Coefficient Of Variation Of Systolic Blood Pressure Research Articles

Remifentanil Reduces Blood Loss During Orthognathic Surgery.

Remifentanil is reported to reduce oral tissue blood flow. We performed a retrospective investigation using logistic regression analysis of anesthesia records to investigate whether the use of remifentanil infusion in a balanced anesthesia technique was useful as a primary technique to reduce blood loss during orthognathic surgery. Subjects were 80 patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy of the mandible. The variables included gender, age, weight, type of maintenance anesthetic, type and dose or infusion rate of opioid, mean systolic blood pressure (SBP-mean), coefficient of variation of systolic blood pressure (CVSBP) during surgery, mean heart rate (HR-mean), duration of surgery, total blood loss, volume of infusion used, amount of local anesthetic used, body temperature, and urine output. Gender, type of maintenance anesthetic, type of opioid, SBP-mean, CVSBP, HR-mean, and duration of surgery were used as candidates for independent variables. Logistic regression analysis was performed for the selected independent variables with the total blood loss as the dependent variable. The factors associated with the reduction of blood loss were the use of remifentanil (odds ratio, 3.112; 95% CI, 1.166-8.307; P = .023) and smaller CVSBP (odds ratio, 2.747; 95% CI, 1.07-7.053; P = .036). Use of remifentanil and smaller CVSBP were associated with a reduction of blood loss during orthognathic surgery.

Parametrii variabilităţii tensiunii arteriale şi afectarea vasculară în hipertensiunea esenţială

The idea that the degree of hypertension (HT) is a predictor of end organ damage and has a prognostic value is widespread and well established, but the assumption that BP variability (BPV) has the same relevance is new. The purpose of this study was to analyze the relationship between BPV determined using ABPM and arterial stifness measured using pulse wave velocity (PWV) in a group of patients with newly diagnosed HT starting from the hypothesis that there is a correlation between vascular damage and BPV. The study enrolled 60 subjects with newly diagnosed and untreated hypertension. The evaluation included medical history, demographics, lifestyle, family history (FH) of hypertension, physical examination, current chronic treatments. All subjects underwent ABPM and blood tests (serum creatinine, total cholesterol, blood glucose and uric acid). We calculated: standard deviation (SD), coefficient of variation (CV), excursion (E) for SBP (s), DBP (d), daytime SBP and daytime DBP, nocturnal SBP and nocturnal DBP. The patients were divided into quartiles of systolic BPV, diastolic BPV, diurnal and nocturnal systolic and diastolic BPV. Results: The mean age of patients was 60.56 +/- 6.76 years; 43.33% of patients were male; 66.66% had FH of HT. The average value of seric cholesterol was 186.8 +/- 45.20 mg / dl; the average value of creatinine was 1.08 +/- 0.21 mg/dl, the average value of uric acid was 5.14 +/- 1.33 mg / dl. The average value of PWV was 89.48 +/- 4.66 cm/s. PWV was statistically significant different between SD quartiles of systolic BP at night, coefficient of variation quartiles of systolic BP at night and nocturnal systolic BPV. Also, PWV was different between E quartiles and CV quartiles of systolic BP. In linear regression, statistical significance was obtained for total cholesterol, E of nocturnal SBP, CV of nocturnal SBP and systolic BPV. In multiple linear regression obtained after excluding the independent variables with high collinearity (CV of nocturnal SBP) we achieved statistical significance for high level of seric cholesterol and nocturnal systolic BPV. The data obtained came to strengthen the data in the literature, that an increased value of seric cholesterol is a major determinant of arterial stiffness.

Locomotive syndrome is associated with large blood pressure variability in elderly hypertensives: the Japan Ambulatory Blood Pressure Prospective (JAMP) substudy.

Chronic pain, represented by locomotive syndrome (LS), and psychosocial factors are possible factors of blood pressure (BP) variability (BPV). The authors tested the hypothesis that there are links among LS, depression, and BPV. In 85 Japanese elderly hypertensive patients with normal daily activities, the authors performed ambulatory BP monitoring, determined the LS scale (LSS), and administered the Self-Rating Questionnaire for Depression (SRQD). The LSS score but not the SRQD score was associated with the standard deviation (SD) and coefficient of variation (CV) of daytime systolic BP (SBP) and SD of nighttime SBP (all P<.05). Higher LSS score (in quartiles) was associated with a higher SD of daytime SBP (P=.041), even after adjusting for covariates. Regarding the components of the LSS score, movement-related difficulty and usual care difficulty were associated with the SD and CV of daytime SBP. In elderly hypertensive patients, the LSS score was associated with exaggerated systolic BPV. The LS state could be an important determinant of systolic BPV.

