Measures Of Blood Pressure Variability Research Articles

In-Hospital Blood Pressure Variability: A Novel Prognostic Marker of Renal Function Decline and Cardiovascular Events in Patients with Coronary Artery Disease

Introduction: Several measures of blood pressure (BP) variability have been associated with kidney disease and cardiovascular events. Although BP is routinely measured during hospitalization in daily practice, the prognostic impact of in-hospital BP and its variability are uncertain. Methods: A total of 226 participants who underwent elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) were included. BP was measured by trained nurses during the 4-day hospitalization for PCI. BP variability was assessed by standard deviation (SD) and coefficient variation of systolic BP. Estimated glomerular filtration rate (eGFR) was calculated at baseline and follow-up (≥6 months). The cardiovascular end point was defined as a composite of cardiovascular death, acute coronary syndrome, stroke, heart failure hospitalization, and any coronary revascularization. Results: In-hospital BP was measured 9.5 ± 0.8 times. During a median follow-up period of 1.7 years, mean eGFR change was −1.7 mL/min/1.73 m² per year, and 35 (15.5%) participants met the cardiovascular end point. Mean systolic BP and SD were negatively correlated with eGFR change. In the receiver operating characteristic curve analysis, SD of systolic BP predicted the cardiovascular end point (AUC 0.63, best cutoff value 14.2 mm Hg, p = 0.003). Kaplan-Meier analysis demonstrated a significantly higher incidence of the cardiovascular end point in patients with SD of systolic BP ≥14.2 mm Hg compared to their counterpart (p = 0.003). A multivariable analysis showed SD of systolic BP as an independent predictor for the cardiovascular end point. When assessed with coefficient variation, BP variability was similarly related to eGFR change and clinical outcomes. Conclusion: Greater in-hospital BP variability was associated with renal function decline and cardiovascular events in patients with stable CAD.

Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study.

Background and Purpose- Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). Methods- In this post hoc analysis of BEST (Blood Pressure after Endovascular Therapy for Ischemic Stroke), a prospective, multicenter cohort study of anterior circulation acute ischemic stroke patients undergoing EVT, we determined the association of BPV with poor outcome or death (90-day modified Rankin Scale, 3-6). We calculated BPV during the first 24 hours after EVT for systolic and diastolic BP using 5 methodologies, then divided BPV into tertiles and compared the highest to lowest tertile using logistic regression. Results- Of the 443 patients included in our analysis, 259 (58.5%) had a poor outcome, and 79 (17.8%) died. All measures of BPV were significantly higher in patients with poor outcome or death, but the difference was more pronounced for systolic than diastolic BPV. In the logistic regression, the highest tertile of systolic BPV consistently predicted poor outcome (odds ratio, 1.8-3.5, all P<0.05). The rate of death within 90 days was 10.1% in the tertile with the lowest systolic BPV versus 25.2% in the tertile with the highest BPV (P<0.001). Conclusions- In EVT-treated stroke patients, higher BPV in the first 24 hours is associated with worse 90-day outcome. This association was more robust for systolic BPV. The mechanism by which BPV may exert a negative influence on neurological outcome remains unknown, but the consistency of this association warrants further investigation and potentially intervention.

RELATIONSHIP BETWEEN COGNITIVE IMPAIRMENT AND PARAMETERS OF CLINIC AND 24H BLOOD PRESSURE IN ESSENTIAL HYPERTENSIVE PATIENTS

