Nighttime Systolic Blood Pressure Variability Research Articles

Associations between nocturnal continuous blood pressure fluctuations and the characteristics of oxygen desaturation in patients with obstructive sleep apnea: a pilot study

BackgroundPatients with obstructive sleep apnea (OSA) frequently experience apnea-related oxygen desaturation events (ODE) accompanied by striking blood pressure (BP) fluctuations during sleep. We aimed to investigate the effects of characteristics of ODE on nocturnal BP fluctuations in OSA patients. Methods and resultsA total of 6199 ODE were obtained from 30 patients with who underwent overnight portable monitoring and beat-to-beat BP monitoring simultaneously. The associations between nocturnal BP parameters and the characteristics of ODE were studied. The mean value of systolic BP (SBP) monitored during ODE was higher than the non-hypoxia SBP value (122.0 ± 15.9 vs. 120.4 ± 15.1 mmHg, P = 0.001) and nighttime SBP value (122.0 ± 15.9 vs. 120.8 ± 15.0 mmHg, P = 0.002). SBP variability (SBPV) during ODE was higher than the values not during ODE (14.0 ± 2.8 vs. 13.2 ± 2.6 mmHg, P = 0.043) and nighttime SBPV (14.0 ± 2.8 vs. 12.9 ± 2.3 mmHg, P < 0.001). Hypoxia SBP index, defined as the percentage of SBP surge (△SBP) ≥10 mmHg to all △SBP during ODE, increased with greater respiratory event index (P = 0.01). Both the coefficient of variation for SBP values of an ODE (SBPV′) and event-related SBP elevation (△SBP′) increased with raised amplitude of ODE (P < 0.001 for SBPV′ and P < 0.001 for △SBP′). Similar results were observed when the duration of events was analyzed (P < 0.001 for SBPV′ and P < 0.001 for △SBP′). ConclusionBP related to ODE may be the main component of increased BP during sleep in OSA patients. In addition to the frequency of respiratory events, the amplitude and duration of ODE may have a role in nocturnal BP fluctuations in OSA patients.

24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea.

To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA). Case series study. Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability. A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P=.002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P=.001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient=0.31, 95% CI=0.06-0.56, P=.015) after adjustment for age, gender, adiposity, and hypertensive status. OSA in children is associated with increased BP and BP variability. 4 Laryngoscope, 131:2126-2132, 2021.

A13994 Blood pressure variability and hypertensive target organ damage

Objectives: to investigate an impact of blood pressure variability (BPV) on heart and brain hypertensive damage in the middle-aged untreated patients with grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases. Methods: we examined 60 naive hypertensive patients (HP) with EAH and 44 sex- and age-matched healthy individuals. Comprehensive transthoracic echocardiography (Vivid 7 Dimension, GE) with 2D speckle tracking analysis and ambulatory blood pressure monitoring were performed in all participants. BPV was estimated as standard deviation. 41 HP underwent brain magnetic resonance imaging (MAGNETOM Skyra 3.0T, Siemens AG). Fazekas scale was used to quantify the amount of white matter hyperintensities (WMH). Results: nighttime systolic BPV (sBPV) and nighttime diastolic BPV (dBPV) were significantly (p < 0,001 for all) higher in HP (12,1 ± 0,1 vs. 9,3 ± 0,4 mmHg in controls and 9,8 ± 0,4 vs. 6,9 ± 0,3 mmHg in controls, respectively). Correlation analyses in HP revealed significant association of nighttime sBPV with left ventricular (LV) end-systolic elastance (r = −0,375; p < 0,01) and LV end-diastolic stiffness (r = −0,429; p < 0,01). Daytime dBPV significantly correlated with LV diastolic elastance (r = 0,265; p < 0,05), nighttime dBPV - with left atrial expansion index (r = −0,282; p < 0,05). WMH (Fazekas 1 and 2) were found in 53,7% HP patients. In HP with WMH 24 hours sBPV (19,7 ± 3,9 mmHg) and daytime sBPV (18,0 ± 4,5 mmHg) were significantly (p < 0,05 for all) higher compared to same parameters in HP without WMH (17,2 ± 3,3 and 15,7 ± 3,1 mmHg, respectively). Conclusion: middle-aged untreated patients with grade 1–2 uncomplicated EAH are different from the sex- and age-matched healthy individuals by higher nighttime BPV. BPV associated with heart and brain hypertensive organ damage.

