Coefficient Of Variation Of Systolic Blood Pressure Research Articles

The impact of blood pressure variation on mortality and symptomatic intracerebral hemorrhage in acute stroke patients after thrombolysis.

Blood pressure variation (BPV) is a known risk factor for unfavorable stroke outcomes. However, little is known about the association between BPV and short-term outcomes in stroke patients after receiving thrombolytic therapy, namely, recombinant tissue plasminogen activator (rt-PA). We conducted a cross-sectional study in the specialized stroke unit of a tertiary-level hospital. Stroke patients who were eligible for rt-PA were enrolled. Blood pressure (BP) was measured every 4 h for 24 h. The SD, coefficient of variation (CV) and successive variation (SV) of both SBP and DBP were calculated. The final outcomes were symptomatic intracerebral hemorrhage (sICH) or in-hospital death from neurologic complications. A total of 278 patients (49.6% men) were enrolled, mean age was 65 years. The final outcomes were reported in 33 patients (11.9%). All systolic and diastolic BPV profiles were associated with the final outcome. Odds ratios (95% confident interval) were SD, 1.07 (1.02-1.13); CV, 1.10 (1.03-1.18) and SV, 1.05 (1.01-1.09) for SBP, and SD, 1.10 (1.02-1.19); CV, 1.08 (1.01-1.16) and SV, 1.09 (1.02-1.15) for DBP. After adjustment for conventional risk factors, SD, CV and SV of SBP, and SD and SV of DBP were still significantly associated with the final outcome. In conclusion, in-hospital systolic (SD, SV and CV) and diastolic (SV, SD) BPV profiles were associated with death and sICH in stroke patients after rt-PA therapy.

Prognostic significance of day-by-day in-hospital blood pressure variability in COVID-19 patients with hypertension.

Hypertension is the most common comorbidity in patients with coronavirus disease 2019 (COVID‐19) and increases in‐hospital mortality. Day‐by‐day blood pressure (BP) variability (BPV) is associated with clinical outcomes in hypertensive patients. However, little information is available on the association of BPV with the outcomes of COVID‐19 patients with hypertension. This study aimed to demonstrate whether day‐by‐day in‐hospital BPV had prognostic significance in these patients. The authors included 702 COVID‐19 patients with hypertension from Huoshenshan Hospital (Wuhan, China), who underwent valid in‐hospital BP measurements on at least seven consecutive days. Day‐by‐day BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM). Overall, patients with severe COVID‐19 and non‐survivors had higher BPV than moderate cases and survivors, respectively. Additionally, higher BPV was correlated with greater age and higher levels of C‐reactive protein, procalcitonin, high‐sensitive cardiac troponin I, and B‐type natriuretic peptide. In multivariable Cox regression, SD of systolic BP (SBP) was predictive of mortality [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.05–1.30] as well as acute respiratory distress syndrome (ARDS) (HR 1.09, 95% CI 1.01–1.16). Similar trends were observed for CV and VIM of SBP, but not indices of diastolic BP variability. The authors demonstrated that day‐by‐day in‐hospital SBP variability can independently predict mortality and ARDS in COVID‐19 patients with hypertension. And high BPV might be correlated with severe inflammation and myocardial injury. Further studies are needed to clarify whether early reduction of BPV will improve the prognosis of these patients.

Abstract WP134: Association Between Hyperacute Blood Pressure Variability And Hematoma Expansion In Patients With Intracerebral Hemorrhage: Secondary Analysis Of The Field Administration Of Stroke Therapy - Magnesium Database

