; MATERIALS AND METHODS: A total of 104 patients [51 men (49%) and 53 (51%) women] with AH were examined. The mean age of the patients was 58.711.73 years, and disease duration was 6.0310.93 years. AH corresponded to grades 1, 2, and 3 in 47 (45.2%), 26 (25.0%), and 31 (29.8%) patients, respectively. Patients with myocardial infarction or stroke, cardiomyopathies, heart defects, diabetes mellitus, thyroid dysfunction, or chronic kidney disease were not included in the study. All patients underwent daily BP monitoring, echocardiography, carotid artery examination, and biochemical blood tests.&#x0D; RESULTS: A significant inverse weak correlation of LVGFI with age (r=0.215, p=0.028), body mass index (r=0.378, p=0.001), BP variability (r=0.307, p=0.002), and daily mean values of systolic (r=0.223, p=0.026) and diastolic (r=0.237, p=0.018) BP were observed. In the regression analysis, an increase in body mass index, abnormal diurnal BP with excessive BP reduction at night, and high BP variability demonstrated a significant and independent association with decreased LVGFI.&#x0D; CONCLUSIONS: The study revealed an independent association of decreased LVGFI with increased body mass index, excessive BP reduction at night, and high systolic BP variability. These factors should be considered in the possible development of a strategy to prevent target organ damage in AH.

BLOOD PRESSURE VARIABILITY ASSESSED WITH OFFICE, HOME AND AMBULATORY MEASUREMENTS BEFORE AND AFTER ANTIHYPERTENSIVE DRUG TREATMENT: THE REVERENT TRIAL

Objective: Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP) and ambulatory BP (ABP) measurements. In this analysis BPV indices derived using all the three methods were compared before and after 10 weeks of antihypertensive drug treatment. Design and method: Untreated hypertensives (or treated after washout period) with elevated BPV (systolic HBP standard deviation [SD] &gt; 7 mmHg and/or systolic daytime ABP SD &gt; 12 mmHg), were nalysedd to ramipril 10 mg or nifedipine gastrointestinal therapeutic system (GITS) 30 mg once daily, in the context of a multicenter 10-week, prospective, nalysedd, open-label, blinded-end point study. BPV was assessed using SD and coefficient of variation (CV) [weighted SD (wSD) and weighted CV (wCV) for 24h-ABP variability) of individual measurements. Results: Data from 146 participants from three research centers (Athens, Milan, Shanghai) were nalysed (mean age 53 ± 10 [SD] years, males 60%, baseline systolic OBP, HBP and 24h-ABP 143 ± 10, 138 ± 10, and 143 ± 10 mmHg, respectively). Systolic CV assessed by HBP was decreased with treatment, by OBP was unchanged and by ABP increased (p &lt; 0.05). HBP and ABP (not OBP) variability indices presented weak to moderate correlation, which was consistent before and after treatment (Table). HBP and ABP (not OBP) variability indices presented slight to fair agreement in detecting participants with high systolic BPV (top quartile of respective distribution) both before and after treatment (kappa statistic range 0.12–0.27). Conclusions: These data showed a moderate association between out-of-office (but not office) BPV indices both before and after administering BP lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar BPV information than office measurements, both before and after administering antihypertensive drug treatment.

The association of blood pressure variability with white matter integrity and cognitive impairment in cerebral amyloid angiopathy

