Increased Blood Pressure Variability Research Articles

Increased blood pressure variability during general anaesthesia is associated with worse outcomes after mechanical thrombectomy: a prospective observational cohort study

ObjectivesOptimal periprocedural blood pressure (BP) management during mechanical thrombectomy (MT) for acute ischaemic stroke is still controversial. The aim of this study was to investigate the association between intraprocedural BP...

Blood pressure variability and early neurological deterioration according to the chronic kidney disease risk categories in minor ischemic stroke patients.

Chronic kidney disease (CKD) increases blood pressure variability (BPV) and affects stroke outcomes. However, the effect of BPV on early neurological deterioration (END) may be different according to the renal function. We enrolled ischemic stroke patients with a National Institutes of Health Stroke Scale of ≤5. END was defined as worsening of ≥1 point in motor power or ≥2 points in total score. BPV was calculated with BP measured during the first 5 days and presented as standard deviation (SD) and coefficient of variation (CoV). Renal function was classified using the Kidney Disease Improving Global Outcomes (KDIGO) classification of CKD. Variables were compared between those with (KDIGO classification: moderate- to very-high-risk) and without renal impairment (KDIGO classification: low-risk) and factors associated with END were investigated. Among the 290 patients (136 [46.9%] renal impairment), END was observed in 59 (20.3%) patients. BPV parameters and the risk of END increased as renal function was impaired. Renal function and systolic BP (SBP) mean, SD, CoV, and diastolic BP (DBP) mean, SD were independently associated with END. We found no association between BPV parameters and END in normal renal function patients; however, among impaired renal function patients, SBP SD (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.09-1.32, P<0.001) and CoV (1.30 [1.12-1.50], P<0.001) were associated with END. The association between END and BPV parameters differs according to renal function in minor ischemic stroke; BPV was associated with END in patients with renal impairment, but less in those with normal renal function.

Time course of beat-to-beat blood pressure variability and outcome in patients with spontaneous intracerebral haemorrhage.

Increased blood pressure variability (BPV) over 24 h or longer was associated with poor clinical outcomes in patients with intracerebral haemorrhage (ICH). However, the characteristics of beat-to-beat BPV, a rapid assessment of BPV and its association with outcome in ICH patients remain unknown. We consecutively and prospectively recruited patients with ICH between June 2014 and December 2020. Five-minute noninvasive beat-to-beat recordings were measured serially at three time points, 1-2, 4-6 and 10-12 days after ICH onset. BPV was calculated using standard deviation (SD) and variation independent of mean (VIM). Favourable outcome was defined as modified Rankin Scale score of less than 2 at 90 days. The analysis included 66 participants (54.12 ± 10.79 years; 71.2% men) and 66 age and sex-matched healthy controls. Compared with that in healthy adults, beat-to-beat BPV was significantly increased 1-2 days after ICH and was completely recovered 10-12 days later. BPV recorded 1-2 days after ICH onset was higher among patients with unfavourable outcomes than among those with favourable outcomes (all P < 0.05) and higher BPV on days 1-2 was independently associated with a 3-month unfavourable outcome after adjustment for major covariates. Beat-to-beat BPV was significantly increased among patients with ICH and could be completely recovered 10-12 days later. In addition, beat-to-beat BPV 1-2 days after ICH was independently associated with prognosis and could be regarded as a potential prognostic predictor and effective therapeutic target in the future.

Blood pressure variability and the development of hypertensive organ damage in the general population.

