Long-term Blood Pressure Variability Research Articles

Association between long-term visit-to-visit blood pressure variability and depression among Chinese middle-aged and older adults

ABSTRACT Background Whether there is a longitudinal association between long-term blood pressure variability (BPV) and subsequent depression among Chinese adults remains inconclusive. Methods This study utilized data from a nationwide cohort of the China Health and Retirement Longitudinal Study, which included participants aged > 45 years without prevalent psychiatric or memory-related diseases. The intra-individual coefficient of variation (CV) and standard deviation (SD) across 3 visits from 2011 to 2015 were used to examine the long-term variability in systolic BP (SBP) and diastolic BP (DBP). The depressive symptoms were examined using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), and moderate-to-severe depression was defined as CES-D-10 ≥ 15. Results A total of 5,249 participants (mean age: 61.4 ± 8.1 years, 46.5% were men) were included in the current analysis. Individuals in the highest quartile of both BP CV and SD were independently correlated with a higher total CES-D-10 score compared to those in the lowest quartile after multivariable adjustment. 1,070 participants (20.4%) had moderate-to-severe depression during the 3-year follow-up period. Participants in the Q4 of SBP and DBP CV had 1.23-fold higher odds (95% CI: 1.01, 1.49) and 1.20-fold higher odds (95% CI: 1.01, 1.41) of moderate-to-severe depression compared to those in Q1. Subgroup analyses revealed that men with higher BP CVs had a greater risk of severe depressive symptoms (p for SBP CV-by-sex interaction = 0.050, p for SBP CV-by-sex interaction = 0.025). Conclusions Depression was common among Chinese middle-aged and older adults and long-term visit-to-visit BPV was positively associated with depressive symptoms, highlighting the importance of implementing intensive prevention strategies for depression and enhancing blood pressure monitors in China.

#2251 Long-term systolic blood pressure variability as an independent risk factor for cardiovascular events in kidney transplant recipients

Abstract Background and Aims Cardiovascular (CV) events represent the main cause of death in patients undergoing renal transplantation. Several studies have described the role of blood pressure variability (BPV) in predicting all-cause mortality and fatal and non-fatal CV events in the general population and in diabetic patients. Systolic blood pressure variability (SBPV) has recently been proposed as a predictor of clinical outcomes in patients with chronic kidney disease. However, evidence is still scarce about the prognostic role of BPV in the setting of renal transplantation. The aim of the study was to evaluate the role of long-term SBPV in the development of fatal and non-fatal CV events (myocardial infarction, unstable angina or revascularization, stroke and hospitalization for heart failure) in subjects undergoing kidney transplantation. Method We performed a single-center retrospective observational analysis in a cohort of 272 kidney transplant patients (mean age 64 ± 13 years, 66% men), with a transplant duration ≥12 months and with at least 6 blood pressure measurements at defined intervals (3 months ±15 days) over an assessment period of 18 months. BPV was expressed as standard deviation of ambulatory systolic blood pressure (SBP) and patients were accordingly classified in tertiles (low <9.3 mmHg, medium 9.3-13 mmHg, high >13 mmHg). The role of SBPV was analyzed by Kaplan-Meier (logrank) and its independent effect by Cox Regression. Results Over a mean follow-up of 58.7 ± 17.2 months, 27 subjects (9.9%) developed CV events. For each increase of 2.7 mmHg in SBP standard deviation, the risk for fatal or non-fatal CV events increased almost 3-folds (P = 0.02) and patients in the highest tertile of SBP standard deviation showed a 4-fold increased risk (P = 0.01) (Fig. 1). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, prior CV event, and dialysis vintage (HR 3.2, 95% CI 1.1–10.0, p 0.04) (Table 1). Conclusion Long-term BPV represents an independent risk factor for CV events in kidney transplant patients. It is therefore essential to seek for stable long-term blood pressure levels in this population in order to minimize the residual CV risk.

Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study.

Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span.