AbstractBackgroundEmerging evidence suggests that blood pressure variability (BPV) may contribute to small vessel disease (SVD) progression and cognitive impairment beyond the deleterious effects of elevated blood pressure, but the mechanisms remain largely unknown. This study investigates if BPV is associated with white matter (WM) microstructural integrity and the slope of cognitive decline in elderly individuals with cerebral amyloid angiopathy (CAA), a well characterized type of SVD.MethodWe recruited 94 non‐demented individuals (73.3 ± 7.0 y, 40 F, MMSE 27.7 ± 1.5) from a memory‐clinic cohort with and without possible/probable CAA with available neuropsychological evaluation and 3.0 T research MRI. Visit‐to‐visit BPV was assessed using the coefficient of variation derived from the serial outpatient BP measures during a 5‐year interval. A novel diffusion tensor imaging marker – peak width of skeletonized mean diffusivity (PSMD) – was used to evaluate the WM integrity. Using linear regression models, we evaluated the association of PSMD with BPV, adjusted for standard cardiovascular risk factors.ResultWe found a significant association between loss of WM integrity and high systolic BPV (β = 0.37, P &lt; 0.001), but not mean BP. The association remained significant after adjusting for age, antihypertensive medication usage, diabetes, smoking, and body mass index. Furthermore, the association of BPV with WM integrity was stronger when CAA was present (P for interaction = 0.018). Higher BPV at baseline was associated with worse executive function in CAA patients at 2‐year follow‐up (β = ‐0.53, P = 0.003), adjusted for baseline function.ConclusionOur findings show that visit‐to‐visit BP fluctuations are associated with loss of WM microstructural integrity and cognitive decline. The association between BP variability and WM integrity might in part be driven by CAA pathology. Further studies are warranted to disentangle the relationship between BP fluctuations, microvascular injury, and cognitive impairment in older adults.

Hipertansiyon Hastalarında Sistolik Kan Basıncı Değişkenliği ve Kardiyovasküler Riskin Vekil Belirteçleri Arasındaki İlişki

Objective: Systolic blood pressure variability (SBPV) is a measure of oscillations in SBP for 24 hours. There are conflicting data about the relationship between SBPV and cardiovascular (CV) diseases. In this study, we aim to document a relationship between SBPV and surrogate markers of CV damage in a hypertensive patient cohort.&#x0D; Methods: Previously documented hypertension patients were enrolled. Patients with previously documented CV disease, diabetes mellitus and secondary hypertension were excluded. 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, electrocardiography and cardio-ankle vascular index (CAVI) measurements were performed. SBPV is defined as the standard deviation of mean systolic blood pressure readings from ABMP records. The relationship between SBPV and QTc distance, QT dispersion, presence of fragmented QRS, CAVI results were examined.&#x0D; Results: 64 patients were enrolled mean age 508, 24(37%) were male]. Mean SBPV was 15.124.6 and there was not a significant correlation between SBPV CAVI, QTc measurements of the study patients but there was a significant positive correlation with QT dispersion values (28.615.2, p=0.004, p=0.354). When patients were divided into two categories as high SBPV and low SBPV, QT dispersion was consistently longer in high SBPV group (p=0.006).&#x0D; Conclusion: In hypertensive patients without documented CV disease and signs of hypertensive CV changes on clinical evaluation, SBPV is positively correlated with QT dispersion but high SBPV is not related with aortic stiffness according to CAVI results. These findings might be a sign of occult left ventricular fibrosis and high risk of arrhythmia in hypertensive patients with high SBPV.

High within-visit systolic blood pressure variability is associated with stroke and diabetes