Background: Blood pressure variability (BPV) has emerged as a significant factor associated with clinical outcomes after intracerebral hemorrhage (ICH). While hematoma expansion (HE) is also associated with clinical outcomes, the relationship between BPV and HE has not been established. In this secondary database analysis, we aim to describe the association between BPV and HE. We hypothesized that BPV was positively associated with HE. Methods: Among 1,690 enrolled in the NIH-funded Field Administration of Stroke Therapy - Magnesium (FAST-MAG) study, 268 patients sustained ICH and received repeat CT or MRI head imaging within 6 to 48 hours of arrival. BPV was calculated by standard deviation (SD) and coefficient of variation (CV) of the hyperacute, prehospital data using the systolic blood pressure (SBP) measurements taken on ED arrival, 15min-post maintenance infusion start, 1-hour post maintenance infusion start, 4-hours after ED arrival. HE was defined by hematoma volume expansion greater than 6ml. Multivariate logistic regression was used for presence of HE in quintiles of SD and CV of SBP. Results: Of the 268 patients from the FAST-MAG study who had follow up head imaging, 116 (43%) had HE. Proportions of patients with HE was not statistically significant in the higher quintiles of the SD and CV of SBP for either hyperacute or acute period. Conclusions: HE was not found to be associated with higher quintiles of BPV using SD and CV of SBP in the hyperacute or the acute period. Expanded inclusion criteria or new statistical markers for BPV incorporating temporality for SBP could help in future studies.

Association of Circulating Osteoprotegerin Level with Blood Pressure Variability in Patients with Chronic Kidney Disease.

Circulating osteoprotegerin (OPG) is a biomarker for cardiovascular complications that are closely related to chronic kidney disease (CKD). To investigate the association between circulating OPG level with long-term visit-to-visit blood pressure variability (BPV) in patients with pre-dialysis CKD, a total of 1855 subjects with CKD from stage 1 to pre-dialysis stage 5 from a prospective cohort were analyzed. Long-term visit-to-visit BPV was determined by average real variability (ARV), standard deviation (SD), and coefficient of variation (CoV) of systolic and diastolic blood pressure (SBP and DBP). ARV of SBP (Adjusted β coefficient 0.143, 95% confidence interval 0.021 to 0.264) was significantly associated with serum OPG level. Although SD and CoV of SBP were not significantly associated with serum OPG level in multivariate linear regression analyses, restricted cubic spline visualized the linear correlation of serum OPG level with all of ARV, SD, and CoV. The association between serum OPG level and DBP variability was not significant. Subgroup analyses revealed that the association of serum OPG with BPV is more prominent in the subjects with Charlson comorbidity index ≤3 and in the subjects without history of diabetes mellitus. In conclusion, circulating OPG level is potentially associated with long-term visit-to-visit BPV in patients with pre-dialysis CKD.

The relationship between day-to-day variability in home blood pressure measurement and multiple organ function.

Blood pressure variability (BPV) is associated with the prognosis of cardiovascular diseases. However, it is unclear how BPV is related to various organs. The aim of this study is to investigate the association between BPV and multiple organ functions. A total of three hundred fifteen participants (114 males; mean age: 70 ± 9 years) participated in a community health checkup held in Tarumizu City. Home blood pressure (BP) was measured using a HEM-9700T (OMRON Healthcare, Kyoto, Japan). Day-to-day BPV was evaluated by the coefficient of variation (CV) of home BP measured in the morning for one month. N-terminal pro B-type natriuretic peptide (NT-pro BNP) and high-sensitivity (hs-)troponin T were measured as cardiac biomarkers. Liver stiffness and renal function were evaluated using the Fibrous-4 (Fib4) index and estimated glomerular filtration rate (eGFR), respectively. NT-pro BNP and hs-troponin T were divided by the median value. Fib4 index greater than 2.67 and eGFR less than 60 mL/min/1.73 m2 were defined as high Fib4 index and low eGFR, respectively. In a multivariable logistic regression analysis, the CV of systolic BP was significantly associated with high NT-pro BNP, high Fib 4 index, and low eGFR, but not with high hs-troponin T. In contrast, the CV of diastolic BP was not associated with low eGFR, and the other three biomarkers had the same results as systolic BP. In conclusion, day-to-day BPV of systolic BP is independently associated with NT-pro BNP, eGFR, and Fib4 index, but not with hs-troponin T. In contrast, diastolic BPV was not found to be associated with eGFR.

