Mean Blood Pressure Variability Research Articles

Abstract 4123826: Very Short-Term Blood Pressure Variability Determined by Pulse Transit Time Predicts Major Adverse Cardiac and Cerebrovascular Event in Patients with Heart Failure

Introduction: It has been reported that day-to-day blood pressure (BP) variability (BPV) is associated with major adverse cardiac and cerebrovascular events (MACCE) in patients with heart failure (HF). However, the clinical significance of beat-to-beat BPV is unclear. Methods and Results: We recruited data on patients with HF who underwent nighttime pulse transit time (PTT)-based continuous beat-to-beat BP measurement (n = 379, median age 71, male sex 53.6%). Standard deviation (SD) of PTT-based BP was considered as BPV. The primary outcome was MACCE defined as coronary artery disease, stroke, or death due to HF, acute coronary syndrome or ventricular fibrillation. Median values (25th and 75th percentiles) of SD of PTT-based systolic, diastolic, and mean BP were 4.2 (3.5, 5.3), 3.3 (2.7, 4.1), and 3.4 (2.8, 4.1) mmHg, respectively. During the follow-up period of median 1,083 days after BPV evaluation, 43 patients experienced MACCE. When patients were divided into three tertiles based on the systolic, diastolic, and mean BPV, MACCE occurred more frequently in those with higher tertiles of BPV ( Figure ). In the Cox proportional hazard analysis, systolic, diastolic, and mean BPV as continuous variables were associated with MACCE (hazard ratio, 1.191, 1.228, and 1.243, respectively). Conclusion: Beat-to-beat BPV was associated with MACCE in patients with HF.

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.

The Influence of Salt Loading on Glomerular Filtration Rate and Blood Pressure Variability in Healthy Young Adults

Purpose High dietary sodium (Na+) is associated with glomerular hyperfiltration in patients with hypertension. Glomerular hyperfiltration is predictive of future cardiovascular and kidney disease. High dietary Na+ is also associated with greater blood pressure variability (BPV), which is predictive of target organ damage. However, it is unclear if short-term Na+ loading influences glomerular filtration rate (GFR) and BPV in healthy young adults. Therefore, we tested the hypothesis that short-term high Na+ intake would induce glomerular hyperfiltration (GFR > 135 ml/min) and increase BPV in healthy young adults. Methods Twenty participants (12M/8F; age: 24±4 years; BMI: 23.1±0.6 kg/m2; BP: 112 ±10/64±9 mmHg; mean ± SD) participated in a double-blind, placebo-controlled, randomized, crossover study. For 10-days, we asked participants to consume a 2,300 mg/day Na+ diet and supplement with salt (3,900 mg/day of Na+) or placebo (dextrose) capsules. The conditions were separated by ≥ two weeks and we tested female participants during the placebo phase of oral contraception. Participants collected their urine for the final 24 hours of each supplementation period to assess Na+ excretion to verify diet adherence. We measured serum creatinine (Jaffe reaction) to assess estimated GFR via the CKD-EPI equation (along with sex, age and race), and serum/urine creatinine to measure creatinine clearance. We measured brachial (oscillometric) and beat-to-beat BP (photoplethysmography). We used the average real variability index and standard deviation (SD) to assess beat-to-beat systolic, diastolic and mean BPV. Our statistical analyses included paired t-tests, Wilcoxon, and Chi-squared tests. Results Compared to placebo, Na+ supplementation increased urinary Na+ excretion (placebo: 139.9±68.4 vs. Na+: 282±69.8 mmol/24 hours, p<0.001) without differences in mean arterial BP (placebo: 77±7 vs. Na+: 77±6 mmHg, p=0.64). Estimated GFR was not different between conditions (p=0.27). However, compared to placebo, creatinine clearance increased with Na+ supplementation when unadjusted (placebo: 111±33 vs. Na+: 145±24 ml/min, p<0.001) and adjusted (placebo: 106±31 vs. Na+: 137±24 ml/min/1.73m2, p<0.001) for body surface area. There was a trend for an increased prevalence of glomerular hyperfiltration in the Na+ condition compared to placebo when evaluating unadjusted (placebo: 6/20 [30%] vs. Na+: 12/20 [60%], p =0.057) but not adjusted creatinine clearance. There were no differences in measures of BPV except SD of systolic BP (placebo: 5.6±2.2 vs. Na+: 6.5±2.0 mmHg, p=0.035) was modestly increased with Na+ supplementation. Conclusion Our preliminary data suggests that compared to CKD-EPI, creatinine clearance is a more sensitive measure for detecting glomerular hyperfiltration with salt loading in healthy young adults. Moreover, salt loading doesn't increase BPV.