Abstract Background Within-visit systolic blood pressure variability (SBPV) has been inconsistently, positively associated with cardiovascular (CVD) outcomes. Purpose We sought to determine whether SBPV was cross-sectionally associated with CVD and CVD risk factors in a nationally representative study population of United States adults. Methods Using the 2011–2018 National Health and Nutrition Examination Surveys, a total of 10,879 adults ≥20 years not taking antihypertensive medications were included. After an initial five-minute rest, participants had three, sitting, consecutive BP readings (30 sec. rest in between) taken by protocol-trained physicians using a mercury sphygmomanometer. SBPV was calculated as 1) the standard deviation (SD) of the three BP readings and categorized into less than, and greater than or equal to the 75th percentile (SD≥4.2 mmHg). We also calculated the maximum minus minimum SBP difference (MMD), categorized into less than 10, and greater than or equal to 10 mmHg. The primary outcomes were self-reported history of CVD outcomes, including stroke, myocardial infarction, coronary heart disease, and heart failure. Secondary outcomes included increased waist circumference, impaired glucose tolerance, diabetes, hypertriglyceridemia, and low HDL. We used one-way ANOVA, chi-square tests, and multivariable logistic regression to determine association between SBPV and CVD outcomes. All analyses accounted for the complex survey design and had a significance level of 0.05. Results Among the 10,879 participants, 2,386 (20%) had high SBPV. Those with high SBPV were older (mean [SD]; 47.0 [0.6] vs. 41.8 [0.3], p&amp;lt;0.0001), had higher mean SBP (mean [SD] mmHg; 121 [0.4] vs. 118 [0.2], p&amp;lt;0.0001), higher max SBP (127 [0.4] vs. 120 [0.2], p&amp;lt;0.0001), higher HbA1c % (5.54 [0.02] vs. 5.48 [0.01]) but similar lipid profiles. Accordingly, high SBPV participants were more likely to have diabetes, but had no difference in other metabolic syndrome criteria (Figure 1). High SBPV participants were more likely to have a history of stroke (1.7% vs. 0.8%, p&amp;lt;0.0001), but less likely to have myocardial infarction (p=0.028; Figure 2). After adjustment for covariates, those with high SBPV had 50% higher odds of stroke compared to those without high SBPV (OR [95% CI]; 1.50 [1.11, 2.03]). This association persisted when using MMD (1.48 [1.04, 2.11]). However, the adjusted associations were attenuated when treating SBPV as a continuous variable (SD, unadjusted OR [95% CI]: 1.14 [1.07, 1.21], adjusted OR: 1.06 [0.99, 1.13]). Conclusion Participants with high SBPV were more likely to have diabetes and history of stroke. SBPV greater than or equal to 4.2 mmHg or maximum-minus-minimum SBP difference greater than or equal to 10 mmHg both were associated with nearly 50% higher odds of stroke. This suggests that stroke survivors may benefit from interventions to decrease within-visit BP variability to improve BP measurement accuracy and potentially prognosis. Funding Acknowledgement Type of funding sources: None. Figure 1. Cardiometabolic Factors &amp; BPVFigure 2. Cardiovascular Disease &amp; BPV

Prognostic importance of long-term SBP variability in high-risk hypertension

In addition to high blood pressure variability (BPV), low BPV was associated with adverse cardiovascular prognosis in selected high-risk patients. We explored this issue in the Systolic Blood Pressure Intervention Trial (SPRINT) using a nonlinear approach with BPV as a continuous variable. Long-term systolic BPV (SBPV) (coefficient of variation, CoV %) was calculated on quarterly visits until a fatal/nonfatal cardiovascular event or all-cause mortality, excluding titration period and patients with missing visits. We used Cox proportional hazard models with penalized smoothing splines to shape the risk of outcomes against the continuum of SBPV (independent variable). Adjusted hazard ratios (aHR, 95% CI) were calculated using the reference range derived from the nonlinear model. Sensitivity analysis based on propensity score matching (PSM) was performed. The association of SBPV with fatal/nonfatal cardiovascular events was J-shaped, whereas that with all-cause mortality was linear. After multivariate adjustment, however, the only significant associations remained that of low SBPV (CoV <5%) with cardiovascular events (hazard ratio 1.85, 95% CI 1.24-2.75, P = 0.003), and of high SBPV (CoV >10%) with the composite of cardiovascular events and all-cause mortality (hazard ratio 1.35, 95% CI 1.02-1.80; P = 0.037). Low SBPV was associated with ischemic heart disease (hazard ratio 2.76, 95% CI 1.55-4.91; P < 0.001). There was a significant U-shaped association of SBPV with cardiovascular events in the PSM cohort. Nonlinear modeling indicates that low and high long-term SBPV have prognostic relevance in high-risk hypertensive individuals from SPRINT. Randomized trials are needed to test these findings and their potential therapeutic implications.

