Higher Blood Pressure Variability Research Articles

A17293 Relationship between amount of salt intake and long-term blood pressure variability

Objectives: Existing data indicate that blood pressure (BP) variability is a strong predictor of cardiovascular events in patients with arterial hypertension (AH). In spite of known influence of salt intake amount on BP level, relationship between amount of salt intake and BP variability (BPV) still needs investigation. Methods: 50 men with AH (mean age 55.94 ± 9.8 years) underwent to three different 10 day salt intake diets: regular (9–12 g/day), low (2.5–4 g/day) and high (>20 g/day). Home BP measurement three times a day (9am; 3pm; 9pm) according to the standard protocol during the whole study period was used. Standard deviation (SD) of measured BPs was used to calculate BPV. Coefficient of variation was calculated in all the groups according to the salt intake amount. Results: Average SBPs, DBPs and SDs during regular, low and high salt intake were as follows: 152.4 mmHg vs 148.2 mmHg and 154.8 mmHg for SBP, 91.4 mmHg, 90.2 mmHg and 93.8 mmHg for DBP, respectively; SDs of SBP were 12.2 ± 4.2 vs 9.4 ± 3.8 vs 13.2 ± 3.5 for systolic and 6.4 ± 3.7 vs 6.3 ± 3 and 6.8 ± 3.3 for diastolic, respectively. Coefficient of variation of SBP for regular, low and high salt diets were 8 ± 2.7%, 6.3 ± 2.5% and 8.6 ± 2.3% and for DBP - 6.9 ± 4%, 7 ± 3.3% and 7.3 ± 3.5%, respectively. High salt diet significantly increased average SBP, DBP and SDs. Conclusion: Study data show, that high sodium diet leads to the higher average BP and BPV. Differences of SBP and DBP between the groups were higher than 2 mmHg. Framingham Heart Study showed that population wide reduction of DBP in 2 mmHg is associated with a 6% reduction in CHD risk and Lewington et al, in 2002 showed that SBP reduction in only 2 mmHg would lead to 7% reduction in the incidence of death secondary to stroke and 10% reduction in IHD. High BPV is considered as a strong indicator for CV events per

A7625 Change in blood pressure variability among elderly treated hypertensive population and its association with mortality

Objectives: Higher blood pressure variability (BPV) is associated with increased cardiovascular and all-cause mortality. We aimed to explore whether BPV changed overtime in response to treatment and whether such change (decline/increase) has any association with long-term mortality amongst an elderly hypertensive population. Methods: We used data from a subset of Second Australian National Blood Pressure study participants (n = 496) aged ≥65 years who had 24 hours ambulatory BP (ABP) recording at study entry (baseline) and then after a median 2-yrs while on-treatment (follow-up). Weighted 24hr systolic BPV was calculated for both baseline and follow-up as a weighted mean of daytime and nighttime BP records standard deviations (SD). The annual rate of change in BPV over-time was calculated from these BPV estimates. Further, we classified both BPV estimates into ‘high’ and ‘low’ based on the baseline median BPV value; and then classified BPV changes into ‘No-change: low’, ‘no-change: high’, ‘decline: high to low’ and ‘increase: low to high’. Association of BPV changes with mortality outcome was assessed over a median 8.5 years after the follow-up ABPM. Results: We observed a decline in average weighted 24hr systolic BPV (mmHg) between baseline (11.8 ± 2.9) and follow-up (11.2 ± 3.2) among the study cohort. The observed BPV annual decline rate (mean ± SD) was –0.78 ± 1.95 (range –7.36 to 9.87). Having a ‘high’ BPV at baseline was associated after adjustment with an increase in all-cause and cardiovascular mortality irrespective of any change in BPV (Table 1). For those with ‘low’ BPV at baseline was not associated with an increase in mortality. Conclusion: In Elderly hypertensives having BPV above baseline median was associated with increased long-term mortality irrespective of any change in BPV.