Effects of different obesity evaluation indexes on long-term blood pressure variability in adults

Abstract Background In recent years, people have a new understanding of the treatment of hypertension. Even at the optimal blood pressure levels recommended by the guidelines, further attention to blood pressure variability is warranted. Obesity and overweight are associated with blood pressure variability, but existing studies mainly focus on the effect of traditional obesity indicators on blood pressure variability (BPV). Objectives To explore the correlation between the new obesity assessment indicators LAP, BRI, CVAI and blood pressure variability. Methods A total of 7092 subjects who had regular physical examination in a community health center, were included for analysis. We used new measures to assess obesity, including LAP, BRI, CVAI. Subjects were grouped according to the baseline CVAI quartile. We used variation independent of mean(VIM) to assess long-term variations in blood pressure. Variance analysis was used to analyze the differences among different blood pressure variables and their baseline characteristics. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of CVAI/LAP/BRI on VIM. Results The average age of the subjects was 60.7±6.8 years old. With the increase of CVAI and BRI, the mean blood pressure variability increased gradually. In contrast, the mean blood pressure variability decreases with increasing LAP. After adjusting for other confounding factors, multiple linear regression analysis showed that VIMSBP increased by 0.007 and 0.216 for each unit increase in CVAI and BRI, respectively. LAP found no correlation. Multiple logistic regression analysis showed that increased CVAI and BRI were risk factors for increased VIMSBP, and increased LAP was protective factor for increased VIMSBP. Conclusion Compared with traditional indicators, the novel obesity indicators were also associated with blood pressure variability. And it has a stronger correlation than traditional indicators.

Associations of long-term visit-to-visit blood pressure variability with subclinical kidney damage and albuminuria in adulthood: a 30-year prospective cohort study

Abstract Background Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be associated with the risk of cardiovascular disease. We therefore aimed to determine the potential associations of long-term BPV from childhood to middle age with subclinical kidney damage (SKD) and albuminuria in adulthood. Methods Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and adolescents aged 6 to 18 years at baseline, we assessed BP variability by standard deviation (SD) and average real variability (ARV) for 30 years (6 visits). Presence of SKD was defined as estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/ 1.73 m2 or elevated urinary albumin-to creatinine ratio (uACR) at least 30 mg/g. Albuminuria was defined as uACR ≥ 30 mg/g. Results During a follow-up of 30 years, of the 1771 participants, 204 SKD events occurred. After adjustment for demographic, clinical characteristics and mean BP during 30 years, higher SDSBP, ARVSBP, SDDBP, ARVDBP, SDMAP, ARVMAP and ARVPP were significantly associated with higher risk of SKD [ORs (95% CIs) were 1.14(1.06-1.23), 1.15(1.08-1.21), 1.12(1.06-1.17), 1.16(1.08-1.25), 1.12(1.07-1.17), 1.18(1.10-1.27) and 1.11(1.03-1.21), respectively]. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria [ORs (95% CIs) were 1.07(1.03-1.10) for SDSBP, 1.13(1.06-1.20) for ARVSBP, 1.11(1.06-1.17) for SDDBP, 1.14(1.06-1.23) for ARVDBP, 1.18(1.09-1.27) for ARVMAP and 1.08(1.01-1.17) for ARVPP]. Long-term BP variability for 30 years from childhood to middle age was associated with higher risk of SKD and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up.The example of SBP across 6 visits

Increased Blood Pressure Variability Over a 16-Year Period Is Associated With Left Ventricular Diastolic Dysfunction in a Population-Based Cohort.