Abstract MP33: Association Between Neurologic Outcomes and Temporal Profile of Systolic Blood Pressure Variability After Endovascular Thrombectomy

Introduction: Higher systolic blood pressure variability (BPV) after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and worse functional outcomes. However, the time-varying behavior of BPV after EVT and its effects on functional outcome have not been well characterized. Methods: We analyzed data from an international cohort of patients with acute large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Parameters of BPV were calculated in 12-hour epochs using five established methodologies: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), successive variation (SV), and residual SD (rSD). Patients’ overall mean BPV was then used to assign patients into tertiles for regression analysis: low BPV, intermediate BPV, and high BPV. Functional outcome was measured with the modified Rankin Scale (mRS) at 90 days. Results: Of the 1,791 patients (age 69 ± 14, NIHSS 15 ± 6) included in our analysis, 1,085 (60.6%) had a poor 90-day outcome (mRS &gt;3). Patients with poor outcome had significantly higher systolic BPV (p&lt;0.05) measured as standard deviation (SBP SD) at each epoch (Figure 1B). Compared to patients with low BPV, those in the highest tertile group had significantly greater odds of a poor functional outcome after adjusting for age, sex, hypertension, NIHSS, ASPECT, tPA, time to reperfusion, and TICI score (OR 1.5; 95% CI 1.2-2; p=0.001). Patients in the highest tertile of BPV demonstrated time-dependent variability with the highest SBP SD during the first 24 hours after thrombectomy (Figure 1A). Conclusions: Higher BPV measured by SBP SD appears to be associated with poor 90-day outcome in EVT-treated stroke patients. Early treatment strategies targeting early high BPV warrant further prospective investigation.

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

Abstract P191: Greater Beat-To-Beat Blood Pressure Variability is Associated With Lower Cognitive Performance Independent of Mean Blood Pressure Among Cigarette Smokers

Introduction: Cigarette smoking is associated with increased cerebrovascular disease risk and reduced cognitive performance, particularly in domains sensitive to vascular insults, such as executive function and processing speed. Short-term blood pressure variability (BPV) is associated with cognitive decline among older adults with and without hypertension (HTN) and BPV is significantly greater among smokers than non-smokers. However, it is unknown if greater short-term BPV contributes to lower cognitive performance in smokers. We hypothesized that greater beat-to-beat BPV would be associated with lower cognitive performance in smokers and that this relation would be independent of mean blood pressure (BP). Methods: Twenty-three smokers (3 current/20 former; age 69 ± 9; pack-years 33 ± 17; systolic BP (SBP) 133 ± 18; diastolic BP (DBP) 71 ± 8; anti-HTN medication use 16Y/7N)), without chronic obstructive pulmonary disease, completed measurements of beat-to beat BPV by 10 minutes of finger plethysmography and electrocardiography, and neuropsychological testing. Age-adjusted neuropsychological test t-scores were grouped into four cognitive domains (executive function, processing speed, language and memory recall). Results: Greater systolic BPV was associated with lower cognitive performance in the executive function (r=-0.59, p&lt;0.01), processing speed (r=-0.60, p&lt;0.01) and language (r=-0.49, p&lt;0.01) domains. The associations between systolic BPV with executive function and processing speed remained significant after adjusting for age, sex, pack-years, years of education, mean SBP and anti-HTN medication use (all p&lt;0.05). Similarly, greater mean BPV was associated with lower executive function (r=-0.50 p=0.01), processing speed (r=-0.60, p&lt;0.01) and language (r=-0.59, p&lt;0.01). However, only the association between mean BPV and executive function remained significant after adjusting for age, sex, pack-years, years of education, mean SBP and anti-HTN medication use (p&lt;0.05). There was no association between systolic or mean BPV and memory recall. Conclusion: These data suggest that greater beat-to-beat BP variability may contribute to lower cognitive performance in smokers and that this relation is independent of mean SBP.