Relationship between year-to-year blood pressure variability and target organ damage in the general population

Abstract Background/Introduction Visit-to-visit blood pressure variability (BPV) is a strong predictor of cardiovascular events as well as target organ damage (TOD) in hypertension. However, effects of year-to-year BPV on the development of TOD have not been investigated in the general population. Purpose The present study was designed to investigate a possible relationship between year-to-year BPV and TOD in the general population. Methods Consecutive 5542 subjects (male=3771, 58.6±10.7 yea-old) who visited our hospital for an annual physical check-up for 5 years in a row during 2008 and 2013 were enrolled. The average, standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic blood pressure (SBP) were calculated using data during the period. Other baseline data were obtained in 2013; left ventricular hypertrophy (LVH; Sokolow-Lyon voltage >3.8 mV and/or Cornell product >2440 mm ms) and kidney impairment (estimated glomerular filtration rate; eGFR<60) were taken as TOD. Then, subjects without TOD at baseline (2013) (n=3801, male=2584, 57.4±10.4 yea-old) were followed up until 2019 (median = 5 years) and the impact of BPV on the development of TOD was investigated. Results The average, SD, CV and ARV of SBP were 123.8 mmHg, 8.04 mmHg, 6.50%, and 9.19 mmHg, respectively. At baseline, these parameters were higher in subjects with TOD than those without TOD (Table 1-A). During the follow-up of subjects without TOD at baseline, LVH and kidney impairment developed in 425 and 623 subjects (24.7 and 35.8 per 1000 person-year), respectively. In retrospective analysis, the average, SD, and ARV were higher in subjects with than without future TOD (Table 1-B). Although some indices of year-to-year BPV predicted future development of TOD in univariate Cox-hazard analysis, only the average of SBP predicted incident TOD after adjustment. Conclusions Year-to-year BPV is a marker of the incident TOD in the general population. However, these indices do not independently predict the onset of TOD and, thus, there may be unknown pathway that links TOD and BPV. Funding Acknowledgement Type of funding sources: None. Table 1. BP variability and TODTable 2. Cox-hazard analyses

Reduced resting beat‐to‐beat blood pressure variability in multiple sclerosis

Multiple Sclerosis (MS) is an autoimmune disease associated with central nervous system demyelination known to impair healthy autonomic function. We have previously demonstrated individuals with MS exhibit lower resting muscle sympathetic nerve activity and impaired carotid baroreflex control of arterial blood pressure compared to controls. Recently, increased resting beat-to-beat blood pressure variability (BPV) has been shown to be a strong predictor of cardiovascular risk in other clinical populations. Taken together, the aim of the current investigation was to test the hypothesis that resting beat-to-beat BPV is increased in individuals with MS compared to matched healthy controls. In 7 patients with relapsing-remitting MS (5 females/2 males, EDSS <4) and 7 sex-, age-, and weight-matched healthy controls, beat-to-beat blood pressure (Finometer) was recorded during 10 minutes of quiet supine rest. Individuals with MS had similar resting mean blood pressure (BP) compared to healthy controls (P= 0.736), however the BP standard deviation (SD) and coefficient of variation (CV) was less in MS (BP SD; MS: 3.2 ± 0.2 vs. CON: 4.0 ± 0.2, P=0.022 and BP CV; MS: 3.8 ± 0.3 vs. CON: 4.7 ± 0.2, P=0.025). Similarly, mean resting systolic blood pressure (SBP) was not different between MS and healthy controls (P=0.207) but the SBP standard deviation and coefficient of variation was less in MS (SBP SD; MS: 4.7 ± 0.4 vs. CON: 6.6 ± 0.5, P=0.013 and SBP CV; MS: 4.3 ± 0.4 vs. CON: 5.8 ± 0.4, P=0.033). In contrast, there was no difference in the DBP standard deviation or coefficient of variation between the two groups (P= 0.321 and P=0.295; respectively). In summary, contrary to our original hypothesis, individuals with MS exhibited reduced resting beat-to-beat BPV compared to healthy controls. These preliminary findings may be related to altered autonomic function in this clinical population.

Impact of in-hospital blood pressure variability on clinical outcomes in patients with symptomatic peripheral arterial disease.