Left ventricular diastolic dysfunction (LVDD) is often associated with elevated blood pressure (BP). It is prevalent among hypertensive patients. Additionally, increased BP variability has been linked to LVDD. However, the precise connection between LVDD and BP variability within the general population remains unclear. Thus, this study aimed to evaluate this association in a general population. A total of 2,578 participants(1,311 females) with a mean age of 47.8 ± 6.7 years who had echocardiographic data from the Korean Genome and Epidemiology study with 16 years of follow-up were analyzed. LVDD was identified through the last echocardiography during the follow-up period. BP variability was assessed using mean, standard deviation (SD), and coefficient of variance (CV). LVDD was detected in 249 individuals. The cohort was divided into an LVDD group and a normal LV diastolic function group. The LVDD group had a higher percentage of females, more advanced age, higher body mass index (BMI), higher BP and BUN levels, lower heart rate, lower hemoglobin, and lower serum creatinine than the normal LV diastolic function group. Remarkably, LVDD was associated with higher BP variability. In the multivariate analysis, LVDD was associated with increased age, female sex, increased BMI, hypertension, and increased BUN. Elevated mean systolic and diastolic BPs, SD of systolic BP, mean pulse pressure (PP), SD of PP, and CV of PP were significantly linked to LVDD even after adjusting for other significant variables in the multivariate analysis. LVDD was identified in 249 (9.7%) participants. Increased long-term BP variability was significantly associated with LVDD in this population-based cohort.

ЦИФРОВЫЕ РЕСУРСЫ В ПРЕДИКЦИИ ПРЕЭКЛАМПСИИ И ЗАДЕРЖКИ РОСТА ПЛОДА

Abstact. Introduction. Preeclampsia and fetal growth restriction are pregnancy complications related to Great Obstetrical Syndromes and having a similar pathogenesis. No antipathogenetic therapy methods have been found for both pathologies, but there is a means of prevention: Acetylsalicylic acid. The drug is effective only in high-risk pregnant women; therefore, various models are being developed to predict preeclampsia and fetal growth restriction, including digital models. They aim to help select patients who need that prophylaxis. Aim. This study is aiming to create a digital model for the early prediction of preeclampsia, based on the patient’s electronic medical card. Materials and Methods. The investigation involved 231 pregnant women. An algorithm was developed for the early prediction of preeclampsia and fetal growth restriction, based on detecting a combination of systemic and local hemodynamic markers: High variability of blood pressure between visits (long-term variability) and high resistance of blood flow in uterine arteries. Long-term (intervisit) variability of blood pressure is calculated for each trimester: First, the arithmetic mean is calculated among the values of systolic blood pressure at successive visits; second, the standard deviation is computed based on the result. Uterine arteries are checked using Doppler ultrasound technology at 11-13 weeks of gestation: Resistivity of blood flow (peripheral resistivity) in the right and left uterine arteries is assessed. Results and Discussion. For this new prediction algorithm, a digital model was developed, the ECAPP program (registration certificate No. 2018660666 – Electronic Prenatal Record with assessing the risk of developing preeclampsia based on blood pressure variability and uterine blood flow resistance). Conclusions. The IT resource presented has a potential for the effective early prediction of preeclampsia, as well as for predicting fetal growth restriction. Keywords: preeclampsia, fetal growth restriction, prognosis, digital model.

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.

Long-Term Blood Pressure Variability and Cortical Thickness in Older Adults

Long-Term Blood Pressure Variability and Cortical Thickness in Older Adults

1322-P: Association of Long-Term Blood Pressure Variability and Decrease in GFR on Type 2 Diabetes Mellitus Patients with Hypertension