A4137 Relationship between home self - measured high blood pressure variability and white matter hyperintensities

A4137 Relationship between home self - measured high blood pressure variability and white matter hyperintensities

A13842 Blood pressure variability was associated with Cystatin c level in Acute Hemorrhage Stroke

Objectives: Cystatin c (Cys c) is a good indicator in early renal dysfunction. Blood pressure variability (BPV) is closely related to target organ damage, especially the kidney. We aimed to explore Cys c level and the relationship with BPV in hemorrhage strokes. Methods: A total of 141 first-ever hemorrhage stroke cases were recruited in our study. Cys c, blood uric acid, blood creatinine were determinate and 24-hours ambulatory blood pressure for the first 7 consecutive days (7-day/24-hours) were monitored. Standard deviation was used to describe the BPV. Patients were divided into low BPV group (L-BPV) and high BPV group (H-BPV) according to the median of the 7-day/24-hours BPV. Described methods, univariateanalysis and multiple linear regressions were used for analysis. Results: The concentration of Cys c in H-BPV group (1.01 ± 0.38 mg/L) was higher than that in L-BPV group (0.85 ± 0.41 mg/L), (t = 2.35, P = 0.02). The 7-day/24-hours BPV of systolic blood pressure (SBP) in H-BPV group (17.21 ± 2.76)was higher than that of L-BPV group (11.14 ± 1.78), (t = 15.47, P = 0.001). The 7-days SBP BPV was positively correlated with Cys c level (r = 0.34, P = 0.001). Multiple linear regression analysis showed that 7-days/24-hours SBP BPV, serum creatinine, blood uric acid, gender and age were the main influencing factors of cys c level (all P < 0.05). Conclusion: BPV was the important influencing factors for Cystatin c level and may be an useful indicator for early renal dysfunction in acute hemorrhage stroke.

Abstract 026: High In-Hospital Systolic Blood Pressure Variability and Poor Functional Outcomes in Primary Intracerebral Hemorrhage Patients

Introduction: High in-hospital SBP variability (HSBPV) is an emerging marker for poor outcomes among Intracerebral Hemorrhage (ICH) patients. We aimed to determine the risk of severe disability or death (SDD) at day-90 among ICH patients with HSPBV and explore pre-hospital factors associated with HSPBV. Methods: Adult, radiologically confirmed primary ICH patients were prospectively enrolled and followed-up until day-90. All routinely collected SBP values were recorded for the inpatient stay. Inter and intra-patient SBPV was quantified using generalized estimating equations. Modified Rankin Scale (mRS) Score of 4 - 6 was defined as SDD. Poisson and logistic regression models were fit to determine the risk of day-90 SDD, and the association of pre-hospital characteristics with HSBPV. Results: A total of 566 patients [mean age: 63.5, females 36.6% (207 of 566)] were included. Total in-hospital follow-up period was 4,908 days [median (IQR) per patient = 8.7 (3-11)]. Over 120,500 SBP readings were analyzed. Inter and intra-patient mean SBP standard deviation (SD) was 11.1 and 13.2, respectively. A SD of 13.0 was parameterized as a cut-off for HSBPV. HSBPV patients had a 17% higher adjusted risk of day-90 SDD (Relative Risk, 95% CI: 1.17, 1.02-1.35) (Table). Older age and female sex were independently associated with HSBPV after controlling for hemorrhage volume, pre-morbid mRS, and Glasgow Coma Scale (Figure). Conclusion: Quantification of HSBPV is feasible utilizing routinely collected SBP readings. HSBPV is associated with poor outcomes. Elderly and female patients may be more likely to demonstrate HSBPV during hospitalization.

Twenty-four-hour ambulatory blood pressure variability is associated with total magnetic resonance imaging burden of cerebral small-vessel disease.