Increasing blood pressure variability (BPV) has been reported to be a strong predictor of cardiovascular events in patients with hypertension. However, the effects of BPV in the general population have not been intensively studied. The present study was designed to investigate a possible relationship between year-to-year BPV and hypertensive target organ damage (TOD) in a relatively low-risk general population. A total of 5489 consecutive patients (mean age 58.6 ± 10.7 years) who visited our hospital for an annual physical checkup for five consecutive years during 2008-2013 were enrolled in this study. The average systolic and diastolic blood pressures and pulse pressure were calculated, as well as standard deviation, coefficient of variation, and average real variability in blood pressures. Cross-sectional analysis was conducted and subjects without TOD at baseline (n=3115) were followed up (median 1827 days) with the endpoint of TOD, defined as left ventricular hypertrophy on electrocardiogram or declining glomerular filtration rate. At baseline, BPV was closely associated with TOD. During follow-up, left ventricular hypertrophy and declining glomerular filtration rate developed in 189 and 400 subjects, respectively. Although the standard deviation for systolic blood pressure and pulse pressure predicted future development of TOD in a univariate analysis, BPV was not a significant determinant of incident TOD in adjusted Cox hazard models. These results suggest that year-to-year BPV is a marker of the presence of TOD in the general population but does not independently predict future TOD.

Blood Pressure Variability After Cerebrovascular Events: A Possible New Therapeutic Target: A Narrative Review.

Blood pressure variability, the variation of blood pressure during a certain period, results from the interaction of hemodynamic, neuronal, humoral, behavioral, and environmental factors. Cerebral autoregulation is impaired in acute cerebrovascular disease. Hence, increased blood pressure variability (BPV) may provoke or exacerbate secondary brain injury. In fact, available data showed that increased blood pressure variability is associated with worse outcomes after acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Consequently, BPV may represent a usual modifiable therapeutic target. This concept is particularly attractive because reduction of BPV can be feasible in regions with lower resources and can be applicable to patients with various forms of acute stroke. Prospective studies are needed to further clarify the relationship between BPV and secondary brain damage and the determinants of BPV in different clinical populations. Ultimately, cerebrovascular disease-specific randomized controlled trials aimed at reducing BPV, irrespective of the absolute blood pressure values, are needed to determine whether reduction of BPV can improve outcomes in patients with acute cerebrovascular disease.

Mat Pilates training reduces blood pressure in both well-controlled hypertensive and normotensive postmenopausal women: a controlled clinical trial study

ABSTRACT Aim The aim of this study was to compare the Mat Pilates training-induced responses in resting and ambulatory blood pressure monitoring (ABPM), blood pressure variability (BPV), and heart rate variability (HRV) in well-controlled hypertensive and normotensive postmenopausal women. Methods Forty-seven postmenopausal women were allocated in well-controlled hypertensive (HT) and normotensive (NT) groups. The exercise program was performed three times a week for 12 weeks. Before and after the intervention resting, blood pressure (BP), ABPM, HRV, and BPV were analyzed. Results Student’s t-test showed no difference in baseline anthropometric and resting BP values between groups. The generalized estimation equation (GEE) showed no interactions (group*time), but time (p < .05) reductions in resting systolic, diastolic and mean BP after training in both groups. Sleep ambulatory systolic, diastolic and mean BP were higher overall in the HT group (p < .05 in group effect). We also found a time effect (p < .05) with significant increases in BPV in the mean diurnal and nocturnal deviations weighted for the duration of the daytime and nighttime interval (SDdn) in systolic, diastolic and mean BP, and in the average real variability (ARV) in diastolic and mean in both groups. In addition, HRV increases (p < .05 in time effect) through the percentage of pairs of adjacent RR intervals with a difference of at least 50 ms (pNN50) after training in both groups. Conclusion Both normotensive and well-controlled hypertensive postmenopausal women may have similar Mat Pilates exercise training-induced responses in ambulatory BP, BPV and HRV.