Effects of Glucose and Blood Pressure Variability on Oxidative Stress in Type 2 Diabetes with Hypertension

Aims: This study was performed to evaluate the effects of glucose variability (GV) and blood pressure variability (BV) on oxidative stress in type 2 diabetes patients with hypertension. Methods: Fifty-seven inpatients with type 2 diabetes (studied from May 2015 to august 2017) underwent continuous glucose monitoring (CGM) and ambulatory BP monitoring (ABPM) in a cross-sectional study. The plasma total oxidant capacity against N,N-diethylparaphenylendiamine was measured as a marker of oxidative stress using the d-ROMs test. The GV, mean glucose level (MGL), mean amplitude of glycemic excursions (MAGE), and area under the postprandial plasma glucose curve (AUCPP) were measured by CGM. The BV, mean blood pressure (MBP), max blood pressure (MaxBP), minimum blood pressure (MinBP), and standard deviation of blood pressure (BPSD) during the systole (S) and diastole (D) were measured by ABPM over daytime (day), nighttime (night), and 24-hour (24) periods. Results: The 57 participants were 65.3±12.9 years old, with a disease duration of 14.7±12.4 years and HbA1c of 8.5±1.2 %. In univariate analysis, MAGE (r=0.446,p&amp;lt;0.001), night DBPSD (r=0.323,p=0.014), and eGFR (r=0.287, p=0.030) were significantly correlated with the d-ROMs. In the stepwise multiple regression analysis, MAGE (β=0.344, t=3.075, p=0.003), night DBPSD (β=0.230, t=2.034, p=0.047), eGFR (β=-0.234, t=-2.137, p=0.037), and smoking (β=0.315, t=2.873, p=0.006) were identified as independent factors contributing to the d-ROMs (multiple R2 = 0.363). Conclusions: Daily glucose variability and nighttime systolic blood pressure variability are associated with oxidative stress in type 2 diabetes with hypertension. Disclosure M. Ohara: None. H. Nagaike: None. T. Yamamoto: None. T. Hayashi: None. T. Fukui: None. T. Hirano: Speaker's Bureau; Self; Novo Nordisk Inc., AstraZeneca.

Metabolomic Profiling of Nonproteinogenic Amino Acids in Patients with Type 2 Diabetes and Hypertension

Introduction: Identifying the amino acid signature of increased blood pressure might help us understand hypertension pathophysiology. We aimed to investigate the relationship of non-proteinogenic amino acids with ambulatory blood pressure mean and variability in type 2 diabetes patients. Methods: Serum non-proteinogenic amino acids’ profiling was performed by high performance liquid chromatography coupled with mass spectroscopy analysis. Blood pressure variability was calculated as standard deviation of mean systolic and diastolic blood pressure evaluated over 24-hour ambulatory monitoring. Results: The study population consisted of type 2 diabetes hypertensive patients (n=80), 58% women, aged 59.8±7.7 years old with diabetes duration 9.0±8.7 years. Serum non-proteinogenic amino acids levels (nmol/mL) were: gamma-aminobutyric acid 0.2±0.1, aminoisobutyric acid 22.6±7.9, beta-aminoisobutyric acid 1.2±0.7, 4-hydroxyproline 12.2±9.9, 3-methylhistidine 4.7±2.8, alpha-aminoadipic acid 1.0±0.5, sarcosine 11.3±5.6. In linear regression analysis, aminoisobutyric acid was significantly associated with 24-hour systolic blood pressure variability (r=0.23; p=0.044), sarcosine was significantly associated with nighttime systolic blood pressure variability (r=0.27; p=0.017), while beta-aminoisobutyric acid was significantly associated with mean daytime (r=-0.25; p=0.024) and 24-hour (r=-0.24; p=0.032) diastolic blood pressure. Conclusion: Serum metabolomes aminoisobutyric acid and sarcosine directly associated with ambulatory systolic blood pressure variability, while beta-aminoisobutyric acid inversely associated with mean diastolic blood pressure. Our results indicate changes in serum non-proteinogenic amino acids as consequences of increased blood pressure that should be further evaluated in connection to cardiovascular disease, particularly in the presence of type 2 diabetes. Disclosure D.M. Ciobanu: Other Relationship; Self; Sanofi, AstraZeneca, Merck Sharp &amp; Dohme Corp., Eli Lilly and Company, Merck KGaA. C.G. Bala: Consultant; Self; Sanofi, AstraZeneca. G. Roman: None.