Introduction: Increased long-term blood pressure variability (BPV), defined as monthly to yearly BPV, has been reported a risk factor of cardiovascular events independent of mean BP level. However, the relationship between long-term BPV and decrease in GFR remains unknown. In this study, we examined the association of Long-Term BPV and decrease in GFR. Methods: We included 214,443 type 2 diabetes mellitus patients with hypertension, registered in the Japan Diabetes Data Management Study Group, whose BP and HbA1c were simultaneously measured at least 4 times per year for 5 years from 2014-2018. BPV was defined as the 5-year coefficient of variation (CV), and the relationship between BPV and eGFR was examined. We also examined the relationship between BPV and the following background factors: (1) age (2) duration of diabetes (3) HbA1c (4) antihypertensive medications. The Ca-antagonist group was patients who took only Ca-antagonists during the 5-year period, and the ARB group was patients who took only ARBs. This study was a retrospective analysis. Data analyses were performed using the SPSS 28.0 software. Results: The group with greater 5-year BPV had lower eGFR than the group with smaller BPV, independent of mean BP (P&amp;lt;0.001). Regarding BPV and patient background, (1) BPV tended to increase with increasing age, and was significantly greater in patients over 50 years of age compared to those in their 30s (P&amp;lt;0.001). (2) The longer diabetic duration, the greater the BPV (P&amp;lt;0.001). Especially in patients more than 20 years’ diabetic duration, BPV was significantly larger than that of less than 5 years (P&amp;lt;0.001). (3) There was no association between HbA1c and BPV. (4) BPV was significantly lower in the Ca antagonist group compared with the ARB group over 5 years (0.069 vs. 0.078 P&amp;lt;0.001). Conclusion: Increased long-term BPV was observed older age and long duration of diabetes, but was not related to HbA1c. Interestingly, Patients with greater BPV had lower eGFR at 5 years. Disclosure M.Sakamoto: None. M.Yuki: None. K.Miyashita: None. T.Yamazaki: None.

Blood Pressure Variability and Risk of Atrial Fibrillation in Adults With Type 2 Diabetes

BackgroundThere is a paucity of epidemiological data on the association between long-term variability of blood pressure (BP) and incident atrial fibrillation (AF). ObjectivesThe purpose of this study was to evaluate the association of BP variability with incident AF in a large sample of adults with type 2 diabetes. MethodsWe included participants who had ≥5 BP measurements in the first 24 months of action to control cardiovascular risk in diabetes. The visit-to-visit variability of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was estimated using the coefficient of variation, SD, and variability independent of the mean. Incident AF was recorded using follow-up electrocardiograms. Modified Poisson regression was used to generate risk ratios (RRs) and 95% CI for AF. ResultsA total of 8,399 participants were included (average age 62.6 ± 6.5 years, 38.8% women, 63.2% White). Over a median follow-up of 5 years, 155 developed AF. Compared to the lowest quartile, the highest quartile of BP variability was associated with an increased risk of AF (RR: 1.85 [95% CI: 1.13-3.03] and 1.63 [95% CI: 1.01-2.65] for coefficient of variation of SBP and DBP, respectively). Participants in the highest quartile of both SBP and DBP had a 2-fold higher risk of AF compared to those in the lowest 3 quartiles of both SBP and DBP (RR: 1.94; 95% CI: 1.29-2.93). ConclusionsIn a large cohort of adults with type 2 diabetes, higher variability in SBP and DBP was independently associated with an increased risk of AF.

ASSOCIATIONS OF LONG-TERM VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY WITH SUBCLINICAL KIDNEY DAMAGE AND ALBUMINURIA IN ADULTHOOD: A 30-YEAR PROSPECTIVE COHORT STUDY

Objective: Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be associated with the risk of cardiovascular disease. We therefore aimed to determine the potential associations of long-term BPV from childhood to middle age with subclinical kidney damage (SKD) and albuminuria in adulthood. Design and method: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and adolescents aged 6 to 18 years at baseline, we assessed BP variability by standard deviation (SD) and average real variability (ARV) for 30 years (6 visits). Presence of SKD was defined as estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/ 1.73 m2 or elevated urinary albumin-to creatinine ratio (uACR) at least 30 mg/g. Albuminuria was defined as uACR greater than 30 mg/g. Results: During a follow-up of 30 years, of the 1771 participants, 204 SKD events occurred. After adjustment for demographic, clinical characteristics and mean BP during 30 years, higher SDSBP, ARVSBP, SDDBP, ARVDBP, SDMAP, ARVMAP and ARVPP were significantly associated with higher risk of SKD [ORs (95% CIs) were 1.14(1.06 - 1.23), 1.15(1.08 - 1.21), 1.12(1.06 - 1.17), 1.16(1.08 - 1.25), 1.12(1.07 - 1.17), 1.18(1.10 - 1.27) and 1.11(1.03 - 1.21), respectively]. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria [ORs (95% CIs) were 1.07(1.03 - 1.10) for SDSBP, 1.13(1.06 - 1.20) for ARVSBP, 1.11(1.06 - 1.17) for SDDBP, 1.14(1.06 - 1.23) for ARVDBP, 1.18(1.09 - 1.27) for ARVMAP and 1.08(1.01 - 1.17) for ARVPP]. Long-term BP variability for 30 years from childhood to middle age was associated with higher risk of SKD and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up. Conclusions: Identifying long-term BP variability from early age may assist in predicting kidney disease and cardiovascular disease in later life.