Various types of blood pressure (BP) variability have been recognized as risk factors for future cardiovascular events. However, the prognostic impact of in-hospital BP variability in patients with symptomatic peripheral arterial disease (PAD) has not yet been thoroughly investigated. A total of 386 patients with PAD who underwent endovascular therapy in two hospitals were retrospectively included. BP variability was assessed by the coefficient of variation (CV) of systolic BP measured during hospitalization by trained nurses. The primary endpoint was a composite of major adverse cardiovascular events (cardiovascular death, acute coronary syndrome, stroke, and hospitalization for heart failure) and major adverse limb events (major amputation, acute limb ischemia, and surgical limb revascularization). The mean systolic BP and the CV of systolic BP during hospitalization were 130.8 ± 15.7 mmHg and 11.2 ± 4.1%, respectively. During the median follow-up period of 22 months, 80 patients (21%) reached the primary endpoint. Receiver operating characteristic curve analysis showed that the CV of systolic BP significantly predicted major adverse cardiovascular and limb events (area under the curve 0.60, best cutoff value 9.8, P = 0.01). Using the best cutoff value, patients with high BP variability (n = 242) had a higher risk of clinical events than those with low BP variability (n = 144) (26% vs. 12%, P < 0.001). Multivariable analysis indicated that the CV of systolic BP, age, hemodialysis, and atrial fibrillation were associated with the primary endpoint. In conclusion, greater in-hospital systolic BP variability was associated with major adverse cardiovascular and limb events in patients with symptomatic PAD undergoing endovascular therapy.

IN-HOSPITAL BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIOVASCULAR EVENTS AND RENAL DYSFUNCTION IN THE SETTING OF ACUTE MYOCARDIAL INFARCTION

Abstract Objective: Recent data have associated blood pressure variability (BPV) with cardiovascular morbidity and renal dysfunction but not in the setting of acute coronary syndrome (ACS). The aim of this study is to determine the impact short-term BPV on in-hospital cardiovascular outcomes and renal function in patients suffering a myocardial infarction (MI). Design and method: A total population of 250 MI patients (79.6% male; mean age 62.5 years;68.4% hypertensives)underwent 24-h ambulatory BP measurement during their hospitalization. The parameters of BPV analyzed were: a) 24-h standard deviation (SD), b) coefficient of variation (CV) and c) average real variability (ARV) of systolic and diastolic BP. The study population was divided intoa STEMI (n = 127) and a non-STEMI (n = 123) group. Cardiovascular outcomes included: new onset of ACS, pulmonary edema, hypertensive emergency, life threatening arrhythmias,whereas worsening of renal function (WRF) was defined as a reduction of GFR &gt; or = 25% according to the RIFLE criteria. No deaths or strokes occurred. Results: In the total population a significant association was demonstrated between SBP CV andthe incidence of cardiovascular outcomes (OR = 1.136; 95% CI: 0.452–1.819; P = 0.001). After separate analysis for each MI group, SBP CV remained a predictor in the STEMI group (OR = 1.825; 95% CI: 0.814–2.835; P = 0.001). Regarding WRF CV SBP demonstrated a prognostic role (OR = 1.946; 95% CI:0.923–2.969; P &lt; 0.001)in the entire population. Results for STEMI group were similar (OR = 3.769; 95% CI:2.056–5.481; P &lt; 0.001). However, non-STEMI group failed to demonstrate any significant associations. We therefore, conducted multivariate regression models for STEMI group, in which the CV SBP retained predictive value of cardiovascular outcomes (OR = 1.502; 95% CI:0.470–2.534; P = 0.005) and WRF (OR = 4.139; 95% CI:2.423–5.962; P &lt; 0.001)independently of age, gender, history of hypertension, diabetes mellitus (DM), smoking and low-density lipoprotein (LDL-C). Conclusions: In the setting of STEMI, assessment of BPV using CV could have a prognostic role of in-hospital cardio-renal outcomes suggesting a clinical need for further individualization of BP regulation in the integrative ACS management.

Elevated levels of short-term blood pressure variability: A marker for ascending aortic dilatation in hypertensive patients

ABSTRACT Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD). Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV. Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT patients with normal AA, daytime SBP, daytime SD of SBP, 24-h SD of SBP, daytime CV of SBP, and 24-h CV of SBP were significantly higher in HT patients with AAD. Compared with the HT patients with normal AA, the frequency of nondipper pattern was higher and dipper pattern was lower in HT patients with AAD. In multivariate logistic regression analysis, the daytime CV of SBP, daytime SD of SBP, 24-h SD of SBP, daytime SBP, and left ventricular mass index were independently associated with AAD. In receiver operating characteristic curve analysis, the daytime CV of SBP levels of >12.95 had a sensitivity of 61% and a specificity of 59% (area under the curve, 0.659; 95% CI, 0.562–0.756; P= .01); moreover, daytime SD of SBP > 16.4 had sensitivity of 62% and specificity of 61% (AUC, 0.687; 95% CI, 0.591–0.782; P< .001). :Conclusion Increased short-term BPV is independently associated with AAD and may be recommended as a remarkable factor risk for AAD in HT patients.