Markers of endothelial injury and subclinical inflammation in children and adolescents with primary hypertension.

IntroductionAdhesion molecules: E-selectin and intercellular adhesion molecule 1 (ICAM-1) are well-established markers of endothelial injury. The aim of the study was to assess the relation between E-selectin and ICAM-1 and clinical and biochemical parameters in children and adolescents with primary hypertension (PH).Material and methodsIn 77 patients with PH (15.04 ±2.62 years, 50 boys, 27 girls) we evaluated serum E-selectin, ICAM-1, and selected clinical and biochemical parameters including inflammatory indicators and ambulatory blood pressure monitoring (ABPM).ResultsThe E-selectin concentration was 55.63 ±26.49 ng/ml and the ICAM-1 concentration was 302.17 ±67.14 ng/ml. E-selectin and ICAM-1 correlated (p < 0.05) with BMI Z-score (r = 0.24, r = 0.29), ICAM-1 also with uric acid (r = 0.35), HDL-cholesterol (r = –0.28), platelet-to-lymphocyte ratio (r = 0.26), and systolic and mean blood pressure variability (r = 0.24, r = 0.24); in boys ICAM-1 correlated with mean platelet volume (r = 0.29). In multivariate analysis the only significant predictor of E-selectin was mean arterial pressure during 24 hours (β = 0.329, 95% CI: 0.012-0.646) and of ICAM-1 – uric acid (β = 0.430, 95% CI: 0.040-0.819). In 27 children with newly diagnosed PH E-selectin correlated negatively with diastolic blood pressure dipping (r = –0.54, p = 0.004) and positively with ambulatory arterial stiffness index (r = 0.51, p = 0.012).ConclusionsElevated mean arterial pressure and hyperuricemia are risk factors of endothelial damage in paediatric patients with primary hypertension. In children with untreated primary hypertension there may be a relation between endothelial damage and disturbed circadian blood pressure profile.

PARATHYROID HORMONE, BUT NOT 25-HYDROXI VITAMIN D, SERUM LEVELS ASSOCIATE WITH ALDOSTERONE-TO-RENIN RATIO AND NOCTURNAL MEAN BLOOD PRESSURE VARIABILITY

Objective: To assess the association between serum parathyroid hormone (PTH) or vitamin D serum levels with blood pressure, aldosterone-to-renin ratio, and target organ damage in a series of hypertensive patients. Design and method: Observational cross-sectional study of hypertensive patients who undergone 24-hour ambulatory blood pressure monitoring (24-h ABPM), in whom plasma aldosterone, plasma aldosterone-to-renin ratio, PTH and 25-OH D serum levels were available. Blood pressure (BP) was measured by 24-hour ABPM. BP was assessed as average real variability. Renin-angiotensin-aldosterone axis status was assessed through plasma aldosterone levels and aldosterone-to-renin ratio. Electrocardiography, echocardiography and urine albumin-to-creatinine ratio were used to evaluate left ventricular hypertrophy and renal damage, respectively. Patients with primary hyperparathyroidism were excluded. Results: We enrolled 170 consecutive patients (median age [IQR] -year), 52 [42–64]; 48.2%, female). In comparison with patients with normal PTH serum levels (<88 pg/ml), those with high PTH serum levels (>88 pg/ml) showed a significantly increase in plasma aldosterone-to-renin ratio [mean ± SD] (37.8 ± 46.6 vs. 20.7 ± 27.0; p = 0.032), and nocturnal pulse pressure (56.3 ± 17.9 vs. 50.6 ± 13.1 mm Hg; p = 0.029). Furthermore, when compared with patients in the PTH 1st quartile, those in the 4th PTH quartile showed significantly higher nocturnal systolic BP (129.5 ± 25.6 vs. 119.9 ± 14.4 mm Hg; p = 0.038), plasma aldosterone (204.9 ± 128.4 vs. 153.8 ± 88.7 pg/ml; p = 0.037), plasma aldosterone-to-renin ratio (36.4 ± 45.8 vs. 18.9 ± 24.5; p = 0.033), and nocturnal mean BP variability (8.9 ± 4.4 vs. 7.1 ± 1.7 mm Hg; p = 0.016). Differences in aldosterone-to-renin ratio and nocturnal mean BP variability remained significant after adjusting by age, gender, renal function and ACE/ARB therapy in multivariate analysis. No such differences were observed in patients with vitamin D deficiency (25-OH D < 20 ng/ml), when compared with patients with normal vitamin D serum levels. Conclusions: High PTH, but not low 25-OH D serum levels associate with increased aldosterone-to renin ratio and elevated nocturnal mean blood pressure variability. Our results might explain, in part, the lack of consistent clinical benefit of vitamin D supplementation on high blood pressure and cardiovascular risk. We suggest that serum PTH status should be considered in trials searching for cardiovascular benefits from vitamin D supplementation in patients with hypovitaminosis D.