INFLUENCE OF HEART RATE AND HEART RATE VARIABILITY TO BLOOD PRESSURE LEVEL AND VARIABILITY

Objective: To analyze influence of heart rate and heart rate variability to blood pressure level and fluctuations. Design and method: 65 patients (63,1 ± 7,7 years old) with permanent artificial pacemaker (VVI) were examined. All of them had fixed ventricle rate thus no heart rate variability. Control group include 49 patients (63,8 ± 3,7 years old) with sinus rhythm and normal heart rate variability. The main and control groups were divided to subgroups of patients with and without arterial hypertension. 24-hour ambulatory blood pressure monitoring was done in all cases at baseline. In patients with artificial pacemaker we repeated ambulatory blood pressure monitoring after ventricle rate reduction by 10–15 beats per minute at night (31 patient) or for 24 hours (34 patients). Results: Arterial hypertension was accompanied by elevated daytime and night-time systolic blood pressure variability in persons with sinus rhythm as well as in patients with artificial pacemaker (p < 0,01). The nigh-to-day systolic (p < 0,05) and diastolic (p < 0,01) blood pressure ratio and blood pressure variability at night (p < 0,001) were lower in patients with arterial hypertension and artificial pacemaker (no heart rate variability) then in hypertensive persons with sinus rhythm. In patients with fixed ventricle rate nigh-to-day ratio was low (1,9 ± 6,0% for systolic blood pressure and 1,3 ± 7,2% for diastolic blood pressure). Ventricle rate reduction by 10–15 beats per minute at night-time led to diastolic blood pressure lowing and improved nigh-to-day diastolic blood pressure ratio (9,5 ± 6,0%, p < 0,001). Permanent heart rate reduction from 70 to 55 or from 75 to 60 beats per minute for 24-hour in patients with artificial pacemaker was accompanied by diastolic blood pressure lowing at daytime (p < 0,001) and night-time (p < 0,01). Conclusions: Fixed ventricle rate (absence of heart rate variability) in patients with arterial hypertension leads to low blood pressure variability and low night-to-day blood pressure ratio. Ventricle rate reduction in patients with artificial pacemaker accompanies by lowering of diastolic blood pressure.

MPS 10-06 Seasonal variations of 24-hour ambulatory blood pressure and blood pressure variability in the young and elderly essential hypertensive patients

Objective: Seasonal blood pressure (BP) changes has been described in clinic BP. Few studies have examined the seasonal variation in BP and BP variability, assessed by 24-hour ambulatory blood pressure monitoring (ABPM) and it remains uncertain whether the seasonal trend differs between young and elderly hypertensive patients. Design and Method: A total of 1028 untreated essential hypertensive patients (mean age 52 ± 14 years) who underwent 24-hour ABPM between January 2009 and April 2013 were enrolled. Patients were divided into young (age ≤ 70 years, n = 927) and elderly (age > 70 years, n = 101) groups. Results: Compared to elderly group, young age group had higher clinic, 24-hour, daytime and night-time diastolic BP (DBP), higher clinic, 24-hour and daytime heart rate (HR), higher 24-hour and daytime HR variability (HRV), lower night-time systolic BP (SBP) and daytime SBP variability. In young age group, significant seasonal variation of clinic DBP and daytime SBP variability with a peak in autumn, and nighttime DBP and HR with a peak in spring and the increased prevalence of non-dippers in summer were observed. On the other hand, elderly group demonstrated seasonal variation of clinic, 24-hour, daytime and nighttime HR with a peak in autumn, daytime DBP with a peak in winter and night-time SBP variability with a peak in summer. Conclusions: There was an apparent seasonal variation of DBP, HR and SBP variability in both young and elderly hypertensive patients. However, elderly patients showed more pronounced seasonal change in HR compared to younger patients.