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status.

Background:Blood pressure (BP), recanalization status, and collateral circulation are important factors for cerebral autoregulation after stroke. We aimed to investigate the association of various BP variability (BPV) parameters with clinical outcomes after mechanical thrombectomy (MT) according to recanalization and collateral status.Methods:We included 502 consecutive patients who underwent MT due to anterior circulation large vessel occlusion stroke at three comprehensive stroke centers. BPV parameters were standard deviation (SD), maximum/minimum BP, coefficient of variation (CV) and successive variation (SV). The clinical outcomes included 90-day functional outcome assessed by modified Rankin Scale score and symptomatic intracranial hemorrhage (sICH).Results:Among the included patients, 219 (43.6%) achieved good functional outcomes and 59 (11.8%) developed sICH. After adjusting for confounders, higher systolic BP (SBP) variability [CV (odds ratio (OR), 1.089, p = 0.035), SV (OR, 1.082, p = 0.004). and SD (OR, 1.074, p = 0.027)] was associated with a lower likelihood of a favorable outcome. In addition, higher SBP [CV (OR, 1.156, p = 0.001) and SD (OR, 1.118, p = 0.001)] were significantly associated with increased odds of sICH. Moreover, the relationship between BPV and the outcomes depended on recanalization status. However, regardless of collateral status, a higher BPV after MT was associated with worse outcomes.Conclusions:Higher SBP SD and CV during the first 24 h after MT was a powerful predictor of worse clinical outcomes, regardless of the collateral status. However, the effects of BPV on outcomes were more substantial among patients with successful reperfusion.

Visit-to-visit systolic blood pressure variability associates with vascular thrombosis in hemodialysis patients

Abstract Background Blood pressure variability (BPV) is an independent risk factor for cardiovascular events and death in general population. Hemodialysis patients have higher BPV and higher vascular events than general population. However, the impact of BPV on vascular events of hemodialysis patients is not clear. Purpose To determine the association of BPV with vascular outcomes in patients on maintenance hemodialysis. Method In this prospective multi-center study, we enrolled 927 maintenance hemodialysis patients from Jan, 2017 to Dec, 2017. We used the coefficient of variation (CV) and the variance independent of mean (VIM) of predialysis systolic blood pressure (SBP) derived from the first 3 months (36 dialysis sessions) after enrollment as the metrics of BPV. Patients were prospectively followed at 3-month interval. Outcomes included death, systemic vascular thrombosis (nonfatal myocardial infarction, ischemic stroke, and acute limb ischemia), and dialysis vascular access thrombosis. Results In all, 707 subjects with at least 20 measurements were included in the analysis. Patients' mean age was 66 years and 50% of patients were male. Baseline factors associated higher BPV included diabetes, high co-morbidity scores, low albumin, high systolic and diastolic blood pressure. The mean pre-dialysis SBP CV was 10.9% and VIM was 28.9%. The median follow-up duration was 2.5 years, during which 103 deaths, 81 systemic vascular thrombosis, and 155 dialysis access thrombosis occurred. In unadjusted model, we found that the highest BPV tertile had a 52% increased risk of vascular thrombosis than the lowest BPV tertile (HR=1.52, 95% CI 1.23–1.86, P&amp;lt;0.001). After multivariable adjustment (including age, diabetes, co-morbidity score, albumin, baseline systolic and diastolic BP), this association remained statistically significant (HR=1.47, 95% CI=1.18–1.84, P=0.001). Systolic BPV was associated with either systemic vascular thrombosis (HR=1.44, 95% CI=1.08–1.93, P=0.01) or dialysis vascular access thrombosis (HR=1.55, 95% CI=1.16–1.82, P=0.001). Conclusion In the cohort of patients on maintenance hemodialysis, high pre-dialysis systolic BPV was associated a higher risk of vascular thrombosis events, both for systemic vascular thrombosis and dialysis vascular access thrombosis. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): National Taiwan University Hsinchu Branch

Twenty-Four-Hour Ambulatory Blood Pressure Variability Associated With Cerebral Small Vessel Disease MRI Burden and Its Progression in Inpatients With Cerebrovascular Disease.