BackgroundLacunae, brain atrophy, white matter hyperintensity, enlarged perivascular space and microbleed are magnetic resonance imaging (MRI) markers of cerebral small-vessel disease (cSVD). Studies have reported that higher blood pressure variability (BPV) predicted cardiovascular risk in hypertensive patients; however, the association between BPV and the total MRI burden of cSVD has not been investigated. In this study, we aimed to explore this relationship between BPV and cSVD MRI burden.MethodsWe prospectively recruited patients who attended our hospital for annual physical examination. Twenty-four-hour ambulatory BP monitoring was performed using an automated system. BPV was quantified by SD, weighted SD, and coefficient of variation. One point was awarded for the presence of each marker, producing a score between 0 and 5. Spearman correlation and ordinal logistic regression analyses were used to test the relationship between BPV and total cSVD MRI burden.ResultsA total of 251 subjects with an average age of 68 years were enrolled in this study, and 52.6% were male; 163 (64.94%) had one or more markers of cSVD. Correlation analysis indicated that higher systolic BP (SBP) levels and BPV metrics of SBP were positively related to higher cSVD burden. Ordinal logistic regression analyses demonstrated that higher SBP levels and SBP variability were independent risk factors for cSVD. There were no significant differences in 24-hour, day and night diastolic BP levels or BPV metrics of diastolic BP among the five subgroups.ConclusionTwenty-four-hour, day and night SBP levels and SBP variability were positively related to cSVD burden. Higher SBP levels and SBP variability were independent risk factors for cSVD.

BLOOD PRESSURE VARIABILITY AS A FACTOR OF BETTER CARDIOPROTECTIVE EFFICACY OF RENAL DENERVATION

Aim : to study the cardioprotective efficacy of renal denervation in patients with normal and increased blood pressure variability. Material and Methods. Initially, at 6 and 12 months after renal denervation 84 patients were evaluated by 24-h blood pressure, Doppler echocardiogram and cardiac contrast-enhanced magnetic resonance imaging. Retrospectively, all patients were divided into two groups: the 1 st — with normal (SSD&lt;15 mm Hg, n=28) and the 2nd — with high 24-h blood pressure variability (SSD≥15 mm Hg, n=56). Results. Left ventricular mass reduced in the 2 nd group at 6 month by 6.9% (p=0.036), at 12 month by 9.6% (р=0.029). By magnetic resonance imaging in the 2 nd group left ventricular mass reduced at 12 month by 15.2% (р=0.010), volume of subendocardial damage — by 28.8% (р=0.039). There were no changes in the 1st group. Conclusion. After renal denervation left ventricular hypertrophy and subendocardial damage reduce better in patients with high blood pressure variability than in normal.

Blood Pressure Variability and Nocturnal Dipping in Diabetic Patients With and Without Chronic Kidney Disease

Background: Both increased blood pressure variability (BPV) and lack of nocturnal blood pressure dipping (NBPD) are independently associated with excess mortality in patients with diabetes mellitus. We hypothesised that patients with diabetes and CKD have higher BPV and are more likely to demonstrate a lack of nocturnal blood pressure dipping, than their counterparts without CKD. Methods: Clinical and biochemical data were collected from 124 patients attending diabetes clinics at Austin Health, Melbourne Australia. Stage 3 to 5 CKD (from here on referred to as “CKD”) was defined by a CKD-EPI eGFR of &amp;lt;60ml/min/1.73m2. Patients underwent 24h ambulatory blood pressure monitoring within one year either side of the eGFR measurement. BPV was calculated using standard deviation (SD) and coefficient of variation (SD/mean*100). Night-to-day systolic BP ratio of&amp;gt;90% suggested abnormal NBPD (“non dippers”). Results: Thirty-four patients (27%) had CKD. The mean±SD 24h systolic blood pressure was higher in patients with CKD than those without (135±16mmHg vs. 129±13mmHg respectively, p=0.03), and there was a negative correlation between eGFR and 24h systolic BP (r = -0.21, p=0.02). No association was found between eGFR and BPV. A negative correlation was found between eGFR and night-to-day systolic BP ratio, whereby lower eGFR was associated with higher night-to-day systolic BP ratio (i.e., with lack of NBPD). This relationship remained significant after adjusting for age and sex. Conclusion: Amongst patients with diabetes, reduced eGFR was associated with higher blood pressure and abnormal NBPD, but not with BPV. Further study is needed to characterise blood pressure fluctuations in diabetic patients with CKD, who constitute a high risk group. Disclosure R. Libianto: None. S. Baqar: None. T.D. Vu: None. R. MacIsaac: None. E.I. Ekinci: None.