Influence of blood pressure variability on early carotid atherosclerosis in hypertension with and without diabetes.

Carotid intima-media thickness (IMT) has been one widely used index of early carotid atherosclerosis. We speculated that the influence of blood pressure variability (BPV) on early carotid atherosclerosis may be varied by the location of the carotid artery and diabetes history. Thus, the goal of this study was to evaluate the effects of BPV on early arteriosclerosis progression in different segments of the carotid artery for hypertension with and without diabetes.A total of 148 hypertension patients who underwent 24 hours ambulatory blood pressure (BP) monitoring and carotid ultrasonography were enrolled in this study. Of them, 84 subjects were without diabetes, and 64 subjects were with diabetes. Short-term BPV during daytime, nighttime, and over 24 hours were evaluated through standard deviation (SD) and average real variability (ARV). We measured carotid IMT at left and right common carotid artery (CCA), carotid bulb, and the origin of the internal carotid artery (ICA). The associations between segment-specific measurements of carotid IMT and 24 hours ambulatory BPV were analyzed.We found that IMT at the common carotid artery (CCA-IMT) and IMT at the internal carotid artery (ICA-IMT) were more closely associated with BPV than was carotid bulb IMT. In addition, for all subjects, BPV was clearly associated with left CCA-IMT but not with right CCA-IMT. Furthermore, in diabetes patients, nighttime systolic BPV was independently related to mean CCA-IMT (P < 0.01) and mean bulb IMT (P < 0.01). In contrast, in nondiabetes patients, daytime and 24 hours systolic BPV was positively associated with mean CCA-IMT (P < 0.05), but not independent after adjusting for baseline characteristics such as age and sex.The findings of our study indicate a segment-specific association between carotid IMT and 24 hours ambulatory BPV, and the associations also vary according to the diabetes history. We conclude that BPV plays a distinct role in early carotid arteriosclerosis progression within different segments of the carotid artery, especially for the hypertensions with and without diabetes.

PP.03.26

Objective: Blood Pressure Variability (BPV) is a novel marker of cardiovascular risk and a significant contributor to target-organ-damage for hypertensive patients. The aim of the study was to investigate the relation between short-term BPV, expressed as Standard Deviation (SD) and assessed by noninvasive 24-hour Ambulatory Blood Pressure Monitoring (ABPM), and the number of oral antihypertensive drugs used, as an index of difficulty in controlling essential hypertension. Design and method: 64 hypertensive patients (mean age 59.8 ± 10.2 years, 42 women) underwent 24-hour ABPM and blood sample testing, and their medicinal history was recorded. 30 hypertensive patients were uncontrolled and 34 were well-controlled. 28.1% of patients received monotherapy, 29.7% received two-drug therapy, 18.8% received at least three-drug therapy, while 23.4% were newly diagnosed hypertensives and did not receive any medication. Daytime, nighttime and 24 h BP and BPV, both systolic and diastolic, were measured for the patients under none (D0), one (D1), two (D2) or three or more (D3) antihypertensive drugs. ANOVA statistical test between groups was performed (by SPSS 19). Results: 32.8% of patients were on ACE-inhibitors, 31.3% on ARB, 39.1% on CCB, 20.3% on diuretic and 28.1% on b-blocker. Mean 24 h systolic BP was 129.8 ± 13.8 mmHg, mean 24 h diastolic BP was 74.3 ± 8.1 mmHg, mean daytime systolic BP was 133.9 ± 14.3 mmHg, mean daytime diastolic BP was 77.4 ± 8.6 mmHg, mean nighttime systolic BP was 121.7 ± 16.5 mmHg and mean nighttime diastolic BP was 68.2 ± 9.5 mmHg. Statistical differences between groups were recorded regarding daytime diastolic BPV (D0 = 6.33 ± 2.2, D1 = 7.50 ± 2.2, D2 = 6.26 ± 1.9, D3 = 8.83 ± 1.9, p = 0.005), nighttime systolic BPV (D0 = 9.67 ± 4.0, D1 = 8.44 ± 3.4, D2 = 10.32 ± 2.7, D3 = 12.3 ± 3.6, p = 0.030) and nighttime diastolic BPV (D0 = 7.07 ± 3.0, D1 = 6.33 ± 2.2, D2 = 6.74 ± 1.9, D3 = 9.00 ± 3.1, p = 0.042). The D3 group developed constantly higher BP and BPV compared with the rest of the groups, regarding systolic and diastolic and daytime, nighttime and 24 h ABPM measurements respectively. Conclusions: These findings suggest that BPV is a vital component of the difficulty in controlling essential hypertension particularly in patients that need at least a three-drug combination therapy for achieving normal BP values.