Background: Lacunar infarcts, white matter lesions, cerebral microbleed, enlarged perivascular space and brain atrophy are regarded as magnetic resonance imaging (MRI) manifestations of cerebral small vessel disease (cSVD). 24-hour blood pressure variability (BPV) has been reported to relate with cerebral small vessel disease, but the impact of 24-h BPV on the total MRI cSVD burden and its progression in inpatients with cerebrovascular disease has not been investigated yet.Methods: We enrolled inpatients with cerebrovascular disease, who underwent the 24-h ambulatory blood pressure monitoring (ABPM) and the brain MRI scan at baseline and had the follow-up brain MRI images stored in the clinical information system of our hospital. BPV was quantified by the calculation of standard deviation (SD), coefficient of variation (CV), weighted standard deviation (wSD) of blood pressure record. We evaluated the total cSVD score on baseline MRI and the MRI followed-up to obtain the total burden of cSVD. The cSVD burden progression was estimated through the comparison of the total cSVD score on the two MRIs.Results: A total of 140 patients with an average age of 65.6 years were finally enrolled, 82.9% (116/140) of whom had one or more cSVD markers. After a median of 4.4 years follow-up, cSVD score progression were found in 50.7% (71/140) of the patients. Both SD and CV of SBP and DBP during 24-h and daytime as well as the SBP wSD differed significantly among different total cSVD score groups. The SBP SD and CV during 24-h and daytime, the SBP SD in nighttime, the DBP SD and CV during the daytime were significantly higher in the cSVD progression group than those in the cSVD no-progression group. The SBP wSD and the DBP wSD were significantly higher in the cSVD progression group than those in the cSVD no-progression group. Logistic regression analyses revealed that daytime SBP SD and SBP wSD were independent risk factors for total cSVD burden [daytime SBP SD: OR = 1.628, 95% CI = 1.105–2.398 (per 5 mmHg increase in SD), P = 0.014; SBP wSD: OR = 2.248, 95% CI = 1.564–3.230 (per 5 mmHg increase in wSD), P < 0.001)] and SBP wSD was a significant predictor for cSVD progression [OR = 2.990, 95% CI = 1.053–8.496 (per 5 mmHg increase in wSD), P = 0.040].Conclusion: Higher BPV were significantly related with total cSVD burden in inpatients with cerebrovascular disease. SBP SD during daytime and SBP wSD were independent risk factor for total cSVD burden and SBP wSD was an predictive factor for cSVD progression.

Visit-to-visit blood pressure variability and renal outcomes: results from ONTARGET and TRANSCEND trials.

There is conflicting evidence on whether in treated hypertensive patients the risk of renal outcomes is associated with visit-to-visit SBP variability. Furthermore, limited evidence is available on how important is SBP variability for prediction of renal outcomes compared with on-treatment mean SBP. We addressed these issues in 28 790 participants of the Ongoing Treatment Alone and in combination with Ramipril Global End point Trial and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant Subjects with Cardiovascular Disease trials. SBP variability was expressed as the coefficient of variation of the mean with which it showed no relationship. SBP variability and mean values were obtained from five visits during the first 2 years of treatment after the end of the titration phase. Incidence of several renal outcomes (end-stage renal disease, doubling of serum creatinine, new microalbuminuria, new macroalbuminuria and their composite) was calculated from the third year of treatment onward. Patients were divided in quintiles of SBP-coefficient of variation (SBP-CV) or mean SBP, which exhibited superimposable mean blood pressure and SBP-CV values, respectively. A progressive increase of SBP-CV was not accompanied by a parallel increase in a widely adjusted (baseline and on-treatment confounders) risk of most renal outcomes (end-stage renal disease, new macroalbuminuria, new microalbuminuria and their composite) in the subsequent on-treatment years. In contrast, the adjusted risk of most renal outcomes increased progressively from the lowest to the highest quintile of on-treatment mean SBP. Progression from lowest to highest mean on-treatment SBP, but not SBP-CV, was also associated with a less frequent return to normoalbuminuria in patients with initial micro or macroalbuminuria. Renal outcome prediction was slightly improved by the combined use of SBP-CV and mean SBP quintiles. Visit-to-visit SBP variability had no major predictive value for the risk of renal outcomes, which, in contrast, was sensitively predicted by mean on-treatment SBP. A further slight increase in prediction of renal outcomes was seen by combining on-treatment mean SBP and variability.