The relationship between long-term blood pressure variability and cortical thickness in older adults

High blood pressure variability (BPV) is a risk factor for cognitive decline and dementia, but its association with cortical thickness is not well understood. Here we use a topographical approach, to assess links between long-term BPV and cortical thickness in 478 (54% men at baseline) community dwelling older adults (70–88 years) from the ASPirin in Reducing Events in the Elderly NEURO sub-study. BPV was measured as average real variability, based on annual visits across three years. Higher diastolic BPV was significantly associated with reduced cortical thickness in multiple areas, including temporal (banks of the superior temporal sulcus), parietal (supramarginal gyrus, post-central gyrus), and posterior frontal areas (pre-central gyrus, caudal middle frontal gyrus), while controlling for mean BP. Higher diastolic BPV was associated with faster progression of cortical thinning across the three years. Diastolic BPV is an important predictor of cortical thickness, and trajectory of cortical thickness, independent of mean blood pressure. This finding suggests an important biological link in the relationship between BPV and cognitive decline in older age.

Intra-dialytic blood pressure variability is a greater predictor of cardiovascular events in hemodialysis patients

BackgroundShort-term and long-term blood pressure variability (BPV) in hemodialysis (HD) population are risk factors of cardiovascular diseases (CVD) and all-cause mortality. There is no full consensus on the best BPV metric. We compared the prognostic role of intra-dialytic and visit-to-visit BPV metrics for CVD morbidity and all-cause mortality in HD patients.MethodsA retrospective cohort of 120 patients on HD was followed up for 44 months. Systolic blood pressure (SBP) and baseline characteristics were collected for 3 months. We calculated intra-dialytic and visit-to-visit BPV metrics, including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), average real variability (ARV) and residual. The primary outcomes were CVD events and all-cause mortality.ResultsIn Cox regression analysis, both intra-dialytic and visit-to-visit BPV metrics were associated with increased CVD events (intra-dialytic CV: HR 1.70, 95% CI 1.28–2.27, p < 0.01; visit-to-visit CV: HR 1.55, 95% CI 1.12–2.16, p < 0.01), but not associated with increased all-cause mortality (intra-dialytic CV: HR 1.32, 95% CI 0.99–1.76, p = 0.06; visit-to-visit CV: HR 1.22, 95% CI 0.91–1.63, p = 0.18). Overall, intra-dialytic BPV showed greater prognostic ability than visit-to-visit BPV for both CVD event (AUC of intra-dialytic BPV and visit-to-visit BPV metrics respectively: SD 0.686, 0.606; CV 0.672, 0.425; VIM 0.677, 0.581; ARV 0.684, 0.618; residual 0.652, 0.586) and all-cause mortality (SD 0.671, 0.608; CV 0.662, 0.575; VIM 0.669, 0.581; ARV 0.529, 0.588; residual 0.651, 0.602).ConclusionCompared to visit-to-visit BPV, intra-dialytic BPV is a greater predictor of CVD event in HD patients. No obvious priority was found among various BPV metrics.