INTENSIVE ANTIHYPERTENSIVE TREATMENT ON PATIENTS WITH LOW BLOOD PRESSURE VARIATION REDUCES RISK OF DEATH FROM CARDIOVASCULAR DISEASES

Objective: High blood pressure (BP) contributes to the burden of cardiovascular diseases (CVD). Recently, blood pressure variability (BPV) was suggested to be associating with CVD; however, no standardized risk stratification for BPV level exists and the corresponding antihypertensive treatment strategy remains unclear. This study aims to stratify BPV level by using machine learning and compare the risk of CVD between standard and intensive treatment groups. Design and method: Data of Systolic Blood Pressure Intervention Trial (SPRINT) were obtained from a clinical data sharing platform; non-diabete mellitus participants who had hypertension or at risk of CVD were recruited. Participants were randomized to receive intensive treatment (targeting systolic blood pressure (SBP) below 120 mmHg) or standard treatment (targeting SBP below 140 mmHg). BP were measured and recorded throughout the study. To stratify BPV level, this study included patients with more than 6 visit-to-visit BP measurements in 18 months. BPV was measured by the deviation between the BP records and the personalized BP trends, which were fitted by linear regression. Two-dimensional clustering on SBP and diastolic BP were conducted by applying K-means clustering. The risk of CVD death, stroke, myocardial infarction (MI), non-MI acute coronary syndrome and serious adverse event (SAE) were assessed regarding the BPV level and presented in terms of hazard ratio (HR) with 95% confidence interval (CI). Results: With 8,092 patients, the mean age was 67.9 and 65.1% were male. A total of 3,532, 3,385 and 1,175 patients were classified into low, medium and high BPV group. Patients with low BPV who took intensive treatment had reduced risk of CVD death (HR, 0.26; 95% CI, 0.10 to 0.69) when compared to the standard treatment group. Patients with high BPV and intensive treatment were at increased risk of SAE (HR, 1.23; 95% CI, 1.03 to 1.47). Subgroup analysis on BPV for stroke, MI and non-MI acute coronary syndrome showed no significant results.Conclusions: Hypertensive patients with low BPV who take intensive treatment would have significant reduction in risk of CVD deaths and insignificant increase in risk of SAE. The opposite holds true for patients with high BPV.

Dietary nitrate supplementation reduces low frequency blood pressure fluctuations in rats following distal middle cerebral artery occlusion.