Objective: To evaluate the relationship between values of clinic and 24 h blood pressure (BP) and cognitive function values in pts with essential hypertension (EH) Design and method: 24 h blood pressure monitoring was performed in 139 pts (51,5 ± 0,94 years; 87 males) with EH. Clinic (C) BP (average of 3 measures), 24 h, daytime (D) and nighttime (N) BP, 24 h BP index (I) were obtained separately for systolic (SBP) and diastolic (DBP) values. We took standard deviations (SD) for SBP and DBP during diurnal (D) and nocturnal (N) periods of monitoring as a measure of BP variability (mmHg). Cognitive function was assessed in all pts by Montreal cognitive assessment (MoCA) test. All patients were divided into 2 groups depending on the MoCA Results: group I (n = 75) – MoCAscore > or = 26, group II (n = 64) - MoCA score<26. Results: Pts of II gr. had significantly higher C and 24hDBP than pts of I gr. (accordingly: C DBP – 99,9 ± 3,1 vs 86,7 ± 3,4 mmHg, p < 0,05, 24hDBP – 95,6 ± 2,7 vs 84,00 ± 3,0 mmHg, p < 0,05). Values of C, 24 h, D and N SBP were not significantly different between two groups. Bivariate correlation analyses have shown that MoCA results related to N SBP (r = −0,34; p < 0,01), C DBP (r = −0,32; p < 0,02), 24hI SBP (r = 0,46; p < 0,001) and variability of D DBP (r = −0,30; p < 0,03). Adjustment for age and hypertension duration did not abolish these relationships. Multiple regression analysis have shown that only 24hISBP, 24hIDBP and variability of D DBP are predictors of MoCA results in pts with EH. Conclusions: cognitive function in pts with EH depend on level of clinic and 24 h DBP, BP rhythm and variability of DBP during diurnal period. Values of BP rhythm and variability of DBP during diurnal period are predictors of cognitive impairment in pts with EH.

Bioinformatics Study on Serum Triglyceride Levels for Analysis of a Potential Risk Factor Affecting Blood Pressure Variability

Objective: The purpose of this study was to establish whether Triglycerides (TGs) are related to Blood Pressure (BP) variability and whether controlling TG levels leads to better BP variability management and prevents Cardiovascular Disease (CVD). Methods: In this study, we enrolled 106 hypertensive patients and 80 non-hypertensive patients. Pearson correlation and partial correlation analyses were used to define the relationships between TG levels and BP variability in all subjects. Patients with hypertension were divided into two subgroups according to TG level: Group A (TG&lt;1.7 mmol/L) and Group B (TG&gt;=1.7 mmol/L). The heterogeneity between the two subgroups was compared using t tests and covariance analysis. Results: TG levels and BP variability were significantly different between the hypertensive and non-hypertensive patients. Two-tailed Pearson correlation tests showed that TG levels are positively associated with many BP variability measures in all subjects. After reducing other confounding factors, the partial correlation analysis revealed that TG levels are still related to the Standard Deviation (SD), Coefficient of Variation (CV) of nighttime systolic blood pressure and CV of nighttime diastolic blood pressure, respectively (each p&lt;0.05). In the subgroups, group A had a lower SD of nighttime Systolic Blood Pressure (SBP_night_SD; 11.39±3.80 and 13.39±4.16, p=0.011), CV of nighttime systolic blood pressure (SBP_night_CV; 0.09±0.03 and 0.11±0.03, p=0.014) and average real variability of nighttime systolic blood pressure (SBP_night_ARV; 10.99±3.98 and 12.6±3.95, p=0.024) compared with group B, even after adjusting for age and other lipid indicators. Conclusion: TG levels are significantly associated with BP variability and hypertriglyceridemia, which affects blood pressure variability before causing target organ damage.