PP.21.36] CORRELATION OF PROTHROMBOTIC STATUS WITH EARLY MORNING BLOOD PRESSURE MEASUREMENTS

Objective: The correlation of prothrombotic risk factors of hypertensive patients to early morning blood pressure measurements. Design and method: We studied 306 newly diagnosed hypertensive patients, not treated with anti-hypertensive therapy (male sex 49%, mean age 51.8 years old, mean systolic/diastolic blood pressure 155.5/98.4 mmHg, mean heart rate 78 beats per minute, mean body mass index 27.9 kg/m2). Blood fibrinogen levels were measured and in 30 patients antithrombin III test (ANT III) was performed. We measured 24 h ambulatory blood pressure and systolic/diastolic and mean blood pressure variability were calculated.The values obtained were correlated according to Pearson or Kendall method.Conclusions: It is important to correlate the prothrombotic factors, positive or negative to blood pressure variability during night and early morning hours in hypertensive patients and this may be part of the incidence of cardiovascular events in the aforementioned hours.

Acute effects on cardiovascular oscillations during controlled slow yogic breathing.

Background & objectives:Breathing exercises are believed to modulate the cardiovascular oscillations in the body. To assess the validity of the assumption and understand the underlying mechanism, the key autonomic regulatory parameters such as heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) were recorded during controlled slow yogic breathing. Alternate nostril breathing (ANB) was selected as the yogic manoeuvre.Methods:Twelve healthy volunteers (age 30±3.8 yr) participated in the study. ANB was performed at a breathing frequency of 5 breaths per minute (bpm). In each participant, the electrocardiogram, respiratory movements, beat-to-beat BP and end-tidal carbon dioxide were recorded for five minutes each: before, during and after ANB. The records were analyzed for HRV, BPV and BRS.Results:During ANB, HRV analysis showed significant increase in the standard deviation of all NN intervals, low-frequency (LF) component, LF/HF (low frequency/high frequency) ratio and significant decrease in the HF component. BPV analysis showed a significant increase in total power in systolic BPV (SBPV), diastolic BPV (DBPV) and mean BPV. BRS analysis showed a significant increase in the total number of sequences in SBPV and DBPV and significant augmentation of α-LF and reduction in α-HF. The power spectrum showed a dominant peak in HRV at 0.08 Hz (LF component) similar to the respiratory frequency. The acute short-term change in circulatory control system declined immediately after the cessation of slow yogic breathing (ANB) and remained elevated in post-ANB stage as compared to the pre-ANB.Interpretation & conclusions:Significant increase in cardiovascular oscillations and baroreflex recruitments during-ANB suggested a dynamic interaction between respiratory and cardiovascular system. Enhanced phasic relationship with some delay indicated the complexity of the system. It indicated that respiratory and cardiovascular oscillations were coupled through multiple regulatory mechanisms, such as mechanical coupling, baroreflex and central cardiovascular control.

Beneficial Effects of Paeoniflorin Enriched Extract on Blood Pressure Variability and Target Organ Damage in Spontaneously Hypertensive Rats.

