Night-time Blood Pressure Variability Research Articles

Prognostic Relevance of Short-Term Blood Pressure Variability. The Spanish ABPM Registry.

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, with all-cause and cardiovascular mortality in a large cohort of patients with hypertension. We selected 59 124 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry from 2004 to 2014 (median follow-up: 9.7 years). Systolic and diastolic BP SD and coefficient of variation from daytime and nighttime, weighted SD, weighted coefficient of variation, average real variability (mean of differences between consecutive readings), and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through baseline 24-hour ambulatory BP monitoring. Association with all-cause and cardiovascular mortality were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In adjusted models systolic and diastolic daytime and weighted SD and coefficient of variation, average real variability, as well as systolic nighttime SD and BP variability ratio were all significantly associated with all-cause and cardiovascular mortality. Hazard ratios for 1-SD increase in the systolic components ranged from 1.05 to 1.12 for all-cause mortality and from 1.07 to 1.17 for cardiovascular mortality. A daytime SD≥13 mm Hg, a nighttime and a weighted SD≥12 mm Hg, and an average real variability ≥10 mm Hg, all systolic, were independently associated with mortality. Short-term blood pressure variability shows a relatively weak but significant association with all-cause and cardiovascular mortality in patients with hypertension.

Nocturnal blood pressure dipping, blood pressure variability, and cognitive function in early and middle-aged adults.

Higher nighttime blood pressure (BP), less BP dipping, and higher BP variability have been linked with worse cognitive function in the elderly. The goal of this study is to explore whether this relationship already exists in early and middle adulthood. We further examined whether ethnic differences between African Americans and European Americans in BP parameters can explain ethnic differences in cognitive function. 24-h ambulatory BP monitoring and cognitive function were obtained from 390 participants (average age: 37.2 years with a range of 25-50; 54.9% African Americans; 63.6% females). We observed that higher nighttime BP, decreased dipping, and higher variability were significantly associated with lower scores on the Picture Sequence Memory Test. Significant negative associations between variability and overall composite scores were also observed. No significant associations between average 24-h or daytime BP and cognitive function were observed. Ethnic differences in nighttime diastolic pressures and dipping can explain 6.81% to 10.8% of the ethnicity difference in the score of the Picture Sequence Memory Test (ps<.05). This study suggests that the associations of nighttime BP, dipping, and variability with cognitive function already exist in young and middle-aged adults. Ethnic differences in nighttime BP and dipping can at least partially explain ethnic differences in cognitive function. The stronger association of these parameters with cognitive function than daytime or average BP in this age range raises the importance of using ambulatory BP monitoring for more precise detection of abnormal BP patterns in young adulthood.

24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

BackgroundBlood pressure variability is an emerging risk factor for dementia, independent and oftentimes beyond mean blood pressure levels. Recent evidence from interventional cohorts with rigorously controlled mean blood pressure levels suggest blood pressure variability over months to years remains a risk for dementia, but no prior studies have investigated relationships with blood pressure variability over shorter time periods.ObjectivesTo investigate the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering.DesignPost hoc analysis of the randomized, controlled, open-label Systolic Blood Pressure Intervention Trial clinical trial.SettingMultisite Systolic Blood Pressure Intervention Trial.Participants793 participants at increased risk for cardiovascular disease and without history of dementia at study randomization.InterventionStandard (<140 mmHg systolic blood pressure target) vs intensive (<120 mmHg systolic blood pressure target) lowering of mean blood pressure.Measurements24-hour ambulatory blood pressure monitoring 27 months after treatment randomization (standard vs intensive) and follow-up cognitive testing. Intraindividual blood pressure variability was calculated as the average real variability over 24-hour, daytime, and nighttime periods. Participants were categorized into 3 adjudicated clinical outcomes: no cognitive impairment, mild cognitive impairment, probable dementia. Cox proportional hazards models examined the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering. Associations with mean blood pressure were also explored.ResultsHigher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard group (adjusted hazard ratio [HR]: 2.56 [95% CI 1.16, 5.62], p = 0.019) but not in the intensive group (HR: 0.54 [95% CI 0.24, 1.23], p = 0.141). Similar findings were observed with daytime systolic blood pressure variability but not nighttime blood pressure variability. Mean blood pressure was not associated with cognitive outcomes.ConclusionsHigher systolic 24-hour and daytime blood pressure variability via ambulatory monitoring is associated with risk for dementia under standard blood pressure treatment. Findings support prior evidence that blood pressure variability remains a risk for dementia despite strict control of mean blood pressure levels.