Blood Pressure Variability and Neurological Improvement on Acute Ischemic Stroke Patients

Background: Several studies have confirmed the relationship between systolic blood pressure variability (BPV) and target organ damage, but only few studies have investigated the relationship between systolic BPV and neurological improvement on acute ischemic stroke patient. Objective: Define the correlation between systolic BPV and neurological improvement on acute ischemic stroke patients Methods: We recruited patients with acute ischemic stroke at Atma Jaya Hospital, North Jakarta, Indonesia. Systolic blood pressure (SBP) for every patient is taken 4 times a day (04.00, 11.00, 16.00, 23.00) on first three days of hospitalization. Variability of SBP is calculated as Standard Deviation (SD) of each patient's blood pressure. Neurological improvement is defined as at least a four score increase on National Institute of Health Stroke Scale (NIHSS) at discharge. We use chi square to determine the relationship between variability of daytime systolic pressure (11.00, 16.00) and nighttime systolic pressure (04.00, 23.00) with neurological improvement. Results: A total of thirty-four patients were included with twelve patients (35,3%) fulfilled the criteria for neurologic improvement. Age, sex, length of stay (LOS), and hypercholesterolemia were not associated with neurological improvement (P > 0.05). There is no significant relationship between systolic BPV and neurological improvement on acute ischemic stroke patients (P > 0.05). There is, however, a tendency of a significant relationship between nighttime systolic BPV and neurological improvement (P = 0.121) Conclusion: There is no significant relationship between systolic BPV and neurological improvement on acute ischemic stroke patients while hospitalized.

Ambulatory blood pressure as a predictor of diabetic nephropathy

Objective: The aim was to study the ambulatory blood pressure as a predictor of diabetic nephropathy (DN). Materials and Methods: A total of 73 patients with DN at Stage III were selected as DN group and 73 cases with 5-10 years of diabetes were as diabetes group. The results of blood routine, biochemical indexes, dynamic blood pressure and the diversity index, which as the predictors of DN, analyzed by multivariate logistic regression analysis and compared between two groups. Results: Body mass index, the dose of oral glucose (GLU)-lowering drugs, the levels of fasting plasma GLU, HbA1c, total cholesterol, triglyceride, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and high-sensitivity C-reactive protein index had no statistically significant difference in two groups in the course of the disease. There were significant differences in peripheral blood leukocyte count, platelet count, erythrocyte sedimentation rate, uric acid, estimated glomerular filtration rate, average daytime systolic blood pressure (SBP), average nighttime SBP, average daytime diastolic blood pressure (DBP), average night DBP, 24 h SBP variability, daytime SBP variability and nighttime SBP variability between the two groups. In univariate analysis, we found that platelet count ( P = 0.03), average night DBP ( P = 0.01), nighttime SBP variability ( P Conclusion: Platelet count, average diastolic pressure and SBP at night are the independent predictors of DN.