Blood pressure variability (BPV) is associated with the development and progression of severe target organ damage (TOD). This study aims to evaluate the protective effect of paeoniflorin enriched extract from Radix Paeoniae Alba (PG) on BPV and TOD in spontaneously hypertensive rats (SHR). All SHR were orally treated with distilled water, metoprolol (MP, 20 mg/kg), and PG (PG-H, 90 mg/kg or PG-L, 30 mg/kg) for a single time or daily for 7 weeks. The 24-hour dynamic blood pressure was monitored and then calculated BPV including long- and short-term systolic blood pressure variability (SBPV), diastolic blood pressure variability (DBPV), mean blood pressure variability (MBPV), and heart rate variability (HRV) as well as the 24-hour-SBP, 24-hour-DBP, and 24-hour-MBP. The protective effects of PG on TOD were observed by histopathologic and biochemical detection. The results indicated that long- and short-term SBPV, DBPV, MBPV, and HRV as well as 24-hour-SBP, 24-hour-DBP, and 24-hour-MBP showed no significant changes after single-dose administration of PG and significantly decreased after administration with PG for 7 weeks. PG could also markedly improve the damage of aorta, heart, kidney, and brain. This study suggested that PG could notably reduce BPV, stabilize blood pressure, and mitigate TOD in SHR.

PP.15.01] VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN UNCOMPLICATED AND COMPLICATED ARTERIAL HYPERTENSION

Objective: Visit-to-visit blood pressure variability (BPV) is associated with adverse cardiovascular outcomes in different patients’ populations. Mechanisms of visit-to-visit BPV in different groups of patients have not been determined yet. The aim of our study was to assess visit-to-visit systolic BPV in patients with uncomplicated controlled arterial hypertension (AH) and patients with controlled AH and stable coronary heart disease (CHD) or heart failure (HF) with reduced ejection fraction. Design and method: In retrospective study we assessed 3 groups of patients with controlled AH. Group 1 included 52 patients with uncomplicated AH (20 men, age 58,9 ± 9,0 yrs) who achieved target BP on RAAS-inhibitor/amlodipine combination. Group 2 included 40 pts with stable CHD (28 men, age 69,2 ± 5,9 yrs). Group 3 included 100 pts with HF with reduced EF (80 men, age 64,4 ± 9,3yrs, mean EF 32,3 ± 4,3%). Pts in groups 2 and 3 received stable therapy for CHD and HF. BP was measured with a validated oscillometric device. Visit-to-visit BPV was calculated as SD for 5–7 visits during 8–18 months of stable therapy. p < 0,05 was considered significant. Results: At first evaluated visit BP in group 1 was 126,4 ± 7,6/76,7 ± 7,2 mmHg, in group 2 - 125,5 ± 7,5/75,2 ± 8,8 mmHg, in group 3 - 127,6 ± 15,1/77,9 ± 8,3 mmHg. At final evaluated visit BP was 123,7 ± 9,7/76,8 ± 6,7mmHg, 124,2 ± 13,4/72 ± 8,5 mmHg and 123,6 ± 13,6/74,8 ± 8,9 mmHg, respectively. Despite stable levels of BP, BPV on stable therapy varied in wide range in all groups: 1,8–16,8 mmHg, 0,7–23,3 mmHg, 2,3–20,0 mmHg for systolic BPV, respectively and 1,0–11,4 mmHg, 0–17,9 mmHg and 1,5–13,1 mmHg for diastolic BPV, respectively. Despite similar levels of final BP, there were significant differences in mean BPV between groups: systolic BPV in group 1 was 7,2 ± 3,6 mmHg vs 7,8 ± 6,6 mmHg in group 2 and 10,2 ± 3,8 mmHg in group 3; diastolic BPV – 4,8 ± 2,7 mmHg vs 7,0 ± 4,4 mmHg and 7,3 ± 2,2 mmHg, respectively (p < 0,01 for trend). No predictors of BPV were found in all groups. Conclusions: Despite similar BP levels HF with reduced EF is associated with the highest visit-to-visit BPV compared to uncomplicated AH and stable CHD. Thus high visit-to-visit BPV may be a marker of the severity of cardiovascular disease.