It is known that high blood pressure variability (BPV) in acute ischemic stroke is associated with adverse outcomes, yet there are no therapeutic treatments to reduce BPV. Studies have found increasing nitric oxide (NO) bioavailability improves neurological function following stroke, but whether dietary nitrate supplementation could reduce BPV remains unknown. We investigated the effects of dietary nitrate supplementation on heart rate (HR), blood pressure (BP), and beat-to-beat BPV using wireless telemetry in a rat model of distal middle cerebral artery occlusion. Blood pressure variability was characterized by spectral power analysis in the low frequency (LF; 0.2-0.6 Hz) range prestroke and during the 7 days poststroke in a control group ( n = 8) and a treatment group ( n = 8, 183 mg/l sodium nitrate in drinking water). Dietary nitrate supplementation moderately reduced systolic BPV in the LF range by ~11% compared with the control group ( P = 0.03), while resting BP and HR were not different between the two groups ( P = 0.28 and 0.33, respectively). Despite systolic BPV being reduced with dietary nitrate, we found no difference in infarct volumes between the treatment and the control groups (1.59 vs. 1.62 mm3, P = 0.86). These findings indicate that dietary nitrate supplementation is effective in reducing systolic BPV following stroke without affecting absolute BP. In light of mounting evidence linking increased BPV with poor stroke patient outcome, our data support the role of dietary nitrate as an adjunct treatment following ischemic stroke. NEW & NOTEWORTHY Using a rat model of stroke, we found that dietary nitrate supplementation reduced low frequency blood pressure fluctuations following stroke without affecting absolute blood pressure values. Since blood pressure fluctuations are associated with poor clinical outcome in stroke patients, our findings indicate that dietary nitrate could be an effective strategy for reducing blood pressure fluctuations, which could help reduce stroke severity and improve patient recovery.

AN HIGHER WHITE-COAT EFFECT IN THE FIRST HOURS OF AMBULATORY BLOOD PRESSURE MONITORING IS ASSOCIATED WITH MORE BLOOD PRESSURE PEAKS DURING THE WHOLE DIURNAL PERIOD

Objective: White-coat effect (WCE) is a common finding also in ambulatory blood pressure monitoring (ABPM) and like in office blood pressure (BP) measurement can determine an over-diagnosis of arterial hypertension. In our previous work we found that WCE magnitude (WCEm) is correlated with an higher BP variability during the entire 24-hours ABPM period but the effective BP load remain to be established. Design and method: We analysed 421 ABPMs (M/F 146/275) characterized by the first systolic BP value at least 10 mmHg higher than mean diurnal systolic BP (mDSBP). WCEm was evaluated as the mean value of the first two hours of recording, both for systolic and diastolic BP (sysWCEm and diaWCEm, respectively). The diurnal BP load was estimated with BP peaks, i.e. the number of systolic and diastolic BP values respectively 10 and 5 mmHg higher than mDSBP and mean diurnal diastolic BP (mDDBP). We evaluated the correlations between WCEm, BP peaks and drug classes (angiotensin-converting enzyme/angiotensin receptor blockers, beta-blockers, calcium channel blockers, thiazide diuretics, alpha-blockers, central alpha-agonists and anti-aldosterone) with a multivariate regression analysis with a p-value < 0.01 considered as statistically significant. Results: Mean age was 65 ± 1 years (M/F 66 ± 1/64 ± 1 years, n.s.) and overall mDSBP and mDDBP were 137 ± 1 and 79 ± 0.5 mmHg, whereas sysWCEm and diaWCEm were respectively 150 ± 1 and 86 ± 1 mmHg, without gender differences. Systolic and diastolic peaks were respectively 12.5 ± 0.1 and 13.5 ± 0.1; only the first was directly correlated with age (r = 0.21; p < 0.01) whereas neither of the two was correlated with drug therapy. Both systolic and diastolic peaks were significantly correlated with sysWCEm (respectively r = 0.17 and r = 0.19; p < 0.01) but not with diaWCEm; they were also correlated with mDSBP and mDDBP (respectively r = 0.35 and r = 0.31; p < 0.01). Conclusions: In patients with an higher sysWCEm, systolic and diastolic BP peaks are increased confirming an influence of WCE on the entire diurnal period of ABPM, suggesting that in patients with WCE the alarm reaction persists well beyond the two initial hours of recording alarm.

Persistence of elevated blood pressure during childhood and adolescence: a school-based multiple cohorts study.