Higher visit-to-visit blood pressure variability and N-terminal pro-brain natriuretic peptide elevation: influence of left ventricular hypertrophy and left ventricular diastolic function

The issue of whether visit-to-visit blood pressure variability (VVV) is associated with higher levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) has been controversial, and the underlying mechanism is not well understood. We hypothesized that (1) VVV is associated with the NT-proBNP level, and (2) this association is mediated by left ventricular (LV) hypertrophy and LV diastolic dysfunction. A total of 72 hypertensive patients were examined. Clinic blood pressure was measured at each visit for 12 months (1×/month or every 2 months), and echocardiography was performed during this period. VVV is expressed as the SD, coefficient of variation (CV), and delta (Δ; the difference between the maximum and the minimum) in SBP and in DBP. We investigated the association between VVV and NT-proBNP and whether the LV mass index (LVMI) and the mitral early diastolic inflow velocity (E) to mitral annular early-diastolic peak velocity (e') ratio (E/e') influence this association. The loge NT-proBNP values were significantly correlated with the CV of SBP (r = 0.42), ΔSBP (r = 0.41), the CV of DBP (r = 0.32), and ΔDBP (r = 0.28). The CV and Δ in SBP or those in DBP were not significantly correlated with LVMI or E/e'. A multiple linear regression analysis revealed that higher CV of SBP and ΔSBP were significantly associated with loge NT-proBNP. Higher VVV was significantly associated with higher NT-proBNP independently of LV hypertrophy and diastolic function.

1416-P: Blood Pressure Variability and Risk of Heart Failure Events in ACCORD and the VADT

We examined the relationship between blood pressure variability and risk of heart failure (HF) in two cohorts of type 2 diabetes (T2D) participating in trials of glucose and/or other risk factor management. Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials. In ACCORD (Table), CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: HR=1.15, p = 0.01; CV-DBP: HR=1.18, p = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR=1.16, p = 0.001; CV-DBP: HR=1.09, p = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP (e.g., for CV-SBP: those with baseline SBP ≥ 140, &amp;lt; 140, &amp;lt; 130 and &amp;lt; 120 mmHg, respectively had the following HRs; 1.03, 1.21, 1.50, and 1.69). Blood pressure variability is independently associated with HF risk and this relationship is most robust at low blood pressure in individuals with T2D. These results may have implications for optimizing blood pressure treatment strategies in those with T2D. Disclosure D.S. Nuyujukian: None. J. Koska: None. P. Reaven: Consultant; Self; Boston Heart Diagnostics, Intercept Pharmaceuticals, Inc. Research Support; Self; Bristol-Myers Squibb, Lysulin. J. Zhou: None. Funding National Institutes of Health (R01067690, R01094775)

Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT.

Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management. Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials. In ACCORD, CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: hazard ratio [HR] 1.15, P = 0.01; CV-DBP: HR 1.18, P = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR 1.16, P = 0.001; CV-DBP: HR 1.09, P = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP. Effects of blood pressure variability were related to dips, not elevations, in blood pressure. Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes.

Visit-to-visit blood pressure variation and outcomes in heart failure with reduced ejection fraction: findings from the Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms trial.