Abstract 191: BRAVE: Blood Pressure and Vascular Health Around Menopause

Background: Post-menopausal women are more likely to have uncontrolled hypertension and are at higher risk of cardiovascular disease compared with age-matched men. Blood pressure variability (BPV) has recently emerged as a predictor of adverse cardiovascular outcomes. It is unknown if there is a relationship between BPV and menopause and whether BPV can predict vascular health in perimenopausal women. Methods: BRAVE (Blood pRessure And Vascular hEalth around menopause) is an observational study recruiting perimenopausal healthy women, aimed at studying the relationship between BPV, the menopause transition and vascular health. A 24-hour blood pressure (BP) measurement [including 24-hour coefficient of variation, night dipping and maximum BP] was used to define the BPV. Menopausal status and cardiovascular risk factors were collected through questionnaires. Arterial stiffness, as a marker of vascular health status, was measured using pulse wave velocity. Multivariable models were performed to identify factors associated with BPV as well as those associated with arterial stiffness in perimenopausal women. Results: Fifty healthy women (mean age 52.9 ± 4.0, 62% post-menopausal) were recruited. There was a low prevalence of cardiovascular risk factors, except physical inactivity (60%). In around 40% of patients, we observed an abnormal pattern of BPV. However, all measures of BPV were similar between peri and post menopausal women. In the multivariable analysis, BMI was the only factor associated independently with maximum overnight BP (ß=1.95, p&lt;0.0001) and maximum daytime BP (ß=2.46, p=0.008). Furthermore, maximum overnight BP was found to significantly associated with the arterial stiffness measurement (ß=0.035, p=0.048) after adjusting for confounders, including mean BP and cardiovascular risk factors. Conclusion: An abnormal pattern of BPV is common in perimenopausal women with normal office BP measurement. Maximum overnight BP provides useful information on vascular health beyond mean blood pressure in this population. BPV measurements in normotensive perimenopausal women may therefore have additional clinical value in stratifying their cardiovascular risk.

Relationship between blood pressure variability and cognitive function in geriatric hypertensive patients with well-controlled blood pressure.

Hypertension is an important risk factor for cardiovascular diseases and cognitive function. Blood pressure (BP) variability has been associated with cognitive dysfunction, but data are sparse regarding the relationship between BP variability and cognitive function in geriatric patients with well-controlled BP. The aim of this study was to demonstrate the relationship between blood pressure variability and cognitive functions in geriatric hypertensive patients with well-controlled BP. We analyzed 435 hypertensive patients (167 male, 74.9 ± 8.3; 268 female, 76.1 ± 8.6) treated at least with one antihypertensive drug. All patients underwent ambulatory BP monitoring and the standardized mini mental test (sMMT). We divided the weighted standard deviation (SD) of systolic BP (SBP) as a measure of BP variability into quartiles. The top quartile group (≥ 18.5mmHg) had a significantly lower total sMMT score (23.3 ± 3.2, p < 0.001). According to the results of multivariate logistic regression analysis for sMMT, the SD of 24-h SBP was related to sMMT (p = 0.007, 95% confidence interval - 0.301 [- 0.370 to - 0.049]). Although there are some inconsistencies among the studies investigating the relationship between blood pressure variability and cognitive functions in elderly patients, we demonstrated the relationship between increased 24-h blood pressure variability and cognitive functions assessed with sMMT in geriatric population with well-controlled BP. The increased blood pressure variability was associated with poorer cognitive functions in geriatric hypertensive patients with well-controlled blood pressure.

Abstract 93: Increased Blood Pressure Variability After Acute Ischemic Stroke Increases the Risk of Death

Introduction: Increased visit-to-visit blood pressure variability (BPV) is linked to a higher risk of incident ischemic stroke in large epidemiologic studies. Hypothesis: Increased BPV in the acute phase after ischemic stroke will be correlated with death and poor outcome. Methods: This is a secondary analysis of patients in the placebo arms of the Virtual Stroke International Stroke Trial Archive (VISTA) with 4 or 5 blood pressure readings in the 24 hours after enrollment. Our primary outcome is death and the secondary is poor outcome, defined as a modified Rankin Scale of 3 to 6, both at 90 days from enrollment. We calculated BPV using 6 statistical methodologies (Table 1) and compared the highest to lowest tercile for each measure of BPV. Results: We included 1,947 patients, of whom 907 (46.6%) were female and the mean±SD age was 69.7±12.3 years. The mean±SD time from stroke onset to study enrollment was 4.8±2.4 hours and 534 (27.4%) received intravenous tPA. Of the 1,947 patients, 332 (19%) died within 90 days and 1,125 had a poor outcome (58%). We found that higher systolic BPV had a robust association with all-cause death, but not poor outcome (Tables 1 &amp; 2). Diastolic BPV had a less consistent association with either outcome. Conclusion: Increased BPV in the first day after acute ischemic stroke is associated with a higher risk of death within 90 days, in the VISTA database. Prospective studies can establish if this is causal or an epiphenomenon.