Blood pressure (BP) screening is advocated in children. However, identification of children with sustained elevated BP is difficult because of high BP variability. We assessed the tracking of BP and the persistence of elevated BP across childhood and adolescence. Three cohorts of children from schools in the Seychelles were examined on two occasions at 3-4-year intervals. Obesity was defined as BMI at least 95th sex-specific, and age-specific percentile. On each visit, BP was based on the average of two readings and elevated BP was defined as BP at least 95th sex-specific, age-specific, and height-specific percentile. Data was collected in 4519 children of mean ages of 5.5 and 9.2 years, 6065 of ages of 9.2 and 12.5 years, and 5967 of ages of 12.5 and 15.6 years, respectively. Prevalence of elevated BP was 10% at age 5.5 years, 10% at 9.2 years, 7% at 12.5 years, and 9% at 15.6 years, respectively. Among children with elevated BP at the initial visit, the proportions who had elevated BP at the subsequent visit 3-4 years later was 13% between ages of 5.5 and 9.2 years, 19% between 9.2 and 12.5 years, and 27% between 12.5 and 15.6 years. These proportions were higher among obese children with elevated BP, that is, 33, 35, and 39%, in each cohort, respectively. Tracking coefficients were slightly larger for SBP (range of tracking coefficients: 0.23-0.40) than for DBP (range: 0.19-0.35), and increased with age. By comparisons, tracking coefficients for BMI were much higher (range: 0.74-0.84). During childhood and adolescence, having an elevated BP on one occasion is a weak predictor of elevated BP 3-4 years later. Tracking is, however, larger in older and obese children than in younger and nonobese children.

E impact of visit-to-visit systolic blood pressure variability on residual renal function and le ventricular hypertrophy in peritoneal dialysis patients

Background/aim: Blood pressure (BP) variability is more closely associated with adverse outcomes than ‘usual’ BP in the general population. Residual renal function (RRF) and left ventricular hypertrophy (LVH) are thought to be predictors of poor outcome in dialysis patients. However, only a few studies have focused on BP variation and its link to RRF, LVH, and outcome in peritoneal dialysis (PD) patients. Therefore, we aimed to explore the effect of visit-to-visit BP variability on RRF and LVH in continuous ambulatory PD (CAPD) patients. Materials and methods: We performed an observational study that included all prevalent PD patients between 1 February 2006 and 31 January 2007. All patients underwent BP measurements, pulse wave velocity (PWV), cardiac ultrasound, and biochemical examination during the 1-year observation. Patients were divided into the HBPV group (higher BP variability) and LBPV group (lower BP variability) based on the standard deviation of systolic BP (SBP). Results: There were 70 patients recruited for the final analysis. Patients with HBPV had a higher SBP as compared to patients with LBPV at baseline. Renal Kt/V decreased significantly from 0.50 ± 0.49 to 0.32 ± 0.35 (P < 0.01) in HBPV group (but not in the LBPV group) during follow-up. Patients with HBPV also showed a higher left ventricular mass index (LVMI) and PWV than those with LBPV at the end of follow-up. Conclusion: Our study suggests that BP variability may affect RRF in PD patients. PD patients with HBPV had a faster decline in RRF and higher PWV and LVH.

The Clinical Significance of Circadian Rhythm and Blood Pressure Variability

— Sleep-wake cycle is the most evident 24 hour rhythms observed in humans. This circadian variation is a normal biological clock. The physiological phenomenon, however has been able to explain the onset of cardiac events that also tend to occur during certain time of day. It has been known that there is a tendency for major cardiovascular episodes to occur during the mid-morning hours. With the advent of ambulatory blood pressure monitoring, the fluctuations of blood pressure throughout the day are able to be captured. This is called blood pressure variability (BPV). The factors affecting BPV include age, sex, physical activity, mental activity, behavioural and environmental. Recent studies have shown that high BPV is associated with target organ damage, in particular cardiovascular and coronary artery diseases. In the effort to explain the mechanisms related to these complications out of excessive BPV, several studies explored the role of history of family with hypertension, hyperglycaemia and hyperlipidemia towards developing pre-existing condition that lead to high BPV.

Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients

Background/Aims: Blood pressure variability (BPV) is a novel cardiovascular risk factor for the population undergoing hemodialysis (HD). Methods: We conducted a retrospective cohort study of 526 HD patients. Four short-term peridialysis BPV metrics were analyzed: systolic blood pressure (SBP) change, SBP coefficient of variation (CV), SBP intradialytic average real variability (ARV), and absolute SBP residual. Multi variate analysis with Cox regression models were used to account for the potential confounders. Results: Short-term BPV is found to be affected by age, pre-dialysis SBP, antihypertensive drugs, dialysis time, and vascular access. Calcium-channel blockers (CCBs) were found to be associated with lower BPV than those on non-CCB therapy or no antihypertensive drugs. Patients dialyzed in the morning had a greater absolute SBP change than those dialyzed in the afternoon or evening. Patients using fistulas had a lower BPV than catheters. Higher BPV metrics including SBP CV (unadjusted hazard ratio [HR]: 1.37, 95% confidence interval [CI] 1.14-1.66, p=0.001), SBP intradialytic ARV (unadjusted HR: 1.46, 95% CI: 1.20-1.77, p< 0.001), and SBP residual (unadjusted HR: 1.47, 95% CI: 1.21-1.79, p< 0.001) were associated with a greater risk of cardiovascular events. After complete multivariate adjustment for other potential confounders, the HR remained statistically significant for SBP intradialytic ARV (HR 1.31, 95% CI: 1.04-1.66, p=0.024). Conclusion: Peridialytic BPV may be a potential target for improved blood pressure (BP) management in HD patients. Each short-term BPV metric has different advantages and disadvantages and should be applied according to the clinical context and purpose.

Anxiety-related blood pressure variability in patients with atrial fibrillation after cardioembolic stroke

To investigate whether of anxiety-related blood pressure (BP) variability can be corrected in patients with atrial fibrillation (AF) who have experienced cardioembolic stroke (CES). The investigation enrolled 125 patients (mean age, 68.5±5.7 years) with AF, who had experienced CES. The patients were randomized into 2 groups by the envelope technique: 1) 63 patients received antihypertensive drugs and an anxiolytic (adaptol) (a study group); 2) 62 patients had antihypertensive drugs only (a comparison group). Effectiveness was evaluated 2 and 6 weeks later from the time course of changes in BP readings obtained by 24-hour Holter monitoring in relation to reactive anxiety (RA) and personal anxiety (PA) scores. The latter were determined using the Spielberger-Hanin Anxiety Self-Esteem scale. The patients with AF who had experienced CES were noted to have high BP variability associated with increased RA and PA scores. Group 1 showed statistically significant improvements in RA and PA 2 and 6 weeks after the start of treatment. The efficiency of anti-anxiety therapy (adaptol at a dose of 500 to 1500 mg/day) in combination with antihypertensive drugs is confirmed by the normalized circadian BP profile. The incorporation of an anxiolytic into pharmacotherapy regimens could improve BP, namely, to reduce and stabilize its circadian profile.

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome.

BackgroundHow short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.MethodsPatients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.ResultsA total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03–1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01–1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.ConclusionShort-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.

Relationship between blood pressure variability and target organ damage in elderly patients.