Visit-to-visit office blood pressure (BP) variability (BPV) has been associated with morbidity and mortality outcomes in several cardiovascular conditions. The aim of this study was to evaluate the association between BPV and outcomes in patients with heart failure and reduced ejection fraction and the effect of eplerenone on BPV. We evaluated the associations between BPV, calculated as SBP coefficient of variation (SBP-CoV = SD/mean × 100%), and the primary composite endpoint of cardiovascular mortality or heart failure hospitalization (HFH), and its components, in 2549 patients from the Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms trial. Lower SBP-CoV was independently associated with a higher risk of all the studied outcomes, while higher as well as lower SBP-CoV were associated with a higher risk of cardiovascular death. After a median follow-up period of 21 months the risk of the composite outcome of cardiovascular death or HFH was almost double in the lower SBP-CoV tertile as compared with the intermediate tertile [adjusted hazard ratio: 2.01, 95% confidence interval (1.62-2.51), P < 0.001]. The relationship between SBP-CoV and outcomes was not modified by eplerenone (P value for interaction = 0.48). An interaction was detected between mean SBP and SBP-CoV for the primary outcome (P = 0.048) and for HFH (P = 0.018). The effect modification was slight, but lower SBP-CoV was associated with worse outcomes in patients with both low and high SBP, while this interaction was less clear for patients with SBP in the 'normal' range. In our patients with heart failure and reduced ejection fraction and mild symptoms, both a lower and higher SBP-CoV were associated with worse outcomes. SBP-CoV did not modify the benefit of eplerenone. Further studies are warranted to clarify the role of BPV in heart failure. CLINICALTRIALS. NCT00232180.

1652-P: The Association between Long-Term HbA1c Variability, Blood Pressure, Cholesterol, and Body Weight in Type 2 Diabetes: Subanalysis of ABC Study

Aim: Visit-to-visit variability (VVV) of HbA1c was reported to be the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). However, factors related to VVV of HbA1c remain unclear. This study is first examined relationship between VVV of HbA1c and various parameters including VVV of blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), and body mass index (BMI). Material and Methods: Analyzed were 4,678 patients with T2DM throughout Japan (38 hospitals). The inclusion criteria were patients whose HbA1c, BP, LDL-C, and BMI were measured 12 or more times during the 24-month period. VVV of HbA1c, BP, LDL-C, and BMI were evaluated using the coefficient of variation (CV). This study is sub-analysis of ABC trial (UMIN000034231). Results: Mean age of participants was 61.3 ± 9.4 years (mean ± SD) and HbA1c was 57.2 ± 13.5 mmol/mol (7.4 ± 1.2%). Table shows univariate correlate and multiple regression analysis of HbA1c CV. HbA1c CV was correlated with HbA1c baseline, SBP CV, LDL-C CV, and BMI CV. In the multiple regression analysis, HbA1c baseline, LDL-C, and BMI CV were the strongest predictors of HbA1c CV. Conclusion: VVV of HbA1c was strongly correlated with VVV of LDL-C and BMI, and HbA1c baseline in patients with T2DM. A large-scale clinical trial needs to be conducted to clarify factors affecting VVV of HbA1c. Disclosure S. Minato: None. D. Matsutani: None. Y. Tsujimoto: None. Y. Kayama: None. M. Sakamoto: None. M. Nishikawa: None. K. Utsunomiya: None.

Effect of Visit-to-Visit Blood Pressure Variability on Cognitive and Functional Decline in Mild to Moderate Alzheimer’s Disease

Visit-to-visit blood pressure (BP) variability (VVV) is increasingly recognized as a marker of cardiovascular risk. Although implicated in cognitive decline, few studies are currently available assessing its effects on established dementia. To investigate if VVV is associated with one-year rate of decline in measures of cognition and function in patients with mild to moderate Alzheimer's disease (AD) in the Doxycycline And Rifampicin for Alzheimer's Disease study. Patients were included if ≥3 BP readings were available (n = 392). VVV was defined using different approaches including the coefficient of variation (CV) in BP readings between visits. Outcomes included rates of decline in the Standardized Alzheimer's Disease Assessment Scale-Cognitive Subscale (SADAS-cog), Standardized MMSE, Clinical Dementia Rating Scale, the Quick Mild Cognitive Impairment screen and the Lawton-Brody activities of daily living (ADL) scale. Half of the patients (196/392) had a ≥4-point decline in the SADAS-cog over one-year. Using this cut-off, there were no statistically significant associations between any measures of VVV, for systolic or diastolic BP, with and without adjustment for potential confounders including treatment allocation, history of hypertension and use of anti-hypertensive and cognitive enhancing medications. Multiple regression models examining the association between systolic BP CV by quartile and decline over one-year likewise showed no clinically significant effects, apart from a U-shaped pattern of ADL decline of borderline clinical significance.∥Conclusions: This observational study does not support recent research showing that VVV predicts cognitive decline in AD. Further studies are needed to clarify its effects on ADL in AD.