PS 05-30 CIRCADIAN BLOOD PRESSURE PATTERN, EPICARDIAL FAT THICKNESS AND LEFT ATRIAL FUNCTION

Objective: Epicardial adipose tissue reflects visceral adiposity and inflammation which can contribute to the fibrotic remodeling of the atrial myocardium. We aimed to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and left atrial (LA) deformation parameter with diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. Design and method: This cross-sectional study included 511 recently diagnosed hypertensive patients, who underwent echocardiography and 24-hours ambulatory BP monitoring. EFT was measured with echocardiography, and global LA strain was obtained by two-dimensional speckle imaging with automated software. The patients were classified as non-dippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Results: The mean EFT, LA volume index as well as left ventricular (LV) filling pressure (E/Ea) were significantly higher in hypertensive patients, especially in non-dippers (all p < 0.001), whereas global LA strain was significantly lowest in non-dippers (normotensives; 23.2 ± 2.0% vs. dippers = 19.0 ± 3.3% vs. non-dippers = 17.4 ± 3.0%, P < 0.001). Moreover, LA strain was significantly associated with LV filling pressure (r = −0.422, p < 0.001), EFT (r = −0.187, p < 0.001), and 24 hour mean BP variability (r = −0.184, p < 0.001). Conclusions: Non-dipper hypertensive patients were associated with increased EFT and impaired LA deformation. This indicates that these subjects may be more prone to atrial rhythm disturbances.

Characteristic enhancement of blood pressure V-shaped waves in sinoaortic-denervated rats in a conscious and quiet state.

A hemodynamic feature of chronic sinoaortic-denervated (SAD) rats is the increase in blood pressure variability (BPV) without significant changes in the average level of blood pressure (BP). The current study was designed to investigate the changes in BP V-shaped waves (V waves) in SAD rats. Sprague-Dawley (SD) rats were divided into 2 groups: SAD rats and sham-operated rats (n=13). Hemodynamics measurements were obtained in conscious, freely moving rats, four weeks after sinoaortic denervation or sham operation. V wave indices were evaluated in rats in both conscious and quiet states. Additionally, normal and high BPV was simulated by the production of V waves with different amplitudes. The results showed that the V wave amplitude was dramatically increased, with a significantly prolonged duration and reduced frequency in SAD rats. V wave BPV in SAD rats was significantly increased, though BP remained unchanged. The twenty-four hour BPV in all rats was positively correlated with amplitude, duration time and V wave BPV and negatively correlated with frequency. The systolic BP spectral powers in the low frequency range (0.38-0.45 Hz) were significantly reduced in the V waves of SAD rats. Moreover, there was a remarkable increase in mean BPV and a normal mean BP after simulating high BPV in SAD rats. These results suggest that enhancement of V waves might be a waveform character of BP in SAD rats in both the conscious and quiet states. These types of V waves appear to be related to a depression of sympathetic regulation of BP induced by sinoaortic denervation.

Nocturnal Blood Pressure Variability in Patients with Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea (OSA) is a common respiratory disorder associated with hypertension and cardiovascular complications. Blood pressure variability may be a sign of risk of cardiovascular events. The aim of this study was to investigate the hypothesis that severe OSA syndrome is associated with increased blood pressure variability. Based on respiratory polygraphy, 58 patients were categorized into two groups: severe OSA with apnea/hypopnea index (AHI) greater than 29 episodes per hour (mean 52.2 ± 19.0/h) and mild-to-moderate OSA with AHI between 5 and 30 episodes per hour (mean 20.2 ± 7.8/h). A 24-h noninvasive blood pressure monitoring was performed. The standard deviation of mean blood pressure was used as the indicator of blood pressure variability. In patients with severe, compared with mild-to-moderate OSA, a higher mean nocturnal systolic blood pressure (133.2 ± 17.4mmHg vs. 117.7 ± 31.2mmHg, p < 0.05) and diastolic blood pressure (80.9 ± 13.1mmHg vs. 73.8 ± 9.2, p < 0.01), nocturnal systolic blood pressure variability (12.1 ± 6.0 vs. 7.6 ± 4.3, p < 0.01) and diastolic blood pressure variability (10.5 ± 6.1 vs. 7.3 ± 4.0 p < 0.05), nocturnal mean blood pressure variability (9.1 ± 4.9 mmHg vs. 6.8 ± 3.5 mmHg) were detected. The findings of the study point to increased nocturnal systolic and diastolic arterial blood pressure and blood pressure variability as risk factors of cardiovascular complications in patients with severe OSA.