To investigate the relationship between 24 h systolic blood pressure variability (SBPV) and target organ damage in elderly patients with essential hypertension. 180 elderly patients (≥ 80 y) with hypertension admitted to our hospital from January 2015 to January 2017 were selected as hypertension group and divided into high blood pressure variability (BPV) group and low BPV group according to the 50th percentile (P50) of 24 h SBPV, while 90 elderly non-hypertension patients admitted during the same period were enrolled as control group. 24 h ambulatory blood pressure values of patients in the three groups were recorded. The total cholesterol (TC), left ventricular mass index (LVMI), carotid artery intima-media thickness (IMT), 24 h microalbuminuria (MA) and complications with cardiovascular disease in patients of the three groups were compared and analyzed. Logistic analysis was conducted with MA, IMT and LVMI as the dependent variables and the remaining risk factors as the independent variables. 24 h SBPV and daytime SBPV (d SBPV) in patients of the hypertension group were significantly higher than those in the control group (p < 0.01); the incidences of coronary heart disease and atherosclerotic plaque as well as IMT, LVMI and MA were higher in the high BPV group than those in the low BPV group (p < 0.05 or p < 0.01). The multivariate results showed that 24 h SBPV was associated with IMT, LVMI and MA. BPV can serve as an important indicator to predict target organ damage in elderly patients with essential hypertension. 24 h SBPV can reflect the degree of target organ damage in elderly hypertensive patients.

Impact of in-hospital blood pressure variability on cardiovascular outcomes in patients with acute coronary syndrome.

To evaluate the impact of blood pressure variability (BPV) on cardiovascular outcomes in patients with acute coronary syndrome, short-term BPV was estimated by using weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings. The primary outcome was in-hospital major adverse cardiac events (MACE). Overall, 200 patients (mean age, 58.6years; 27.5% women; 38% with diabetes mellitus; and 47% smokers) were divided into low and high BPV groups based on the median value (9.45). Patients in the high BPV group were more likely to have in-hospital MACE compared with patients with low BPV (47% vs 27%, P=.003). Multivariate binary logistic regression analysis of incidence of MACE showed that BPV (odds ratio, 2.4; confidence interval, 1.2-4.5 [P=.008]) and presence of type II diabetes mellitus (odds ratio, 2.6; confidence interval, 1.2-5.3 [P=.008]) were the only independent predictors of in-hospital MACE derived mainly by hypertensive emergencies. BPV could be an important risk factor for in-hospital MACE in patients with acute coronary syndrome.

PP.16.11] RELATIONSHIP BETWEEN BLOOD PRESSURE VARIABILITY AND COGNITIVE FUNCTION IN ELDERLY PATIENTS WITH STRICT BLOOD PRESSURE CONTROL

Objective: Although higher blood pressure (BP) level and BP variability has been associated with decline cognitive function, data are sparse regarding to the relationship between BP variability and cognitive function in elderly patients with strict BP control. The aim of this study is to test the hypothesis whether BP variability using ABPM would be associated with cognitive function assessed by MoCA in the population who has already achieved strict home BP control from DCAP Netwrok. Design and method: We analyzed 232 patients from the Disaster CArdiovascular Prevention (DCAP) network, which developed a web-based home BP monitoring to achieve BP control for the support in disaster area after East Japan Earthquake. All patients were performed ambulatory BP monitoring and the Japanese version of Montreal Cognitive Assessment (MoCA-J). Results: The mean age was 77.7 years, 33.6% were male, and 85.3% were administrated anti-hypertensive drug. Average 24-hour BP level was 118.7 ± 10.0/68.3 ± 6.4 mmHg. When we divided weighted standard deviation of systolic BP (SBP) as measure of BP variability into quartiles, the top quartile group was significantly lower total MoCA-J score (15.4 [95% confidence interval 14.2–16.7] vs. 17.9 [17.2–18.6]) and its domains, visuoexecutive (2.2 [1.9–2.6] vs. 2.8 [2.6–2.9]), abstraction (1.0 [0.7–1.2] vs. 1.3 [1.1–1.4]), attention (2.8 [2.4–3.1] vs. 3.6 [3.4–3.8]), and naming (2.1 [1.9–2.3] vs. 2.5 [2.4–2.6]) than the group of other quartiles after adjusted by age and 24-hr SBP. These associations were not found in the quartiles of 24-hour SBP. Conclusions: In elderly patients with strict ambulatory BP control, higher BP variability, not average ambulatory BP level, was associated with cognitive decline.