Abstract P349: Predictive Value of Long-Term Systolic Blood Pressure Variability for the Development of Type 2 Diabetes Mellitus

Background: Better identification of high-risk individuals of type 2 diabetes mellitus (T2DM) for focused delivery of preventive measures requires risk prediction models using novel predictors. We evaluated the predictive value of long-term variability of systolic blood pressure (SBPV), which was recently reported to be associated with T2DM incidence, if added to a model with conventional T2DM predictors in a Japanese cohort study. Methods: A cohort of 3017 Japanese individuals (2446 male, 571 female) ages 36-65 years were followed from 2007 to 2019. Root-mean-square error (RMSE) and slope of systolic blood pressure (SBP) change regressed on year were calculated per individual using SBP values obtained consecutively from 2003 to 2007 to represent SBPV. An initial Cox model included age, sex, smoking status, regular exercise, family history of diabetes, body mass index (BMI), baseline SBP, blood levels of triglycerides (TG), high-density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG), and backward elimination was used for variable selection. The c-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare the performance of prediction models without (Model 1) and with SBPV (Model 2). Results: During 9.8-year (median) follow-up, 135 developed T2DM. We confirmed that RMSE was significantly associated with T2DM incidence independent of other variables used in a conventional model. Backwards elimination procedure selected BMI, TG, HDLC, FBG, SBP RMSE, and SBP slope for the final model (Table 1). Although the c-indices were not statistically different between Model 1 (0.77) and Model 2 (0.78) as well as the NRI (7.1%), the IDI was statistically significant (0.8%, p&lt;0.05). Conclusions: The present study revealed that long-term variability of SBP slightly improved the predictive value of T2DM if added to a conventional prediction model.

Short- to long-term blood pressure variability: Current evidence and new evaluations.

Increased blood pressure (BP) variability and the BP surge have been reported to be associated with increased cardiovascular risk independently of BP levels and can also be a trigger of cardiovascular events. There are multiple types of BP variation: beat-to-beat variations related to breathing and the autonomic nervous system, diurnal BP variation and nocturnal dipping related to sleep and physical activity over a 24-hr period, day-to-day BP variability with anomalous readings within a several-day period, visit-to-visit BP variability between outpatient visits, and seasonal variations. BP variability is also associated with the progression to hypertension from prehypertension and the progression of chronic kidney disease and cognitive impairments. Our research group proposed the "resonance hypothesis of blood pressure surge" as a new etiological hypothesis of BP variability and surges; i.e., the concept that when the time phases of surges and hypertension-inducing environmental influences coincide, resonance occurs and is amplified into a larger "dynamic surge" that triggers the onset of cardiovascular disease. New devices to assess BP variability as well as new therapeutic interventions to reduce BP variability are being developed. Although there are still issues to be addressed (including measurement accuracy), cuffless devices and information and communication technology (ICT)-based BP monitoring devices have been developed and validated. These new devices will be useful for the individualized optimal management of BP. However, evidence regarding the usefulness of therapeutic interventions to control BP variability is still lacking.

PS-C12-8: BLOOD PRESSURE VARIABILITY IN PREVIOUSLY UNTREATED HYPERTENSIVE PATIENTS RANDOMIZED TO NIFEDIPINE GITS OR RAMIPRIL. REVERENT STUDY