Abstract 157: High Systolic Blood Pressure Variability After Successful Reperfusion Therapy in Acute Ischemic Stroke Predicts Unfavorable Outcomes

Introduction: There has been increasing evidence that higher systolic blood pressure variability (SBPV) is related to unfavorable outcomes in patients with stroke. We explored the relation between SBPV and clinical outcomes after reperfusion therapy; intravenous thrombolysis (IVT) and endovascular therapy (EVT). Methods: We retrieved data of consecutive patients with acute ischemic stroke (AIS) treated with reperfusion therapy from our prospective stroke registry between October 2005 and December 2018. We calculated the following five SBPV during 24 hours after IVT or EVT; mean, standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV). Clinical outcomes included unfavorable outcomes as modified Rankin Scale (mRS) score 3-6 at 3 months and symptomatic intracranial hemorrhage (sICH) as any hemorrhage with neurological deterioration of 4 points of more on the National Institute of Health Stroke Scale (NIHSS). Successful reperfusion was indicated with early neurological improvements of 4 points of more on the NIHSS after IVT alone or Thrombolysis in Cerebral Infarction scores of 2b or 3 after EVT alone or EVT combined with IVT. Results: Among 933 patients with premorbid mRS scores of 0-1 (72±12 years; 316 women), 426 patients with unfavorable outcomes and 35 patients with sICH were observed. In adjusted analyses, all measures of SBPV but CV were related to unfavorable outcomes, while all measures of SBPV but mean SBP were related to sICH. In 566 patients with successful reperfusion, 228 patients with unfavorable outcomes and 10 patients with sICH were observed. In adjusted analyses, all measures of SBPV but mean SBP were positively related to unfavorable outcomes, while no measures of SBPV were independently related to sICH (table). Conclusion: High SBPV after successful reperfusion therapy contributed to unfavorable outcomes, suggesting high SBPV after reperfusion therapy might need more attention.

Abstract TP437: Machine Learning Based Approach for Predicting High In-Hospital Systolic Blood Pressure Variability Among Intracerebral Hemorrhage Patients During Early Hospitalization

Introduction: Recent data suggest that early high systolic blood pressure variability (HSPBV) is associated with poor long term outcomes in intracerebral hemorrhage (ICH) patients. We employed a Machine Learning (ML) based approach to predict HSBPV during hospitalization. Methods: Adult radiologically confirmed ICH patients were enrolled in a multisite cohort. A semi-automated algorithm extracted systolic blood pressure (SBP) data from electronic medical records (EMR) and linkage to database with demographic, clinical, and outcomes information was created. Pre-hospital and early admission variables were used to develop predictive algorithms. Patients who expired during hospitalization were excluded. Generalized estimating equations quantified inter and intra-patient SBPV. An 80/20 data split was used to train and test predictive models for HSBPV. Two supervised ML models were trained using a repeated cross-validation bagged classification and regression tree, the first with a complete set of records and the second utilizing imputation (Figure). Results: A total of 455 patients were included with mean(SD) age 63.6 (14.98), females 36.7%, African American 34.5%, and median ICH score 2.0. The average per-patient observation time was 9.7 days resulting in 152,691 SBP readings. A 25 variable imputed model was parameterized (accuracy: 72.2%, sensitivity: 76.5%, specificity: 66.7%, and kappa: 0.43) (Figure). The top influential variables were age, hemorrhage volume, glucose, LDL, and platelets. Methodological and output contrasts with traditional likelihood-based modeling approaches will be presented. Conclusions: We demonstrate that ML-based pipelines can be developed for predicting HSBPV by utilizing SBP values generated from routine monitoring of ICH patients. Future development will incorporate streaming EMR SBP data points during patient stay, and evaluating high-dimensionality reduction methods such as principal component analysis.