Influence of HbA1c on short-term blood pressure variability in type 2 diabetic patients with diabetic nephropathy

The aim of this study was to understand the characteristics of blood pressure (BP) variability in subjects with diabetic nephropathy (DN), and identify the probable predictors affecting BP variability. Fifty-one chronic kidney disease (CKD)-hypertensive patients without diabetes (NDN group) and sixty type 2 diabetic patients with overt DN (DN group) were enrolled in this study. The values of short-term BP variability were obtained from 24 h ambulatory BP monitoring (ABPM). Variance analysis or nonparametric analysis revealed that 24-h systolic BP variability and nighttime systolic BP variability of the DN group were significantly higher than those of the NDN group [(12.23±3.66) vs. (10.74±3.83) mmHg, P<0.05; (11.23±4.82) vs. (9.48±3.69) mmHg, P<0.05]. Then the patients of the DN group were divided into two groups according to glycated hemoglobin (HbA1c) level: Group A (HbA1c<7%) and Group B (HbA1c≥7%), and the t-test showed that patients in Group B had larger 24-h diastolic, daytime diastolic, and nighttime systolic/diastolic BP variability compared with Group A. In the DN group, partial correlation analysis revealed that HbA1c exhibited a strong association with 24-h diastolic, daytime diastolic, nighttime systolic and diastolic BP variability (P<0.001, P<0.001, P<0.05, and P<0.001, respectively). Taken together, larger short-term BP variability was detected in hypertensive type 2 diabetic patients with overt nephropathy and renal insufficiency. It may imply that the optimal BP variability level could benefit from a better glycaemic control.

Addition of Aliskiren to Angiotensin Receptor Blocker Improves Ambulatory Blood Pressure Profile and Cardiorenal Function Better than Addition of Benazepril in Chronic Kidney Disease

An altered ambulatory blood pressure (BP) and heart rate (HR) profile is related to chronic kidney disease (CKD) and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18) or the benazepril add-on group (n = 18). Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment. Compared with the benazepril group, nighttime systolic BP variability in the aliskiren group was lower after treatment. Albuminuria was decreased in the aliskiren group, but not in the benazepril group. In addition, left ventricular mass index (LVMI) was significantly lower in the aliskiren group than in the benazepril group after treatment. In the aliskiren group, multivariate linear regression analysis showed an association between changes in albuminuria and changes in nighttime systolic BP. Furthermore, there were associations between changes in LVMI and changes in daytime HR variability, as well as between changes in LVMI and changes in plasma aldosterone concentration. These results suggest that aliskiren add-on therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles.

Ambulatory Blood Pressure Monitoring in Older Nursing Home Residents: Diagnostic and Prognostic Role

Older subjects living in nursing homes (NHs) show a high prevalence of multimorbidity, disability, and cognitive impairment. The clinical meaning of arterial hypertension (AH) in this population is unclear, and few studies have adopted ambulatory blood pressure monitoring (ABPM) with this purpose. The aims of the study were to evaluate the concordance between office and monitored blood pressure in a sample of NH residents and to assess the prognostic meaning of ABPM parameters after 1 year. NH residents underwent a comprehensive geriatric assessment and 24-hour ABPM (Spacelabs 90207). White-coat hypertension (WCH) was defined as office blood pressure of 140/90 or higher and ABPM lower than 135/85 mm Hg. Vital status was assessed after 1 year. A total of 100 residents (mean age 83, 51% affected by AH) showed WCH in 33% of cases and in 70% of cases elevated office blood pressure. Correlation between monitored and office blood pressure was limited for systolic (R = 0.30) and nonsignificant for diastolic blood pressure (R = 0.11). Disability and behavioral disorders were independently associated with 1-year mortality. No ABPM parameter, except low nighttime systolic blood pressure variability, was associated with 1-year mortality. Concordance between office and ABPM values is limited, and WCH prevalence is high among NH residents. Survival at 1-year follow-up is predicted by disability and behavioral disorders, but is not associated with blood pressure values.