Blood pressure (BP) variability (BPV) independently predicts adverse outcomes, making it a potential target for treatment. Preliminary data indicate that dihydropyridine calcium channel blockers (CCB) may reduce BPV more than other antihypertensives. Aim of Reverent: (Reducing blood pressure Variability in Essential hypertension with Ramipril vErsus Nifedipine GITS) Trial was to compare changes in either short-, mid- and long-term BPV in patients treated with a CCB (nifedipine GITS) or an ACE inhibitor (ramipril) in a randomised fashion. Methods: Untreated (treatment-naïve or after treatment washout) patients with mild to moderate essential hypertension and elevated basal BPV, were randomized to open label treatment with nifedipine GITS 30 mg or ramipril 10 mg once daily. BPV after 10 weeks and 12 months of treatment was assessed based on home (primary endpoint; validated AND UA-651BLE monitor), 24-hour ambulatory (A&amp;D TM 2430) and office (AND UA-651BLE) measurements and expressed as standard deviation [SD] of obtained readings. Results: 156 patients were included in the intention-to-treat analysis of the main study (10 weeks, primary analysis) and 138 of the extension study (12 months, exploratory analysis). No significant differences were observed between groups at baseline. Patient characteristics, BP and BPV values after 10 weeks of treatment are reported in the table. No significant differences between groups were observed in home and office BPV at the end of main study, also after adjusting for mean BP reduction. 24-hour weighted SD of systolic BP after 10 weeks of treatment was lower in the nifedipine GITS group (p = 0.032). Exploratory analysis also revealed lower office BPV after 12 months of treatment in nifedipine GITS group (7.15 ± 3.79 vs 9.00 ± 5.28 mmHg, p = 0.026). Conclusions: The study did not identify differences between nifedipine GITS and ramipril in reducing home BPV, while significant differences in favour of nifedipine GITS were observed in 24-hour BPV and in office BPV after 12 months. Clinical impact of these findings remains to be evaluated in outcome studies.

APSH-OP-5: MEASURES OF LONG-TERM SYSTOLIC BLOOD PRESSURE VARIABILITY AND THEIR ASSOCIATIONS WITH THE RISK OF INCIDENT TYPE 2 DIABETES MELLITUS

Objective: The present study investigates the association between long-term systolic blood pressure (SBP) variability and the risk of type 2 diabetes mellitus (T2DM) by using different indicators of the variability including standard deviation (SD), coefficient of variation (CV), maximum and minimum difference (MMD), root mean square error (RMSE), variability independent of the mean (VIM), and average real variability (ARV). Design and method: A cohort of 3017 Japanese individuals (2446 male, 571 female) aged 36 to 65 was followed from 2007 through 2019. SD, CV, MMD, RMSE, VIM, and ARV of long term SBP changes were calculated per individual using SBP values obtained consecutively from 2003 to 2007. A multivariable Cox proportional model was applied to estimate hazard ratio (HR) and the corresponding 95% confidence interval (CI) for tertiles of the each variability measure, SD, CV, MMD, RMSE, VIM, and ARV, adjusted for age, sex, smoking status, regular exercise, family history of diabetes, sleep disorders, sodium intake, body mass index (BMI), BMI slope, fasting blood glucose (FBG), and 2007 SBP. Results: Of the variability measures examined, the highest RMSE tertile compared to the lowest was significantly associated with T2DM incidence (multivariable-adjusted HR: 1.79, 95% CI: 1.15–2.78). Also, the highest ARV tertile compared to the lowest was associated with T2DM incidence (multivariable-adjusted HR: 1.54, 95% CI: 1.00–2.35). The SD, CV, MMD and VIM were not significantly associated with T2DM incidence independent of the covariates. Conclusion: This study revealed that long-term SBP variability is possibly an independent risk factor for the future occurrence of T2DM, and such property can only be measured by either RMSE or ARV.