IMPACT OF OSCILLOMETRIC MEASUREMENT ARTEFACTS IN AMBULATORY BLOOD PRESSURE MONITORING ON ESTIMATES OF AVERAGE BLOOD PRESSURE AND OF ITS VARIABILITY: A PILOT STUDY

Objective: Ambulatory blood pressure monitoring (ABPM) plays an important role in the diagnosis of hypertension. However, methodological factors and the measurement conditions affect the results and may lead to incorrect classification of the patient. We performed a pilot study to evaluate the impact of oscillometric measurement artefacts on ABPM-derived variables. Methods: Four classes of artefacts have been detected: motor activity artefacts, cuff errors, cardiovascular arousals, and arrhythmias. These artefacts were identified via simultaneous recording of actigraphy, cuff pressure, and an ECG. The data consisted of uncorrected measurements (all data), corrected measurements (all artefact free data), and artefact affected data. Design and method: A total of 30 individuals (9 female / 21 male, aged between 36 and 86 years, mean: 65.5 (SD: 9.5) were included in the study. The 24h average blood pressure (BP) was higher in artefacts-affected measurements compared the artefact-free measurements both for systolic (4.6 mmHg) and diastolic (1.3 mmHg) measurements. Further, artefact-affected systolic BP (SBP) was 6.4 mmHg higher than artefact-free measurements during daytime. On average, nocturnal measurements showed no artefact-depended differences. However, individual comparisons yielded that 23% of the subjects crossed the threshold for BP classification for either 24-h, daytime or nocturnal hypertension when comparing uncorrected and artefact-free measurements. Dipping classification changed in 24% of subjects. BP variability was 21% and 12% higher for SPB and DBP, respectively, during daytime when comparing uncorrected and artefact-free measurements. These differences were even higher (27% for SBP and 21% for DPB) when focussing on night-time BP variability. Conclusions: The study reveals that measurement artefacts are frequently present during cuff-based ABPM and do relevantly affect measurement outcome. Exclusion of measurement artefacts is a promising approach to improving cuff-based ABPM accuracy.

Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study)

PurposeThe coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM).Materials and MethodsThis is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9–15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9–15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall.Expected outcomesAs a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.

Blood pressure variability in Parkinson's Disease patients – Case control study

IntroductionThe cardiovascular risk of Parkinson’s Disease (PD) patients is uncertain. Blood pressure variability (BPV) has been associated with cardiovascular and mortality outcomes. We aimed to evaluate blood pressure variability, as a marker of cardiovascular risk, in patients with PD and matched community controls. MethodsCross-sectional case-control study was performed. All subjects included in the analysis were clinically evaluated and performed a 24 h ambulatory blood pressure monitoring. BPV was assessed using standard deviations (SDs) of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) for each period – 24 h, daytime, and night-time. ResultsThe study included 204 participants, 102 in each group. Mean age 66 years old and 59% man. Most PD patients presented mild symptoms (mean Hoehn&Yahr 2.04). Daytime BPV was significantly higher in PD patients (SD SBP 14.1 mmHg vs 12.96 mmHg and SD DBP 9.39 mmHg vs 8.29 mmHg), but 24 h and night-time BPV were non-significantly increased. PD patients present non-significant higher night-time SBP (114 mmHg vs 110 mmHg) as well as higher frequency of non-dippers or reverse dippers BP profiles (51% vs 36%). ConclusionOur exploratory study suggests that PD patients may present a higher blood pressure variability, which may translate in an increased cardiovascular risk. However, further studies are needed to confirm this hypothesis and causality.

Posttraumatic stress disorder, diurnal cortisol, and ambulatory blood pressure in early and late pregnancy.