BLOOD PRESSURE ADAPTATIONS AND ARTERIAL STIFFNESS IN THE GENERAL POPULATION

Objective: Arterial stiffness is independently associated with orthostatic hypotension (OH) in older individuals. The relationship between orthostatic blood pressure (BP) and arterial stiffness has not been thoroughly examined in the younger population. To investigate the relationship between orthostatic BP adaptations, central aortic hemodynamics, and arterial stiffness in the general population of young and mid-aged adults. Design and method: A cross-sectional, observational, population-based study of 4223 individuals. We assessed arterial stiffness and central hemodynamics by carotid-femoral pulse wave velocity (c-f PWV) and pulse wave analysis (PWA) at the arteria radialis in relation to an orthostatic BP adaptation after 3 min standing. Results: The mean age of the population was 41.9 ± 14.5 years and 52.1% were women. We found that higher standing BP was associated with lower arterial stiffness after full adjustment in both men (unstandardized beta coefficient () -0.09, p = 0.02) and women (-0.08, p = 0.03). An increased diastolic BP on standing was inversely correlated with PWV and central aortic hemodynamics in both younger (PWV -0.01, p = 0.02) and older individuals (-0.02, p = 0.001). The lowest arterial stiffness was observed in the lowest and highest quartiles of standing systolic BP differences (p &lt; 0.001), while a gradual reduction in arterial stiffness was observed across increasing quartiles of standing diastolic BP difference for both PWV and measurements of central aortic hemodynamics (p &lt; 0.001). Conclusions: The co-existence of orthostatic hypotension, increased blood pressure variability, and vascular stiffness represents a hemodynamic ageing syndrome with important prognostic implications for public health. Our findings demonstrate that impaired hemodynamic response to orthostatic challenges, traditionally observed in older individuals, are independently and inversely associated with markers of arterial stiffness (vascular ageing) and hemodynamic changes also in a younger population. Further studies are required to assess the relationship between impaired blood pressure adaptations on standing in younger subjects and risk of future incident cardiovascular events.

Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients

Purpose An increased blood pressure variability (BPV) has been reported to be associated with older age and cognitive dysfunction; however, associations between increased BPV and rapid eye movement sleep behaviour disorder (RBD) has not been thoroughly investigated in patients without clinical Lewy body diseases. Materials and methods In frailty outpatient clinic, we evaluated ambulatory BP, RBD screening questionnaire (RBDSQ), and beat-to-beat heart rate variability during positional change from sitting to standing in 112 elderly hypertensive patients. Results The mean age was 81.2 ± 6.3 years (68% male). There were 15 patients who had probable RBD (RBDSQ scores ≥ 5). Patients with RBD had a greater body mass index, coefficient of variation (CV) in 24-h diastolic BP (23.5 ± 6.1 versus 18.7 ± 5.8, p = 0.005), awake diastolic BP (23.0 ± 7.7 versus 18.6 ± 6.2, p = 0.017), and nocturnal systolic BP (14.9 ± 5.5 versus 12.0 ± 4.4, p = 0.025) compared with those without RBD, while systolic BP, diastolic BP, and cognitive function did not differ significantly between patients with and without RBD. Patients with RBD exhibited larger orthostatic BP fall compared with patients without RBD (−4.9 ± 11.0 versus 7.5 ± 11.8, p = 0.009) and lower CV of R–R intervals while standing (1.3 ± 0.6 versus 2.4 ± 1.5, p = 0.039). Multiple regression analysis revealed that patients with RBD had significantly greater CV of nocturnal systolic BP independent of age, sex, BMI, history of diabetes and dyslipidaemia, and use of antihypertensive drugs (p = 0.008). Conclusion An increased BPV in ambulatory BP, associated with autonomic dysfunction, can be observed in patients with probable RBD even in elderly patients without clinical presentation of Lewy body diseases.

Blood Pressure Variability and Diabetes Mellitus

Increased blood pressure variability (BPV) has been found to significantly increase the risk of cardiovascular morbidity and mortality in the non-diabetic population. The prognostic importance of increased BPV for the development of micro- and macrovascular complications in type 2 diabetes has been investigated. Type 2 diabetes can increase BPV through different mechanisms, including increased arterial stiffness and autonomic dysfunction. Several studies in type 2 diabetic patients showed inconclusive results regarding all-cause mortality, microvascular complication, and extended major adverse cardiovascular events (MACE). However, some trials showed that BPV might be regarded as a potentially important therapeutic target in the management of type 2 diabetes regarding MACE. For now, the primary goal of antihypertensive treatment in patients with type 2 diabetes shall remain to controll mean blood pressure levels. However, when future studies show consistent results, BPV might be regarded as a therapeutic target in type 2 diabetic patients.