Abstract WMP52: Systolic Blood Pressure Variability and Incident Ischemic Stroke or All-Cause Mortality: A Secondary Analysis of the Atherosclerosis Risk in Communities Study

Introduction: Increased outpatient “visit-to-visit” blood pressure variability (BPV) has been linked with a higher risk of ischemic stroke, but prior studies have mostly used data from clinical trials with relatively short periods of expsoure and outcome ascertainment. Hypothesis: Higher BPV is associated with incident ischemic stroke and mortality in the Atherosclerosis Risk in Communities (ARIC) study. Methods: The study exposure was BPV during visits 1-4 (1987-1999). Patients were included if they attended all 4 visits, for a total of 12 blood pressure readings. The outcome ascertainment period was from 2000-2011. The primary outcome was stroke and the secondary outcome was all-cause mortality. Patients were excluded if they had either outcome prior to the ascertainment period. Results: The final cohort included 10,155 patients of whom 434 had ischemic stroke and 2,138 died. Five different statistical measures of BPV were increased in patients with stroke (Table 1) and mortality (Table 2). This association remained significant in multivariable Cox models comparing the risk of the highest to lowest tercile of BPV (Table 3). Conclusion: Our data reinforce prior research showing that higher “visit-to-visit” BPV is associated with future stroke or death. Additional research is needed to understand the causal mechanism and methods to reduce BPV.

Blood Pressure Variability and Autonomic Dysfunction.

This review considers the relationship between abnormal blood pressure (BP) variability and autonomic dysfunction through an attempt to answer questions about its clinical relevance and pertinence to diabetes and cardiovascular autonomic neuropathy (CAN) and which therapeutic measures can lessen its cardiovascular impact. Office, ambulatory, and home BP monitoring identify posture-related, circadian, short-term, and long-term BP variabilities. Abnormal BP variability is a risk marker for organ damage, mortality, and cardiovascular events. Moreover, BP variability changes are common in diabetes and associated with CAN and possibly exacerbated by comorbidities like nephropathy, obstructive sleep apnoea syndrome, and chronic pain. The prognostic role of nondipping and reverse dipping is well documented in diabetes. Some findings suggest the possibility of restoring dipping with the dosage time of antihypertensive agents. Diabetes is a favorable scenario for altered BP variability, which might mediate the harmful effects of CAN. Preliminary data suggest the protective effect of targeting BP variability. However, further longitudinal outcome studies are needed. In the meantime, BP variability measures and practical expedients in antihypertensive treatment should be implemented in diabetes.

Influence of age and gender on blood pressure variability and baroreflex sensitivity in a healthy population in the Indian sub-continent.

Background The current exploratory study was aimed at estimating measures of blood pressure variability (BPV) and baroreflex sensitivity (BRS) in a healthy population in the Indian sub-continent. Methods One hundred and forty-two healthy subjects were recruited for the study. Blood pressure (BP) was recorded continuously for 15 min using the Finometer (Finapres Medical Systems, The Netherlands). For offline analysis, Nevrokard cardiovascular parameter analysis (CVPA) software (version 2.1.0) was used for BPV analysis. BRS was determined by spectral and sequence methods. One-way ANOVA and Bonferroni's test were used to compare parameters. Pearson's correlation coefficient was employed to look for possible associations between age and other continuous variables. Results Out of 196 screened volunteers, 54 were excluded and 142 subjects were grouped based on ages as 10-19 years (group 1), 20-29 years (group 2), 30-39 years (group 3), 40-49 years (group 4), and 50-59 years (group 5). Within groups, body mass index (BMI, p=0.000) and BP (systolic and diastolic) were significantly different. Post hoc analysis showed mean blood pressure (MBP) and diastolic blood pressure (DBP) differing significantly between groups 1 and 4 (p<0.05 for both) along with other cardiovascular parameters. Age correlated positively with BMI and all parameters of BP. Significant gender differences were observed for stroke volume, cardiac output, up BRS, total BRS, peripheral resistance (PR), and aortic impedance. Conclusions Our study has provided reference values for BPV and BRS in an Indian population. It also indicates age-related neurocardiac imbalance and possible utility of these tests for screening at the start of neurocardiac damage in a healthy population.

Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension.

Children with primary hypertension have been reported to have diminished scores in measures of cognition. However, little is known about the relative correlation between office and ambulatory blood pressure (BP) and neurocognitive test performance, and whether short-term BP variability is associated with decreased neurocognitive function. We sought to determine whether ambulatory BP monitoring (ABPM) was more strongly associated with neurocognitive test performance compared with office BP, and whether increased short-term BP variability was associated with lower neurocognitive scores. Seventy-five subjects ages 10-18years, with untreated primary hypertension, and 75 matched normotensive controls completed neurocognitive testing. All subjects had office BP and ABPM prior to neurocognitive testing. On multivariate analyses, there was no significant association between office BP and neurocognitive tests. However, several ABPM parameters were significantly associated with neurocognitive test scores in the lower quartile, in particular 24h SBP load and wake systolic blood pressure (SBP) index [Rey Auditory Verbal learning Test (RAVLT) List A Trial 1, 24h SBP load, odds ratio (OR) = 1.02, wake SBP index, OR = 1.06; List A Total, 24h SBP load, OR = 1.02, wake SBP index, OR = 1.06; Short Delay Recall, wake SBP index, OR = 1.06; CogState Maze delayed recall, 24h SBP load, OR = 1.03, wake SBP index, OR = 1.08; Grooved Pegboard, 24h SBP load, OR = 1.02; all p < 0.05]. In contrast, short-term BP variability measures were not associated with neurocognitive test performance. ABPM is superior to office BP in distinguishing hypertensive youth with lower neurocognitive test performance.

BLOOD PRESSURE AND HEART RATE VARIABILITY IN ERECTILE DYSFUNCTION

Objective: Cardiac autonomic dysfunction is associated with increased cardiovascular mortality. No data on sympathovagal balance is available in patients with erectile dysfunction (ED), in whom cardiovascular risk is high. The aim of the study was to assess blood pressure variability (BPV) and heart rate variability (HRV) in patients with hypertension and erectile dysfunction. Design and method: We studied 215 untreated hypertensives (104 diagnosed with ED, mean age 53.9 ± 10.3 and 111 controls, mean age 48.3 ± 11.8). Cardiac autonomic function was evaluated by analysis of short-term BPV and HRV measures over 24-h, daytime, and nighttime using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. ANCOVA was applied and the comparison between the two groups was adjusted for age, office pulse pressure, body-mass index, history of diabetes, smoking status, LDL and high sensitivity C-reactive protein. Results: In comparison with controls, patients with ED had higher daytime diastolic blood pressure variability (11.2mmHg vs. 10.7mmHg, p = 0.046) and daytime HRV (10.5 beats per minute vs. 10.3 beats per minute, p = 0.033). All other daytime, nighttime and 24 h measurements of BPV and HRV were not different between groups (p > 0.05). At echocardiography, hypertensives with ED had similar LVMI compared to hypertensives without ED (p < 0.05). Conclusions: Compared to controls, ED patients showed a daytime sympathovagal imbalance, characterized by a relatively increased sympathetic activity. Whether this autonomic alteration has a prognostic role in hypertensive ED patients for future cardiovascular events warrants further investigation in prospective studies.