Posttraumatic stress disorder (PTSD) affects 1 in 20 reproductive-aged women and is associated with cardiovascular disease morbidity and mortality. The pathophysiology linking PTSD to cardiovascular disease in nonpregnant adults is proposed to include hypothalamic and autonomic dysregulation; however, the pathways explaining this association in pregnancy are unclear. We examined diurnal cortisol and ambulatory blood pressure (BP) among 254 pregnant women at approximately 12 and 32 gestational weeks. Participants were, on average, 31 years old (SD = 5), 24.4% reported their ethnicity as Hispanic, and 62.2% reported their race as White. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). Hierarchical linear regression analyses were performed to examine associations pregnancy between PTSD and cortisol at awakening, 30 min after awakening, and bedtime in early and late pregnancy, as well as associations between PTSD symptoms and daytime and nighttime systolic (SBP) and diastolic BP (DBP) and BP variability. Logistic regression analyses were conducted to test associations between PTSD symptoms and BP dipping. The results showed a positive association between PTSD symptoms and nighttime BP and BP variability at 32 gestational weeks, ∆R2 = .036-.067. PTSD symptoms were negatively associated with awakening cortisol at 12 gestational weeks in unadjusted models. These findings contribute to understanding the associations between PTSD and adverse cardiovascular conditions in pregnancy. More research is needed to replicate these findings and examine whether PTSD interventions are effective at modifying pathways and decreasing the risk for cardiovascular complications in pregnancy.

The rationale, protocol and preliminary results of the ESH ABPM COVID-19 study.

The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The traditional risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. The ESH ABPM COVID-19 Study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes assessed with ambulatory BP monitoring (ABPM). This is a multi-center, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data office BP, 24-hour ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e., after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within similar a 9-15 month interval between the recordings. We will analyze BP variables and phenotypes (including averaged daytime and nighttime BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the groups. Hypertension is one of the major risk factors for established cardiovascular disease (CVD). By extending our knowledge about effects of COVID-19 pandemic on BP control in patients with hypertension, we can propose appropriately effective strategies for providing adequate medical care in case of new pandemic waves and for long-term care, which will reduce incidence of CVD as a consequence of the current pandemic.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Dietary Approaches to Stop Hypertension (DASH)-Style Dietary Pattern and 24-Hour Ambulatory Blood Pressure in Elderly Chinese with or without Hypertension

ABSTRACTBackgroundIt is unknown whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern is associated with other blood pressure (BP) variables, beyond mean systolic blood pressure (SBP) and diastolic blood pressure (DBP).ObjectivesThe study aimed to study the associations between the DASH dietary pattern and daytime and nighttime mean BPs and BP variance independent of the mean (VIM).MethodsA sample of 324 Chinese adults aged ≥ 60 y who were not on BP-lowering medications were included in the analysis. The DASH score was calculated using data collected by a validated FFQ. The 24-h ambulatory BP was measured and the mean and VIM SBP and DBP were calculated for both the daytime (06:00–21:59) and nighttime periods (22:00–05:59). Multivariable linear models were constructed to assess associations between the DASH dietary pattern and daytime and nighttime BP outcomes, adjusting for sociodemographic factors, lifestyle, BMI, and hypertension (clinic SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg), and sleep parameters (only for nighttime BP outcomes). An interaction term between DASH score and hypertension status was added to explore the potential differential association in normotensive and hypertensive individuals.ResultsEvery 1-unit increase in the DASH score was associated with a 0.18-unit (95% CI: −0.34, −0.01 unit) and a 0.22-unit (95% CI: −0.36, −0.09 unit) decrease in nighttime VIM SBP and nighttime VIM DBP, respectively. DASH score was not associated with any daytime BP outcomes, nighttime mean SBP, or nighttime mean DBP. A significant interaction (DASH score × hypertension status) was detected for VIM SBP (P-interaction = 0.04), indicating a differential association between DASH score and nighttime VIM SBP by hypertension status.ConclusionsIndependently of sleep parameters and other factors, the DASH dietary pattern is associated with lower nighttime BP variability in elderly adults.

Reproducibility of nighttime home blood pressure measured by a wrist-type nocturnal home blood pressure monitoring device.