Detrimental effect of increased blood pressure variability on clinical outcome in acute ischemic stroke treated with reperfusion therapy: a case control study

BackgroundBlood pressure variability (BPV) is related to clinical outcome in acute ischemic stroke (AIS) treated with reperfusion therapy, but still is not included in clinical practice. This study aims to associate BPV during the first week of AIS with the outcome at three months.MethodsWe included 236 AIS patients treated with reperfusion therapy, and then divided them into good outcome and poor outcome groups. BPV measurements, including standard deviation, coefficient of variation, average real variability (ARV), and range, were recorded at stages of 2 h, 24 h, and 7 days after reperfusion therapy, respectively. These measurements were compared between the two groups. Then, ROC curve analysis examined the ability of BPV measurements in differentiating good and poor outcome groups; logistic regression analysis detected variables associated with clinical outcome in all subjects.ResultsThe good outcome group exhibited significantly less BPV at all stages relative to the poor outcome group. The BPV measurements exhibited the potential to differentiate the two groups by the ROC curve analysis, especially for those at the 24-h stage. Higher ARV of diastolic BP and higher range of systolic BP at the 24-h stage, together with greater disease severity at baseline, were associated with poor clinical outcome.ConclusionsGreater BPV during the first week of AIS is associated with poor outcome for the patients treated with reperfusion therapy. The BPV measurements play an important role in modulating clinical outcome, and have the potential to be included in future AIS guidelines.

Analysis of blood pressure and blood pressure variability pattern among older patients in long-term care hospitals: an observational study analysing the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) dataset.

There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and its variability among these patients using a novel platform. The Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) platform was used to construct a daily BP dataset using data of 394 older patients from 6 LTCHs. BP variability was expressed as coefficient of variation (CV = standard deviation/mean of BP × 100). Physical frailty and cognitive function were evaluated using the K-FRAIL questionnaire and the Cognitive Performance Scale of the interRAI Long-Term Care Facilities tool, respectively. From September 2019 to September 2020, 151,092 BP measurements, 346.5 (IQR 290.8-486.3) measurements per patient, were included. The mean BP was 123.4 ± 10.8/71.3 ± 6.5mmHg. BP was significantly lower in frail patients (122.2 ± 11.3/70.4 ± 6.8mmHg) than in pre-frail/robust patients (124.4 ± 10.4/72.1 ± 6.1mmHg, P < 0.05). However, CV of systolic (10.7 ± 2.3% versus 11.3 ± 2.3%, P = 0.005) and diastolic (11.6 ± 2.3% versus 12.4 ± 2.4%, P < 0.001) BP was higher in frail patients. The mean BP was lower, but BP variability was higher in patients with cognitive impairment. The mean BP, but not BP variability, was higher in treated hypertensive patients, as the number of antihypertensive medications increased. Older patients with physical or cognitive frailty had lower BP but higher BP variability. Relationship among frailty, increased BP variability and adverse clinical outcomes should be investigated.

Abstract TMP50: Increased Systolic Blood Pressure In The Subacute, But Not Acute, Period After Ischemic Stroke Is Associated With Good Functional Outcome At 90 Days

Background: Prior research has shown that increased blood pressure variability (BPV) after ischemic stroke is associated with lower odds of good functional outcome, but the number, intervals between, and epochs of blood pressure measurements have not been standardized. Methods: We include patients enrolled in the FAST-MAG trial with a final diagnosis of ischemic stroke, premorbid modified Rankin Scale (mRS) of 0, 4 “early” blood pressure measurements (prehospital and 3 in the hour after arrival), and 9 “later” measurements (q4 hours from hours 4-24 and q8 hours from hours 24-48). The primary outcome was 90-day mRS of 0-1 (good outcome). The BPV exposure was the top tertile (highest level) of systolic standard deviation (SD). We fit logistic regression models adjusted for patient age, race, sex, baseline NIH Stroke Scale, tPA, endovascular therapy, mean systolic blood pressure, smoking, atrial fibrillation, hypertension, and diabetes. Results: We included 455 patients, with a mean age of 70.8 years, 46.8% female, 50.8% had tPA, 6.4% had endovascular therapy, the median baseline NIH Stroke Scale was 12 (5-19) and good outcome occurred in 152/455 (33.4%). The mean early SD was not significantly lower in patients with good outcome (p=0.12), but later SD was lower in patients with good outcome (13.5±5.6 vs. 15.1±5.6, p&lt;0.01). The adjusted odds ratio for good outcome in the top tertile of early BPV was 1.09 (95% CI 0.63-1.89), while for the top tertile of later BPV it was 0.54 (95% CI 0.30-0.95). The predicted probability of good outcome for a range of later BPV values is seen in Figure 1. Conclusion: Increased BPV in the hours after ischemic stroke onset was not associated with 90-day good outcome, but increased BPV during hours 4-48 after hospital arrival had a significant association with lower odds of good outcome. While these results are hypothesis-generating, the rigor of outcome adjudication and standardization of blood pressure measurements strengthens the findings.