HOW WE CAN TRUST MEASURES OF BPV SINCE IT'S VALUE IS SO VARIABLE ITSELF?

Objective: In recent years an increasing attention has been paid to blood pressure variability (BPV) because some evidence suggests that it is related to the presence of target organ damage and to the risk of cardiovascular events; home blood pressure (HOME BP) could be an easy way to evaluate medium-term variability as shown by the Ohasama study. However, very rarely HOME BP is measured regularly and/or recorded appropriately. One of our patient measured her BP almost every day for about 5 months (a total of 306 measures because some days she took more than one measurement); during this period the anti-hypertensive therapy was unchanged and the compliance was excellent (from the daily diary it was possible to confirm also a very regular life-style).Design and method: We calculated average BP and BPV in subsets of these measures (morning vs evening and each month separately). Results: Overall BP control was excellent (average systolic BP = 120 mmHg; average diastolic BP = 81.8 mmHg) and BPV, measured as SD was 6.56 mmHg (CV = 5,5%) for systolic and 4.99 mmHg (CV = 6.1%) for diastolic; while average BP was similar in the morning and in the evening, BPV was different (9.44 vs 8.46 mmHg) for systolic; moreover, BPV calculated on the HOME BP taken during each month was quite variable (from 5.15 to 8.5 mmHg, that is + 30% or −21% from the mean for systolic and from 3,97 to 6.83 mmHg, that is +37% or – 20% from the mean for diastolic). We calculated also AVR (average real variability) in the different subsets with similar results. In Figure 1 we show the variable all-cause-mortality risk-increment during BP follow-up according to the recent published literature. Conclusions: We believe that the variability of BPV measures observed in this patient arises some doubts about its value as a prognostic index as it does not appear stable within the single patient. In other words BPV is too variable to be useful!

Autonomic dysregulation in colon cancer patients

To the best of our knowledge, only two studies analyzed the relationship between HRV and carcinoembryonic antigen (CEA) in colon cancer patients. The aim of this study was to analyze changes in the autonomic activity of colon cancer patients using heart rate variability (HRV) and blood pressure variability (BPV) measures, and to verify if HRV and BPV parameters correlate with hemodynamic indices in this group and the plasma levels of CEA. Presence of colon cancer is associated with changes in autonomic activity, namely parasympathetic-sympathetic imbalance in form of sympathetic overdrive. Cancer-related autonomic dysfunction may contribute to impairment of gastrointestinal motility.

Association between B-type natriuretic peptide and within-visit blood pressure variability.

Blood pressure variability (BPV) has been shown to predict cardiovascular events. Within-visit BPV is the simplest and easiest measure of BPV, but previous studies have shown conflicts as to whether within-visit BPV correlates with target organ damage. We aimed to evaluate whether within-visit BPV correlates with B-type natriuretic peptide (BNP) in a general population. Within-visit BPV correlates with BNP in a general population. This was a cross-sectional study that included 633 individuals, randomly selected, age 45 to 99 years, registered in the primary care program from an urban medium-sized town. Patients were scheduled for a single-day visit that consisted of clinical evaluation and laboratory tests. Three blood pressure (BP) readings, 1 minute apart, were done, and within-visit BPV was determined as the coefficient of variation (CV) of the 3 BP measures. Our main outcome was to correlate BNP and within-visit BPV. A multivariable model was estimated using a generalized linear model to evaluate the independent effects of different variables on BNP levels. The median age was 57 years. Median BNP was 16 pg/mL, and the median systolic and diastolic BP-CV were, respectively, 3.9% and 3.5%. There was a weak but positive correlation between BNP and both systolic BP-CV and diastolic BP-CV (r = 0.107 and P = 0.007 and r = 0.092 and P = 0.019, respectively). In multiple regression equation, systolic BP, diastolic BP-CV, body mass index, and estimated glomerular filtration rate were associated with BNP. In the present study, there was a positive, albeit weak, correlation between within-visit BPV and BNP. In addition, diastolic BPV was associated with BNP even after adjustment for multiple confounders.