Prognostic Impact of Blood Pressure Variability on Aortic Dissection Patients After Endovascular Therapy.

Hypertension has been deemed as a pivotal risk factor for the development of aortic dissection; however, the importance and prognostic significance of blood pressure variability (BPV) in aortic dissection are always ignored. A total of 173 acute type B aortic dissection patients were enrolled in and retrospectively reviewed between January 2009 and November 2013. There were 74 patients with high BPV and 99 with low BPV stratified by preoperative mean BPV. Technical success was achieved in all patients. The proportions of hypertension and general anesthesia were significantly higher in the high BPV group (70.3% vs 55.6% and 77% vs 62.6%, P = 0.049 and 0.043, respectively). The risk of aorta-related death in the high BPV group was apparently higher than the low BPV group (28.4% vs 9.1%, P = 0.001). By performing multivariable logistic regression, we found history of hypertension was likely to be a risk factor of BPV (95% confidence interval [CI]: 1.010-3.911), and high BPV was an independent predictor of aorta-related death (95% CI: 1.671-9.587). The difference of aorta-related mortality was pronounced between high and low BPV subgroups regardless of the refractory hypertension (41.4% vs 14.3% and 20.0% vs 7.0%, P = 0.023 and 0.037, respectively). The thrombosis ratio of false lumen was significantly higher in the low BPV group at 3-month (72.4 ± 17.5% vs 51.8 ± 11.6%, P < 0.001) and 6-month (86.4 ± 9.1% vs 69.7 ± 7.9%, P < 0.001). High BPV is an independent risk factor for the prognosis of aortic dissection. Further studies on BPV might provide new preventive and therapeutic strategies for aortic dissection.

The clinical association of the blood pressure variability with the target organ damage in hypertensive patients with chronic kidney disease.

It is known that blood pressure variability (BPV) can independently affect target organ damage (TOD), even with normal blood pressure. There have been few studieson chronic kidney disease (CKD) patients. We evaluated the relationship between BPV and TOD in a cross-sectional, multicenter study on hypertensive CKD patients. We evaluated 1,173 patients using 24-hr ambulatory blood pressure monitoring. BPV was defined as the average real variability, with a mean value of the absolute differences between consecutive readings of systolic blood pressure. TOD was defined as left ventricular hypertrophy (LVH) (by the Romhilt-Estes score ≥4 in electrocardiography) and kidney injury (as determined from an estimated glomerular filtration rate [eGFR]<30 mL/min/1.73 m2 and proteinuria).The mean BPV of the subjects was 15.9±4.63 mmHg. BPV displayed a positive relationship with LVH in a univariate analysis and after adjustment for multi-variables (odds ratio per 1 mmHg increase in BPV: 1.053, P=0.006). In contrast, BPV had no relationship with kidney injury. These data suggest that BPV may be positively associated with LVH in hypertensive CKD patients.Graphical

Blood pressure measurements, blood pressure variability and endothelial function in renal transplant recipients

Background/Aims: Hypertension is an important cardiovascular risk factor in renal transplant recipients. Elevated blood pressure variability (BPV) during 24-h ambulatory blood pressure monitoring (ABPM) is associated with increased risk of target organ damage and cardiovascular events, independent of mean blood pressure levels. We aimed to evaluate the relationship between endothelial function, blood pressure levels obtained by various measurement methods, and BPV in renal transplant recipients.Methods: In total, 73 hypertensive renal transplant recipients were included in the study. Office blood pressure measurements, central blood pressure measurements, home blood pressure measurements and 24-h ABPM were obtained from the subjects. BPV was calculated using the average real variability index. All patients underwent brachial flow-mediated vasodilatation tests. Predictive values of blood pressures obtained by different measurement techniques and BPV on endothelial functions were investigated.Results: Endothelial dysfunction was present in 68.5% of the patients. No difference was found between the group with and without endothelial dysfunction with regard to office systolic or diastolic blood pressure, central blood pressure or home systolic blood pressure. In the group with endothelial dysfunction, 24-h ambulatory systolic blood pressure and night-time ambulatory systolic blood pressure were higher. In patients with endothelial dysfunction, the 24-h systolic, diastolic and mean BPV were all higher. There was also a negative correlation between the percentage of flow-mediated vasodilatation with 24-h mean and systolic BPV.Conclusion: Patients with endothelial dysfunction had significantly higher ambulatory blood pressure values and higher BPV. There was a significant negative correlation between endothelial function and BPV.