Abstract TP222: The Impact Of Il-6 Level On Visit-to-visit Blood Pressure Variability And Incidence Of Stroke: A Post-hoc Analysis Of Mesa

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but no serum inflammatory markers have been identified associated with increased BPV, despite preclinical data suggesting a role. Methods: This is a post-hoc analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. The study exposure was tertiles of serum level of interleukin-6 (IL-6) at the baseline study visit. The primary outcome was visit-to-visit BPV measured as the residual standard deviation (rSD) of at least 4 subsequent study visits (1999-2018). Two logistic regression models were fit to the top tertile (i.e. most variability) of rSD during follow-up: in Model 1, we adjusted for covariates chosen with restricted Least Absolute Shrinkage and Selection Operator (LASSO) and in Model 2, for all covariates. Results: Our analysis included 5,483 patients, of mean (SD) age 61.4 (10.0) years and with 52.9% female. Mean (SD) of IL-6 was 1.7 (1.2) (pg/mL) in the top tertile BPV rSD and 1.4 (1.1) in the bottom tertiles. The incidence of ischemic stroke and all major adverse cardiovascular event was higher in top tertile of BPV (Table 1). Elevated serum IL-6, but not other serum biomarkers of inflammation and clotting (see comment below), was associated with the highest tertile of BPV, independent of potential confounders (Table 2). Conclusion: Higher levels of serum IL-6 were associated with increased subsequent BPV in a large multiracial cohort. Further investigation is needed to better understand the relationship between chronic inflammation and BPV. Table 1. Baseline demographics, serum biomarkers, and clinical outcomes during follow-up (how long was follow-up on average?) in the full cohort, and stratified by the top versus lower tertiles of BPV. Table 2. Association of serum biomarkers at baseline with the highest tertile of blood pressure variability.*Model 1 adjusted for patient age categories (&lt;55, 55-64, 65-69, ≥70), sex, and hypertension. **Model 2 (n=5,447) adjusted for patient age categories (&lt;55, 55-64, 65-69, ≥70), sex, race/ethnicity, education, hypertension, diabetes, smoking, drinking, body mass index, lipid lowering medication, and mean systolic blood pressure

Case report of Parkinson's disease and orthostatic hypotension

Introduction: Parkinson's disease is an idiopathic, slow progressive neurodegenerative condition with the loss of dopaminergic neurons in the substantia nigra compacta of the midbrain. Due to cardiovascular dysautonomia and impaired baroreflex function in Parkinson's disease, the development of orthostatic hypotension is most common, along with increased blood pressure variability, supine hypertension, nocturnal hypertension, etc. Orthostatic hypotension in Parkinson's disease increases the risk of developing coronary heart disease, myocardial infarction, and the risk of overall, and cardiovascular mortality. Case report: Orthostatic hypotension in Parkinson's disease is associated with an increased risk of gait disturbances, loss of balance, falls resulting in injuries and limb fractures, and mortality. In this paper, we presented a patient who had previously been treated for arterial hypertension, with the current clinical presentation of symptomatic orthostatic hypotension in Parkinson's disease. After neurological evaluation and the implementation of pharmacological and non-pharmacological therapy for orthostatic hypotension, gradual improvement and stabilization of blood pressure values are achieved, along with a reduction in orthostatic hypotension symptoms and a decrease in subjective discomfort. Conclusion: In the presence of orthostatic hypotension in Parkinson's disease, in addition to pharmacological therapy, nonpharmacological treatment measures are very important for stabilizing blood pressure values and reducing the symptoms of orthostatic hypotension.