The authors investigated the reproducibility of nighttime home blood pressure (BP) measured by a wrist‐type BP monitoring device. Forty‐six hypertensive patients (mean 69.0±11.6 years, 56.5% male) self‐measured their nighttime BP hourly using simultaneously worn wrist‐type and upper arm‐type nocturnal home BP monitoring devices at home on two consecutive nights. Using the average 7.4±1.3 measurements on the first night and the average 7.0 ± 1.8 measurements on the second night, the authors assessed the reliability and the reproducibility of nighttime BP measured on the two nights. The difference between nights in systolic BP (SBP) measured by the wrist‐device was not significant (1.6±7.0 mmHg, p = .124), while the difference in diastolic BP (DBP) was marginally significant (1.4±4.9 mmHg, p = .050). The intraclass correlation coefficients (ICCs) for agreement between nights were high both in SBP and DBP average (SBP: 0.835, DBP: 0.804). Averaging only three points of SBP resulted in lower ICC values, but still indicated good correlations (ICC > 0.6). On the other hand, the correlations of the standard deviation and average real variability of SBP between nights were low, with ICCs of 0.220 and 0.436, respectively. In conclusion, the average SBP values measured on the first night were reliable even when averaging only three readings. The reproducibility of nighttime BP variability seemed inferior to that of BP average; it might be better to measure nighttime BP over multiple nights to assess BP variability. However, this hypothesis needs verification in other study population. In addition, our study population had well‐controlled BP, which limits the generalizability of this findings to all hypertensive patients.

Author Response: White Matter Hyperintensities Mediate the Association of Nocturnal Blood Pressure With Cognition.

We would like to thank Fisher et al. for their comment on our study1 and apologize for failing to cite their important paper2 in our work. We agree that white matter hyperintensity volumes in periventricular and deep regions are typically highly correlated, and we speculate that the reason we observed regional effects whereas Paganini-Hill and colleagues did not was due to age differences between our samples. White matter hyperintensities are typically more prominent in periventricular regions at early ages and become more diffuse with age.3 Our participants were, on average, 30 years younger than those included in the report of Paganini-Hill et al.; we may have captured the earliest white matter changes, which may have greater regional specificity in terms of their clinical correlates. We also agree that tract-specific analysis of white matter hyperintensities will provide greater insight into the effects of this damage on cognition, and recent work4,5 further supports this as a promising line of inquiry. In addition to the comment regarding the timing of hypertension medications, we would also emphasize that the frequency of ambulatory blood pressure measurements—particularly multiple times per hour6—plays an important role in the diagnostic value of these measurements, and further work is needed to determine the optimal number and overall timescale of ambulatory blood pressure assessment. Given the similar findings between our 2 groups, we concur that the use of nighttime blood pressure variability is an important marker of vascular health.

REPRODUCIBILITY AND DETERMINANTS OF DAYTIME AND NIGHTTIME BLOOD PRESSURE VARIABILITIES

Objective: Night-time blood pressure variability (BPV) has shown to have a greater predictive capacity than daytime BPV for adverse outcome. This has been attributed to a better reproducibility of BPV during sleep than during waking hours but studies comparing the two subperiods are lacking. Design and method: To compare the reproducibility of daytime and night-time short term BPV (Standard Deviation) and to identify the determinants of BPV we recorded 24-hour blood pressure (BP) twice 3 months apart in 1051 hypertensive subjects participating in the HARVEST study. BP was measured every 10 minutes during daytime and 30 minutes during night-time. Correlations were performed with Pearson test. Consistency was obtained by calculating the difference between baseline and repeat recording, disregarding the sign of the difference. Repeatability was defined as twice the standard deviation of the changes between the two repeated recordings. Results: Systolic BPV (mean of the 2 recordings) was higher during daytime (12.9 ± 3.2 mmHg) than during night-time (10.9 ± 3.2 mmHg). Independent predictors of daytime systolic BPV were smoking, mean daytime BP, pulse pressure, BP reaction to standing, nocturnal BP fall, white-coat effect, and physical activity habits (negative). Independent predictors of night-time systolic BPV were young age, smoking, mean night-time BP, pulse pressure, BP reaction to standing, nocturnal BP fall, and male gender. Small mean changes in systolic BPV were observed at repeat recording for both daytime and night-time BPV (−0.11 ± 3.8 mmHg and 0.3 ± 4.4 mmHg, respectively). A higher correlation was found between baseline and repeat measurement for daytime BPV than night-time BPV (0.47 vs 0.36, p = 0.002). Consistency was also better for daytime than night-time BPV (2.6 ± 2.8 vs 2.9 ± 3.3 mmHg, p = 0.007) as was repeatability (7.6 vs 8.8 mmHg, respectively). Similar results were obtained for diastolic BPV. Conclusions: Contrary to what is currently thought BPV, measured twice over a 3-month period, is more reproducible during waking hours than during sleep. Smoking, mean BP level, pulse pressure, BP reaction to standing, and nocturnal BP fall, are main determinants of both daytime and night-time BPVs. In addition, BP reactivity to stress is another strong contributor to daytime BPV.