Visit-to-visit (long-term) and ambulatory (short-term) blood pressure variability to predict mortality in an elderly hypertensive population.

To explore the association of different types of blood pressure (BP) variability measures estimated from either short-term ambulatory reading-to-reading or long-term clinic visit-to-visit BP records with long-term survival in an elderly treated hypertensive population. A subset of patients (n = 508) aged at least 65-years was studied from the Second Australian National Blood Pressure study. We estimated SBP and DBP BP variability as the SD of ambulatory (24-h, daytime, night-time) and clinic visit-to-visit BP directly from all corresponding on-treatment within-individual BP records. Ambulatory 'weighted day-night' variability was calculated as a weighted mean of daytime and night-time SD. Cox-proportional hazard models adjusted for baseline risk factors (Model 1) and corresponding on-treatment BP (Model 2) or average night-time SBP (best predictive BP measure for outcome) (Model 3) were used to determine the relationship between long-term outcome and BP variability. Over a median of 10.6 years, 101 patients died from any cause, of which 51 deaths were cardiovascular. We observed increase in 'daytime' and 'weighted day-night' SBP/DBP variability was significantly associated with increased all-cause mortality in all models. For cardiovascular mortality, only 'weighted day-night' SBP variability significantly predicted risk in all models (Model 3 hazard ratio: 1.09, 95% confidence interval: 1.00-1.19, P = 0.04). Long-term BP variability was not associated with any outcome. On direct comparison, both 'daytime' and 'weighted day-night' BP variability measures provided similar prognostic information. Short-term 'daytime' and 'weighted day-night' SBP variability from ambulatory BP recordings was a better predictor of mortality in elderly treated hypertensive patients than long-term BP variability from visit-to-visit BP recordings.

Abstract WP405: Ultra-short-term Blood Pressure Variability is Increased in Ischemic Stroke Patients Compared to Controls

Introduction: Systolic blood pressure variability (BPV) is increased after ischemic stroke and higher levels are associated with worse outcome. Accurate quantification of BPV requires frequent measurement, which is not practical with conventional sphygmomanometry. Finger photo-plethysmography allows non-invasive continuous blood pressure measurement and has been validated against invasive measurement techniques. Hypothesis: Ultra-short-term BPV (uBPV) will be higher in patients with recent ischemic stroke compared to controls. Methods: We measured uBPV in 10 patients: 5 with stroke in the last 14 days (mean=6 days) and 5 healthy controls. Blood pressure was recorded with an ADInstruments NIBP System (Figure 1) for 15 minutes with 200 measurements/second. For each patient, the 15 minutes was divided into 10 epochs of 90 seconds. uBPV was calculated for each epoch and we used a linear mixed-effects model to account for repeated and clustered observations. Results: There was a mean±SD of 172,265±11,354 measurements per patient and 17,226±2,274 measurements per epoch. All measures of systolic uBPV were significantly higher in the stroke patients compared to controls (Table 1). The identical analyses were performed for diastolic and mean arterial blood pressure without significant results. Conclusion: This study demonstrates the feasibility of measuring BPV in stroke patients with finger photo-plethysmography, which was well tolerated and showed the expected increase in systolic BPV after stroke. Our data also introduce the concept of uBPV as a measure of BPV after stroke, which warrants additional study and correlation with clinical and radiographic outcomes.

Day-by-Day Variability of Home Blood Pressure and Incident Cardiovascular Disease in Clinical Practice: The J-HOP Study (Japan Morning Surge-Home Blood Pressure).