Blood Pressure Variability in Fabry Disease Patients

Introduction: Fabry disease is a rare metabolic, multisystemic, and X-linked lysosomal storage disorder. The involvement of the autonomic nervous system is well defined; however, data on the variability of the blood pressure (BP) and heart rate in Fabry disease are largely missing. In this study, we aimed to examine the circadian variations of BP and heart rate variability in Fabry disease patients. Methods: We recruited 31 consecutive adult (age >18 years) Fabry disease patients (16 males and 15 females) who were regularly followed up in our outpatient clinic between July 2019 and March 2020. We performed ambulatory blood pressure monitoring and echocardiography in all patients. We used standard deviation (SD), coefficient of variation (CV), and average real variability as the measures of variability. We constructed 2 control groups for propensity score matching using age, sex, and eGFR parameters in the first group and adding antihypertensive drug use to the above parameters in the second group. Results: All BP measurements were significantly lower in the FD group compared to that of the control groups, except the nighttime systolic BP. Regarding nondipping and reverse dipping statuses, FD patients and controls were similar. We found that none of the BP variability measures were higher in FD patients. Regarding heart rate variability data, both the nighttime SD and CV were significantly lower in FD patients compared to those of the controls. Conclusion: A decrease in heart rate variability, rather than an increase in BP variability, might be an early marker of autonomic involvement in FD.

Blood pressure variability, endothelial dysfunction, and C-reactive protein levels in arterial hypertension in combination with coronary artery disease

Background. Recently, the role of increased variability in blood pressure (BP) as a new risk factor for cardiovascular events in patients with arterial hypertension (AH) in combination with coronary heart disease (CHD) has been discussed. At the same time, the mechanisms of the participation of blood pressure variability in the development of atherosclerotic damage to the vascular wall are not well understood.&#x0D; Aim. To study the nature of the relationship between the indicators of daily BP variability, vasomotor function of the endothelium and highly sensetive C-reactive protein (hs-CRP) in patients with AH combined with CAD.&#x0D; Materials and methods. 80 patients with AH and CAD (55.50.7 years) were examined. The study assessed the BP variability according to 24-hour monitoring of BP, vasomotor function of the brachial artery endothelium, and the level hs-CRP in blood serum.&#x0D; Results. Increased indicators of diurnal BP variability were recorded in 48.8% of patients. There were revealed signs of endothelial dysfunction in patients in the form of a decrease in endothelium-dependent vasodilation (EDV) to 5.380.48% and an insufficient increase in endothelium-independent vasodilation (EIV) to 15.821.24%. Patients with increased variability of BP differed from patients with normal variability of BP by higher values of hs-CRP (2.980.71 and 1.560.33 mg/l; p0.05), a less pronounced response to administration nitroglycerin when evaluating EIV (13.231.79 and 17.700.77%; p0.05). Correlation relationships of variability of systolic BP (SBP) in the daytime with EVD were recorded (r=-0.44; p=0.012); variability of diastolic BP (DBP) in the daytime with EIV (r=-0.50; p=0.003); nighttime variability of DBP with EIV (r=-0.43; p=0.013). Relationships between the level of hs-CRP and the variability of SBP in the daytime (r=0.30; p=0.008) and with EVD (r=-0.47; p=0.007) were established. In patients with increased variability of SBP, the likelihood of registering an increased level of hs-CRP is 1.6 times higher OR 1.58 (95% CI 1.0142.451; p=0.043). In patients with depletion of the vasodilation reserve during the test with nitroglycerin (EIV), an increase in blood pressure variability is recorded 1.2 times more likely OR 1.22 (95% CI 1.0121.478; p=0.037).&#x0D; Conclusion. The revealed association of the daily variability of BP with indicators of vasomotor function of the endothelium and a marker of the inflammatory reaction of the vascular wall may indicate the presence of a pathogenetic relationship between the parameters that determine the development of adverse events in patients with AH and CAD.