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p&lt;0.0001-0.026). Conclusion. The main BPV indices are higher in patients with asthma and COPD, in comparison with CLAD-free hypertensive patients. ABPM is the most reliable method of BPV assessment in hypertensive patients with CLAD, according to our data. The increase in BPV is associated with irreversible airway obstruction and renal function. Adverse outcomes were associated with both nighttime BPV and nocturnal BP fall, as well as with rhythm disorders and leukocyte count as a marker of systemic inflammation. BPV in patients with CLAD warrants further investigation.

Abstract P317: Nocturnal Blood Pressure Variability is associated with hs-CRP in Hypertensive Patients

Background: 24-hr Blood pressure (BP) variability and high sensitivity C-reactive protein (hs-CRP) have been found to be independently associated with increased cardiovascular diseases (CVD). Studies have shown a positive association between hs-CRP and BP variability in hypertensive population. In particular, nocturnal BP variability is associated with increased risk for CVD. However, the relationship between inflammation and nocturnal BP variability has not been examined in hypertensive patients. Methods: In this prospective study, 237 hypertensive patients were recruited from University of Alabama at Birmingham Hypertension clinic. As part of the study protocol, hs-CRP and 24-hr ambulatory blood pressure monitoring (ABPM) was performed at same visit. Patients with chronic kidney disease and those who did not have complete ABPM and hs-CRP values were excluded. Nocturnal BP variability was assessed using standard deviation. Results: Out of 202 patients who were included, 49.0% were women and 55.9% were African American. The mean age was 58.2 ± 10.9 years, mean nighttime BP (Systolic BP 132.4 ± 22.9 mmHg and diastolic BP 71.9 ± 14.0 mmHg), mean nighttime BP variability (systolic BP 13.4 ± 5.3 and diastolic BP 9.9 ± 4.2) and mean hs-CRP was 5.9 ± 7.0 mg/L. Regression analysis showed significant positive association (p-value = 0.033) between nocturnal BP variability and hs-CRP. Conclusion: In this study, we demonstrated that hs-CRP is strongly correlated with nocturnal BP variability in hypertensive patients, suggesting a likely mechanistic role of inflammation in the pathogenesis of nocturnal BP variability and a possible additive role in adverse cardiovascular outcomes.

Greater nighttime blood pressure variability is associated with left atrial enlargement in atrial fibrillation patients with preserved ejection fraction.

Left atrial enlargement is an independent risk factor for ischemic stroke in patients with atrial fibrillation. Little is known regarding the association between nighttime blood pressure variability and left atrial enlargement in patients with atrial fibrillation and preserved ejection fraction. The study population consisted of 140 consecutive patients with atrial fibrillation (mean age 64 ± 10 years) with preserved ejection fraction (≥50%). Nighttime blood pressure was measured at hourly intervals, using a home blood pressure monitoring device. Nighttime blood pressure variability was expressed as the standard deviation of all readings. Left atrial volume index was measured using the modified Simpson's biplane method with transthoracic echocardiography. Multiple regression analysis indicated that nighttime mean systolic/diastolic blood pressure and its variability remained independently associated with left atrial enlargement after adjustment for age, sex, anti-hypertensive medication class, and left ventricular mass index (P < 0.01). When patients were divided into four groups according to nighttime blood pressure and its variability, the group with higher nighttime blood pressure and its variability had significantly larger left atrial volume than the group with lower nighttime blood pressure and its variability (46.6 ml/m2 vs. 35.0 ml/m2, P < 0.0001). Higher nighttime blood pressure and its variability are associated with left atrial enlargement. The combination of nighttime blood pressure and its variability has additional predictive value for left atrial enlargement. Intensive intervention for these high-risk patients may avoid or delay progression of left atrial enlargement and reduce the risk of stroke.