Relationship between ambulatory blood pressure and aortic arch atherosclerosis

ObjectiveAtherosclerotic plaque in the aortic arch is an independent risk factor for ischemic stroke. Although high blood pressure (BP) measured at the doctor's office is known to be associated with aortic atherosclerosis, little is known on the association between 24-h ambulatory BP and aortic arch plaque presence and severity. Our objective was to clarify the association between ambulatory BP variables and aortic arch atherosclerosis in a community-based cohort. MethodsThe study population consisted of 795 patients (mean age 71±9 years) participating in the Cardiovascular Abnormalities and Brain Lesions (CABL) study who underwent 24-h ambulatory BP monitoring (ABPM). Arch plaque was evaluated by 2D transthoracic echocardiography from a suprasternal window. ResultsAll systolic ABPM variables (24-h/daytime/nighttime mean systolic BP, daytime/nighttime systolic BP variability) were associated with the presence of any plaque and large (≥4mm) plaque, whereas diastolic BP variables were not associated with aortic atherosclerosis. Multiple regression analysis indicated that nighttime systolic BP variability (expressed as the standard deviation of nighttime systolic BP) remained independently associated with large plaque after adjustment for age, sex, cigarette smoking, history of hypertension, diabetes mellitus, hypercholesterolemia, anti-hypertensive medication and nighttime mean systolic BP (odds ratio 1.39 per 1 standard deviation increase, 95% CI 1.00–1.93, P<0.05). ConclusionSystolic ABPM variables are significantly associated with the presence of arch plaque. Nighttime systolic BP variability is independently associated with large arch plaque. These findings may have important implications in gaining further insights into the mechanism of arch plaque formation and progression.

Arterial stiffness and 24 h ambulatory blood pressure monitoring in young healthy volunteers: The early vascular ageing Aristotle University Thessaloniki Study (EVA–ARIS Study)

Differences in 24h blood pressure (BP) monitoring parameters such as average 24h BP, day to night BP ratio and BP variability could have an impact in arterial stiffness. The study hypothesis was that despite similar average BP values in ambulatory blood pressure monitoring subjects with increased 24h BP variability may have increased arterial stiffness.The study population consisted of 115 consecutive young healthy volunteers. Carotid–femoral PWV was measured in all subjects. Clinic BP was measured and an appropriate cuff was fitted on the non-dominant arm of each subject for a 24h ambulatory blood pressure monitoring session. Waist to hip ratio as well as BMI was measured. Family history and smoking habits were recorded. In univariate analysis, estimated carotid–femoral PWV showed a significant correlation with age, weight, waist circumference, height, clinic systolic and diastolic BP, 24-h systolic and diastolic BP, 24-h pulse pressure, 24-h systolic and diastolic BP variability, daytime systolic and diastolic BP, daytime pulse pressure, daytime systolic and diastolic BP variability, nighttime systolic BP, nighttime pulse pressure and nighttime systolic BP variability. In multivariate regression analysis, age (B=0.95, P<0.001) and 24h systolic BP variability (B=0.28, P<0.001) were independent determinanats of arterial stiffness.In conclusions, increased 24h systolic BP variability is associated with arterial stiffness in young healthy volunteers. Pulse wave velocity in a young healthy population is useful to identify determinants of premature arterial stiffness, thus further elucidating the aspects of early vascular ageing.

Blood Pressure Variability As Well As Blood Pressure Level is Important for Left Ventricular Hypertrophy and Brachial-Ankle Pulse Wave Velocity in Hypertensives

Blood pressure (BP) variability is calculated as the standard deviation of ambulatory BP. Blood pressure variability is associated with the cardiovascular morbidity; however whether it is related to target organ damage is controversial. In this study we examined a possible relationship between the BP variability and left ventricular hypertrophy (LVH), and between BP variability and brachial-ankle pulse wave velocity (baPWV). The present study was conducted on 111 consecutive Japanese hypertensive patients who were hospitalized for the educational program in our hospital under stable sodium chloride intake (6 g/day). Blood pressure measurements were at 30-minute intervals all day. In a multivariable analysis adjusted with confounding factor, LVH was associated with 24-hour systolic BP (SBP), 24 hour diastolic BP (DBP), daytime SBP, daytime DBP, nighttime SBP, and nighttime DBP. Additionally, nighttime DBP variability was related to LVH. By the same method, baPWV as a dependent variable was related to 24-hour SBP and nighttime SBP. Furthermore, nighttime SBP variability was concerned with baPWV. The LVH was associated with not only BP level but also with nighttime DBP variability. The baPWV was also related not only to BP level but also to nighttime SBP variability.