Blood Pressure Variability Early After Liver Transplantation Predicts Long-Term Mortality.

Cardiovascular disease is a leading cause of mortality after liver transplantation (LT). Elevated blood pressure (BP) in LT recipients (LTRs) is associated with increased cardiovascular events (CVEs) and decreased survival. Increased visit-to-visit BP variability in the general population is associated with adverse outcomes. Whether BP variability is associated with adverse outcomes in LTRs is unknown. We analyzed data from adult LTRs within a single large transplant center in the United States between 2010 and 2016. Day-to-day BPvariability within the first 60 days after LT was measured usingvariability independent of the mean (VIM). To assess the association between early post-LT BP variability and future CVEs or mortality, we used Cox proportional hazard regression. Among 512 LTRs (34.4% women; 10.7% Black; mean age, 56.5 years), increased systolic BP (SBP) variability was associated with a decreased risk of mortality (adjusted hazard ratio [aHR], 0.97/1 unit VIM; 95% confidence interval [CI], 0.94-0.99). This was particularly true for men (aHR, 0.94; 95% CI, 0.91-0.98), patients with pre-LT atherosclerotic cardiovascular disease (aHR, 0.95; 95% CI, 0.92-0.98), and patients without pre-LT diabetes mellitus (aHR, 0.96; 95% CI, 0.93-1.00). There was no significant effect of BP variability on CVEs. Results were consistent when competing risk analysis was used with death as the competing risk. Increased diastolic BP variability was not associated with a significant effect on CVEs (hazard ratio [HR], 0.96; 95% CI, 0.90-1.02) nor mortality (HR, 1.00; 95% CI, 0.95-1.06). Increased SBP variability, independent of mean BP, is associated with decreased mortality in LTRs. We postulate that increased BP variability reflects a better vascular recovery in patients undergoing LT, but further research is needed as to the mechanism underlying our observation.

Impact of mean blood pressure and blood pressure variability after diagnosis of mild cognitive impairment and risk of dementia.

Hypertension and increased blood pressure variability (BPV) are associated with the development of dementia. However, previous studies did not focus on the risk of dementia among participants with mild cognitive impairment (MCI) and controlled blood pressure level. To address this limitation, the authors performed a post‐hoc analysis of SPRINT MIND participants diagnosed with MCI (mean Montreal Cognitive Assessment score at diagnosis 16.1±3.1). The primary outcome was subsequent diagnosis of probable dementia. The exposure was mean blood pressure and BPV following MCI diagnosis until the end of follow‐up or a dementia event (mean follow‐up 2.6±1.2 years). The primary outcome occurred in 76/516 (14.7%) patients. The mean blood pressure was not significantly higher in participants who developed dementia. In the lowest quartile of BPV (systolic standard deviation), the rate of dementia was 8.5% (11/129), while in the highest quartile it was 21.7% (28/129). The highest quartile of systolic BPV had an adjusted hazard ratio for dementia of 2.73 (95% CI, 1.31–5.69) and for diastolic BPV it was 2.62 (95% CI, 1.26–5.47). In SPRINT MIND participants, the authors found that increased BPV after MCI diagnosis was associated with incident probable dementia during subsequent follow‐up.

Very long term visit‐to‐visit blood pressure variability and the risk of dementia in the Adult Changes in Thought study