PS-BPC04-1: CHARACTERISTICS OF MONTH-BY-MONTH BLOOD PRESSURE VARIABILITY IN HEMODIALYSIS PATIENTS

Objectives: It is well known that blood pressure (BP) exhibits BP variation in patients with hemodialysis (HD). We have previously reported that high visit-to-visit blood pressure variability is independently correlated with cardiovascular mortality in maintenance HD patients. However, the characteristics of long-term BP variability remains to be elucidated in these patients. The present study, therefore aimed to investigate the characteristics of month-by-month blood pressure variability, as an indicator of long-term blood pressure variability, and the relationship between month-by-month blood pressure variability and cardiovascular mortality in these patients. Design and method: A total of 324 maintenance HD patients, who could be followed for 60 months, were recruited. We used variation independent of the mean (VIM), which was estimated using systolic BP (SBP) in pre-dialysis and post-dialysis at the beginning of the month in 12 consecutive months (pre-VIM-SBP and post-VIM-SBP), as an index of month-by-month BP variability. We also estimated the average of 12 values of differences between the highest and lowest SBP values during a dialysis session (average Δ SBP) and the difference between SBP in January and February and SBP in July and August (seasonal variability of SBP). We investigated (1) the reproducibility of these values, (2) the relationship between these values and background factors, and (3) the association between these values and mortality. Results: (1) Pre-VIM-SBP and post-VIM-SBP showed significant reproducibility (intraclass correlation, 0.456 (P &lt; 0.001) and 0.522 (P &lt; 0.001), respectively]. Seasonal variability of pre-SBP and Δ SBP was observed both at beginning / after 12 months [5.0 (-5.0–19.0) / 5.3 ± 18.3, 7.2 ± 16.7 / 5.0 ± 12.8, respectively]. (2) Higher pre-VIM-SBP was associated with higher interdialytic weight gain and poor nutritional status. Higher post-VIM-SBP was associated with glucose intolerance, higher interdialytic weight gain and poor nutritional status. Higher Δ SBP was associated with glucose intolerance and higher interdialytic weight gain. (3) Higher post-VIM-SBP was associated with a higher rate of cardiovascular deaths independent of other factors (hazard ratio: 1.104, 95% confidence interval: 1.011–1.207, P = 0.028). Conclusions: Month-by-month blood pressure variability in HD patients is reproducible and associated with various background factors. Month-by-month blood pressure variability in post-dialysis SBP is independently correlated with cardiovascular mortality. Further studies are necessary to confirm the mechanism of increased month-by-month blood pressure variability and to clarify whether reducing month-by-month blood pressure variability will improve the prognosis for HD patients.

JS-HR-7: BLOOD PRESSURE VARIABILITY; THERAPEUTIC TARGET FOR THE PREVENTION OF CARDIOVASCULAR DISEASE

In the past three decades, there have been many reports on the associations of various parameters of blood pressure (BP) variability with increased risk of cardiovascular disease (CVD) events; these parameters include short term BP variability (BPV), i.e., beat-by-beat BPV and ambulatory BPV, abnormality of nocturnal BP dipping pattern, and mid- to long-term BPV, i.e., day-by-day BPV, visit-to-visit BPV, and seasonal variations in BP. Several factors that are associated with abnormal BPV, as well as environmental factors such as cold or warm temperatures and seasonal changes in climate, increase fluctuations in BP. Individual intrinsic factors such as sympathetic nervous tone, arterial stiffness, physical activity, and mental stress also contribute to elevated BPV. According to evaluations of BPV abnormalities, out-of-office BP measurements such as ambulatory and home BP monitoring are needed. Although there are issues regarding measurement accuracy, cuffless BP monitoring devices, for example, those using pulse transit time, may be used to estimate nighttime BP levels. Such cuffless BP devices can also evaluate beat-by-beat BPV. Moreover, by using the multisensor-equipped ambulatory BP monitoring device developed by our research group, it is possible to evaluate BPV associated with changes in temperature, physical activity, and/or atmospheric pressure. Based on the mechanism(s) behind a given patients BPV abnormality, several methods may be considered for the management of that abnormality (Figure). For example, improving excessive sympathetic nervous system activation may be useful in the management of BPV abnormality, and renal denervation has been reported to decrease ambulatory BPV. Abnormal nocturnal BP dipping may be treated by decreasing nighttime BP. Moreover, early adjustment of antihypertensive drugs has been reported to be useful in suppressing seasonal variations in BP, leading to a decreased risk of CVD events. Furthermore, housing conditions and room temperature are closely related to BP levels, and adaptive control of room temperature would be useful to suppress winter increases in BP. In clinical practice, we must not forget that BPV parameters are interrelated. For instance, frequent evaluation of BP levels and adjustment of antihypertensive drugs can suppress visit-to-visit BPV, which in turn leads to the suppression of seasonal variations in BP. Over the next decade, greater data on how to manage and control BPV need to be accumulated. Additionally, future studies should be conducted to verify whether the different types of BVP management are useful in preventing CVD events.