Identification of an Increased Short-Term Blood Pressure Variability on Ambulatory Blood Pressure Monitoring as a Coronary Risk Factor in Diabetic Hypertensives

We examined risk factors for coronary heart disease (CHD) by ambulatory blood pressure (BP) monitoring in 72 diabetic hypertensives who were hospitalized for the educational program. The patients were divided into two groups (CHD group, 19 subjects; and non-CHD group, 53 subjects) along with or without co-existing CHD. On ambulatory BP monitoring, no significant differences were found between the groups regarding BP values through the day. However, the CHD group had a significantly grater BP variability than non-CHD group. The result of logistic regression analysis demonstrated that nighttime systolic BP variability was an independent risk factor for CHD.

Ambulatory blood pressure, blood pressure variability and the prevalence of carotid artery alteration: the Ohasama study

To investigate the association between ambulatory blood pressure (BP) variables (level, short-term variability, circadian variation and morning pressor surge) and carotid artery alteration in a general population. We measured ambulatory BP every 30 min in 775 participants (mean age 66.2 +/- 6.2 years, 68.8% women) from the Japanese general population. Short-term BP variability during the daytime and night-time were estimated as within-subject standard deviation of daytime and night-time BP, respectively. Circadian BP variation was calculated as the percentage decline in nocturnal BP. Morning pressor surge was defined as morning BP minus pre-waking BP. The extent of carotid artery alteration was evaluated as the average of common carotid intima-media thickness (IMT) and the presence of focal carotid plaque. Daytime and night-time BP values were more closely associated with carotid artery alteration than casual BP. With mutual adjustment for daytime and night-time BP, the latter (P < 0.0001) was more closely associated with IMT, which represents diffuse arterial thickening and arteriosclerosis, than daytime BP (P = 0.2). Night-time systolic BP variability was positively associated with carotid plaque (focal atherosclerotic lesions) independently of possible confounding factors, including night-time systolic BP (P = 0.01). A diminished nocturnal decline in systolic BP was associated with a greater IMT after adjustment for confounding factors (P = 0.03). A morning pressor surge was not associated with carotid artery alteration. Ambulatory BP levels and BP variability were closely associated with carotid artery alteration, suggesting that these parameters are independent risk factors or predictors of carotid artery alteration.

Blood pressure variability in children with essential hypertension

The aim of this study was to assess blood pressure variability (BPV) and its determinants in untreated hypertensive children. The study group consisted of 124 children, 91 boys and 33 girls, aged 14.9+/-2.5 with essential hypertension and no use of antihypertensive drugs. The subjects underwent routine examination, blood tests and ambulatory blood pressure (BP) monitoring. BPV was defined as the value of the standard deviation of BP for day- and night time periods. Daytime BPV was higher than night time BPV, and systolic BPV was higher than diastolic BPV. Significant positive correlations between 24-h, day- and night time systolic blood pressure (SBP), but not for diastolic blood pressure (DBP), and BPV were observed. In univariate analysis, day- and night time systolic BPVs were correlated with fasting glucose (r=0.609, P=0.02 and r=0.439, P=0.04); daytime systolic BPV, daytime diastolic BPV and night time systolic BPV were correlated with birth length (r=0.428, P=0.04; r=0.426, P=0.04 and r=0.439, P=0.04, respectively), and night time systolic BPV and night time diastolic BPV were correlated with age (r=0.604, P=0.02 and r=0.833, P=0.0001). However, in multiple linear regression analysis, daytime diastolic BPV was determined only by gender and systolic 24-h BP; night time systolic BPV depended on age, daytime SBP and DBP values, and daytime SBP and DBPs were determinants of night time diastolic BPV. The results highlighted the complex nature of BPV, with favourable role of host factors in its aetiology. The determinants of BPV in children are consistent with those in adults. Relationships between BPV and its determinants in untreated hypertensive subjects ought to be investigated in further researches.