Abstract 349: Comparison of Systolic, Diastolic, and Pulse Pressure, and Blood Pressure Variability, as Predictors of Kidney Function Loss in Persons With Chronic Kidney Disease in the Chronic Renal Insufficiency Cohort

Blood pressure (BP) predicts kidney function decline in CKD. It’’s unclear if systolic (SBP), diastolic (DBP), or pulse pressure (PP) is the strongest predictor, or if BP variability is a determinant. In a prospective study of CKD we examined the association of 3 brachial BP measures on a composite kidney function outcome: end-stage kidney disease (ESKD) or a halving in the estimated GFR compared to baseline. We also examined whether the amount of variability within the 3 BP measurements at baseline predicted the outcome. CRIC participants (∼half DM; ∼half M; eGFR 44.8(16.8) mL/min/1.73 m 2 ) had 3 seated brachial BP at study baseline. Mean BP [mmHg(SD)] and PP were 128(22)/72(13) and 57(19). Mean BP variability, as the SD of SBP (SBPSD) at baseline was 3.3(2.5). After 3.7 years, 766 participants had a halving in eGFR from baseline or ESKD. We modeled the time to the event with Cox proportional hazards regression. For comparability across different BP measures, results were expressed per 1 SD difference in SBP, DBP, and PP; adjusting for eGFR, proteinuria, age, gender, race, clinical site and diabetes(Y/N) in the 3379 participants with complete data. Death was a censoring event. Akaike Information Criterion (AIC; lower values better) evaluated overall model fit characteristics. The same regression parameters were used to model CKD associated with SBPSD, including the mean of the SBP at baseline as a covariate in this analysis. SBP was the strongest BP predictor of loss of kidney function. Variability of baseline SBP also predicted loss of kidney function, independent of level of SBP at baseline, but this association was considerably weaker than those observed for other BP measures.

Abstract 2477: Repetitive Apneic Events Augment Arterial Blood Pressure Fluctuation in Patients with Central and Obstructive Sleep Apnea Syndrome

Background: Sleep apnea-hypopneas induce transient increases in arterial blood pressure (BP). We test the hypothesis that periodic nocturnal apneic events augment those hemodynamic responses in patients both with central and obstructive sleep apnea syndrome (SAS). Methods: Eleven patients with central SAS (CSAS: mean age 70 ± 10 years), 11 patients with obstructive SAS (OSAS: mean age 64 ± 12 years), and 8 normal controls (Control) were studied. Polysomnography was performed and BP was measured on a beat-by-beat basis by finger plethysmography all through the sleep. Severity of SAS was assessed by apnea-hypopnea index (AHI). The degree of BP fluctuation associated with periodic nocturnal apnea-hypopnea was assessed by spectral analysis of mean BP variability. Spectral plots of mean BP were calculated in 2-min segments using a maximum entropy method. Power spectrum of mean BP variability was quantified by measuring the area in the very-low-frequency band which coincides with frequency of apnea-hypopneas (sleep apnea band: 0.01– 0.03 Hz), and was normalized by dividing by the total power in the spectrum up to 0.4 Hz. Results: AHI was similar in CSAS and OSAS (38.3 ± 9.5* and 39.8 ± 11.3*, *p&lt;0.05 vs. Control: 2.5±1.6*). Repetitive fluctuations in BP coincided with periodic apnea-hypopneas were clearly observed in patients with SAS, and were more prominent in CSAS (Normalized spectral power of mean BP in sleep apnea band: 0.72 ± 0.10*† in CSAS, 0.62 ±0.13* in OSAS, and 0.46±0.07 in Control, * p&lt;0.05 vs. Control, and †p&lt;0.05 vs. OSAS). Conclusion: Periodic nocturnal apneic events augment blood pressure fluctuation in patients both with central and obstructive SAS.smoking.