AbstractBackgroundHigh visit‐to‐visit blood pressure variability (BPV) is associated with an increased risk of cardiovascular disease. However, for incident dementia, conflicting results are reported. Our objective was to assess the association of very long‐term visit‐to‐visit BPV and the risk of all‐cause dementia in community‐dwelling individuals.MethodCommunity‐dwelling individuals aged 65 years or older and free from dementia were randomly sampled from 1994 onwards from Kaiser Permanente Washington (KPW), Seattle, USA, and included in the Adult Changes in Thought (ACT) study. After enrollment, participants were followed‐up biannually. We retrospectively collected yearly data on blood pressure measurements and medical history from the age of 50 up to recruitment into the ACT study, through KPW electronic databases. Visit‐to‐visit BPV was defined as coefficient of variation (SD/mean*100) calculated with systolic blood pressure measurements. Dementia was diagnosed by an expert panel based on DSM‐IV and NINCDS‐ADRDA criteria. We used Cox regression adjusted for sex, blood pressure trend, antihypertensive medication use and cardiovascular risk factors. Subgroup analyses were performed for midlife (50‐64) and later life (≥65).ResultWe included 1174 individuals with a median age of 78 years [IQR=72‐83] at inclusion in the ACT study. Systolic blood pressure measurements (mean=27.9, SD=8.5, range: 2‐50) were collected over 2 to 54 years (mean=31.8, SD=9.4), and 483 (41.1%) individuals developed dementia. There was no significant association between very long term visit‐to‐visit BPV (mean=12.15; SD=2.67) and incident all‐cause dementia (HR=0.98; 95%CI=0.94‐1.02). Competing risk of death analyses (combined outcome dementia/death) showed a dementia/mortality risk reduction of 4% per point visit‐to‐visit BPV increase (HR=0.96; 95%CI=0.94‐0.99). The associations were similar for visit‐to‐visit BPV in later life (dementia: HR=0.99; 95%CI=0.95‐1.02, dementia/death: HR=0.96; 95%CI=0.93‐0.99). Visit‐to‐visit BPV in midlife was not associated with incident dementia (dementia: HR=0.99; 95%CI=0.96‐1.02, dementia/death: HR=1.01; 95%CI=0.99‐1.02).ConclusionIn our sample, higher very long‐term visit‐to‐visit BPV is associated with lower incident all‐cause dementia risks. This association might be stronger in later life than in midlife.

Antemortem visit‐to‐visit blood pressure variability predicts cerebrovascular lesion burden in autopsy‐confirmed Alzheimer’s disease

Blood pressure variability is a risk factor for stroke, cognitive impairment and Alzheimer's dementia, but the underlying neuropathological mechanisms remain understudied. Large blood pressure fluctuations may stress arterial walls and promote vascular-endothelial injury, increasing risk for cerebrovascular disease. Several studies link elevated blood pressure variability to MRI-based markers of cerebrovascular lesions, but less is known about relationships with specific cerebrovascular or Alzheimer's pathologies at autopsy. The aim of the current study was to determine whether antemortem blood pressure variability predicts cerebrovascular and Alzheimer's pathology in autopsy-confirmed Alzheimer's disease. 513 older adults from the National Alzheimer's Coordinating Center study underwent repeated annual blood pressure measurement and were confirmed to have Alzheimer's disease at postmortem evaluation. Visit-to-visit blood pressure variability was calculated over a 3-4 year follow-up period. Multiple linear regression examined relationships between blood pressure variability and an index of overall cerebrovascular lesion burden and Braak & Braak stage. Ordinal logistic regression examined relationships with other specific cerebrovascular and Alzheimer's neuropathological features. All analyses covaried for age, sex, years of education, body mass index, Mini Mental State Examination score, years from first blood pressure measurement to death, antihypertensive medication use and average blood pressure. Elevated blood pressure variability predicted increased postmortem cerebrovascular lesion burden (ß = .26 [.11, .42]; p = .001; R2 = .12). Increased blood pressure variability predicted specific cerebrovascular lesion severity, including atherosclerosis in the Circle of Willis (OR = 1.21 [1.02, 1.43]; p = .03) and cerebral arteriolosclerosis (OR = 1.30 [1.06, 1.61]; p = .01). No significant relationships were observed between blood pressure variability and Alzheimer's disease pathological findings, including Braak & Braak stage, neuritic plaques or diffuse plaques. Findings suggest that elevated blood pressure variability is related to postmortem cerebrovascular lesion burden in autopsy-confirmed Alzheimer's disease, independent of average blood pressure and Alzheimer's disease neuropathology. Blood pressure fluctuation may selectively promote atherosclerotic and arteriolosclerotic brain lesions with potential implications for cognitive impairment and dementia.