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain.

Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ⩾60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (P<0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-h but not daytime or night-time BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (P<0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (P<0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (P<0.001). In conclusion, 24-h BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.

Utilización de la monitorización ambulatoria de la presión arterial

Hypertension (HT) is the most important risk factor in the development of cardiovascular disease. Classically diagnosis and management have been based on conventional office blood pressure (BP) but it has as main limitation that only offers information of a particular time and presents multiple biases dependent on inherent variability of blood pressure and measurement technique itself. Ambulatory blood pressure monitoring (ABPM) consists of performing multiple measurement of blood pressure, performed automatically, outside the medical setting, during the normal activities of the individual and in a 24-hour period. Multiple studies have demonstrated the prognosis superiority in the development of cardiovascular disease of ABPM, it allows detection of white coat HT as well, avoiding overdiagnosis and overtreatment and the detection of patients with masked H T, who contrarily are at risk of underdetection and undertreatment. Also it provides nighttime BP and circadian variability that provides additional prognostic value. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

Night-time blood pressure variability negatively correlated with reactive hyperemia index

Hypertension is a definitive risk for cardiovascular events, and represents the leading risk factor for the overall global burden of disease [ [1] Lim S.S. Vos T. Flaxman A.D. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012; 380: 2224-2260 Abstract Full Text Full Text PDF PubMed Scopus (8597) Google Scholar ]. Recently, several types of blood pressure (BP) variability such as day-to-day, visit-to-visit, or seasonal have been evaluated [ [2] Rothwell P.M. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010; 375: 938-948 Abstract Full Text Full Text PDF PubMed Scopus (560) Google Scholar ]. BP variability within 24 h assessed by ambulatory BP monitoring (ABPM) is also reported to have independent prognostic value for cardiovascular events, especially with night-time BP variability [ [3] Palatini P. Reboldi G. Beilin L.J. et al. Added predictive value of night-time blood pressure variability for cardiovascular events and mortality: the ambulatory blood pressure-international study. Hypertension. 2014; 64: 487-493 Crossref PubMed Scopus (133) Google Scholar ]. However, the pathogenesis is poorly understood.

OS 07-05 DETERMINANTS OF MORNING BLOOD PRESSURE SURGE IN NORMOTENSIVE SUBJECTS AND UNTREATED HYPERTENSIVE PATIENTS

Objective: Morning blood pressure (BP) surge has been regarded as a predictor of adverse cardiovascular events. However, its determinants remain controversial and no previous studies have evaluated whether or not there is a difference in the determinants of morning BP surge between normotensive and hypertensive subjects. Design and Method: We included 476 normotensive subjects (mean age 52.8 ± 15.4 years, 49.2% males) and 1028 untreated hypertensive patients (age 51.7 ± 13.9 years, 56.1% males) from the Korean Ambulatory Blood Pressure Registry. Sleep-trough morning BP surge was defined as the difference between mean systolic BP (SBP) during the 2 hours after awakening and the average of three readings centered on the lowest sleep SBP level. Results: Hypertensive patients had higher sleep-trough morning BP surge compared to normotensive subjects (27.6 ± 17.8 mmHg vs 25.7 ± 13.7 mmHg, p = 0.023). In multivariate linear regression analysis, 24-hour heart rate (24-h HR) variability (β = 0.397, p < 0.0001) was associated with MS in normotensive subjects. Meanwhile, in hypertensive patients, age (β = −0.113, p = 0.046), diabetes mellitus (β = −0.109, p = 0.043), daytime SBP (β = 0.301, p < 0.0001), night-time SBP (β = −0.375, p < 0.0001), 24-h SBP variability (β = 0.290, p < 0.0001) and night-time diastolic BP (DBP) variability (β = 0.185, p = 0.001) were found to be independent determinants of morning BP surge. Conclusions: Morning BP surge was more pronounced in hypertensive patients than in normotensive subjects, and its determinants were also different between them. These findings suggest that different pathogenic mechanism of morning BP surge may exist in normotensive subjects and hypertensive patients, respectively.