We assessed the relationship between day-by-day home blood pressure (BP) variability and incident cardiovascular disease (CVD) in clinical practice. J-HOP study (Japan Morning Surge-Home Blood Pressure) participants underwent home BP monitoring in the morning and evening for a 14-day period, and their BP levels and BP variability independent of the mean (VIM) were assessed. Incident CVD events included coronary heart disease and stroke. Cox models were fitted to assess the home BP variability-CVD risk association. Among 4231 participants (mean±SD age, 64.9±10.9 years; 53.3% women; 79.1% taking antihypertensive medication), mean (SD) home systolic BP (SBP) levels over time and VIMSBP were 134.2 (14.3) and 6.8 (2.5) mm Hg, respectively. During a 4-year follow-up period (16 750.3 person-years), 148 CVD events occurred. VIMSBP was associated with CVD risk (hazard ratio per 1-SD increase, 1.32; 95% confidence interval [CI], 1.15-1.52), independently of mean home SBP levels over time and circulating B-type natriuretic peptide levels or urine albumin-to-creatinine ratio. Adding VIMSBP to the CVD prediction model improved the discrimination (C statistic, 0.785 versus 0.770; C statistic difference, 0.015; 95% CI, 0.003-0.028). Changes in continuous net reclassification improvement (0.259; 95% CI, 0.052-0.537), absolute integrated discrimination improvement (0.010; 95% CI, 0.003-0.016), and relative integrated discrimination improvement (0.104; 95% CI, 0.037-0.166) were also observed with the addition of VIMSBP to the CVD prediction models. In addition to the assessments of mean home SBP levels and cardiovascular end-organ damage, home BP variability measurements may provide a clinically useful distinction between high- and low-risk groups among Japanese outpatients.

Real World Home Blood Pressure Variability in Over 56,000 Individuals With Nearly 17 Million Measurements.

Using the data from 56,365 individuals, from 185 countries, and a Nokia Health Wireless blood pressure (BP) monitor, we investigated real-world characteristics of BP variability (BPV). All included individuals self-measured and uploaded their BP using Bluetooth at least 20 times over a period of ≥1 month at a frequency and duration of their choosing. In total, 16,904,844 BP measurements were analyzed, with a median of 146 measurements per person (interquartile range [IQR] 73-321) over a median of 14 months (IQR 7-31). SD, coefficient of variation, maximum BP, and maximum minus minimum BP difference were all calculated as measures of BPV. BPV showed a distinct pattern, influenced by season of year, day of week, and time of day. BPV index was higher in females compared with males (P < 0.001) and increased with age (P < 0.001). Compared to the weekend, the weekday BPV index was significantly higher, and this finding was more prominent in females (P = 0.001). In multivariate analysis, BPV index were significantly associated with age, gender, geographic location, and mean BP values. Using the largest BP data set we are aware of, with the benefits and limitations of real-world measurement, we could show the pattern of BPV and provide reference values that may be helpful in understanding the nature of BPV as self-measurement at home becomes more common, and help guide individualized management.

The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension

Intermittent fasting is a phenomenon which can be observed in most humans. The effect of intermittent fasting on blood pressure variability (BPV) has not previously been investigated. The purpose of this study was to assess the effect of fasting on blood pressure (BP) (with office, home, central, and ambulatory blood pressure monitoring [ABPM]) and on BPV. Sixty individuals were included in the study. Office, home, ABPM, and central BP measurements were performed before and during intermittent fasting. Standard deviation and coefficient variation were used for office and home BPV measurement, while the smoothness index was used to calculate ABPM variability. Patients’ BP and BPV values before and during intermittent fasting were then compared. Intermittent fasting resulted in a significant decrease in office BP values and ABPM measurements but caused no significant change in home and central BP measurements. Twenty-four hour urinary sodium excretion decreased. Smoothness values obtained from ABPM measurements were low; in other words, BPV was greater. BPV was higher in patients who woke up to eat before sunrise, but BPV was low in patients with high body mass index. Intermittent fasting produced a significant decrease in BP values in terms of office and ABPM measurements in this study but caused no significant change in central BP and home measurements. We also identified an increase in BPV during intermittent fasting, particularly in patients who rose before sunrise.