The relationship between blood pressure variability and Pooled Cohort Risk Assessment Equations 10-year cardiovascular risk score.

Recent attention has focused on the clinical significance of blood pressure variability (BPV) in explaining the adverse cardiovascular consequences of hypertension. We therefore analyze the impact of 24 h BPV on the development of future cardiovascular disease determined by The Pooled Cohort Risk Assessment Equations 10-year risk calculator. We analyzed 250 adult patients, ages 40-80 years old. The ambulatory blood pressure monitoring was recorded automatically. We defined the mean blood pressure values, SD, and coefficient of variation (CV) of blood pressure on the basis of the recorded 24 h ambulatory blood pressure monitoring values as an indicator for BPV.Patients were divided into two groups according to their Pooled Cohort Risk Assessment Equations 10-year risk profile (<7.5 and ≥7.5%). Besides the mean systolic blood pressure (SBP), parameters showing the BPV such as SD and CV of mean blood pressures were also significantly higher in patients with an elevated 10-year risk score compared with others. Only CV of SBP and pulse pressure showed a clear association with the 10-year risk in multivariate logistic regression analysis. The results suggested that each 1% increase in CV of SBP could lead to a 1.258-fold increase in The Pooled Cohort Risk Assessment Equations 10-year risk score. In the present study, we found that independent of baseline SBP, increased CV of SBP within 24 h was associated with increased cardiovascular risk, as assessed by The Pooled Cohort Risk Assessment Equations 10-year risk calculator.

OS 37-05 LONG-TERM VISIT-TO-VISIT VARIABILITY OF SYSTOLIC BLOOD PRESSURE AND DECLINE IN RENAL FUNCTION IN HYPERTENSIVE PATIENTS OVER 15 YEARS

Objective: We aim to examine the relationship between visit-to-visit systolic blood pressure variability (BPV) and decline in renal function in patients with hypertension and determine the level of systolic BPV that contribute to significant renal function decline. Design and Method: This is a 15-year (1998–2012) retrospective cohort study of 825 hypertensive patients with normal renal function at baseline in a primary care clinic. Three monthly blood pressure readings per year were retrieved from the 15 years of clinic visits. We used standard deviation (SD) and coefficient of variation (CV) as measures of systolic BPV. Serum creatinine was captured and eGFR was calculated at baseline, 5-year, 10-year and 15-year. Rate of renal function decline was estimated by fitting a linear regression line through the eGFR measurements for each individual patient and expressed as eGFR slope. Results: A total of 825 hypertensive patients with 15-year of clinic follow up were entered into analysis. The mean SD of SBP was 14.2 ± 3.1mmHg and CV of SBP was 10.2 ± 2.0%. Mean for eGFR slope was −1.0 ± 1.5 ml/min/1.73m2/year. There was significant relationship between BPV and slope of eGFR (SD of SBP r = −0.16, p < 0.001; CV of SBP r = −0.14, p < 0.001, using Pearson's correlation). BPV of SBP for each individual was significantly associated with eGFR slope after adjustment for mean SBP and other confounders. Using receiver operating characteristics curve (ROC) and maximum Youden index, the cutoff values as indicator for the onset of CKD for SD of SBP was 13.5mmHg (sensitivity 69%, specificity 50%) and CV of SBP was 9.74% (sensitivity 68%, specificity 48%). Conclusions: Our study has demonstrated that long-term visit-to-visit variability of SBP is an independent determinant of renal deterioration in patients with hypertension. Hence, every effort should be made to reduce the BPV in order to slow down the decline of renal function in patients with hypertension.

PP.15.04] LONG-TERM VISIT-TO-VISIT VARIABILITY OF SYSTOLIC BLOOD PRESSURE AND DECLINE IN RENAL FUNCTION IN HYPERTENSIVE PATIENTS OVER 15 YEARS.

Objective: We aim to examine the relationship between visit-to-visit systolic blood pressure variability (BPV) and decline in renal function in patients with hypertension and determine the level of systolic BPV that contribute to significant renal function decline. Design and method: This is a 15-year retrospective cohort study of 904 hypertensive patients (1998–2012) in a primary care clinic. Three monthly blood pressure readings per year were retrieved from the 15 years of clinic visits. We used standard deviation (SD) and coefficient of variation (CV) as measures of systolic BPV. Serum creatinine was captured and eGFR was calculated at baseline, 5-year, 10-year and 15-year. Rate of renal function decline was estimated by fitting a linear regression line through the eGFR measurements for each individual patient and expressed as eGFR slope. Results: A total of 904 hypertensive patients with 15-year of clinic follow up were entered into analysis. The mean SD of SBP was 14.3 ± 3.13 mmHg and CV of SBP was 10.3 ± 2.0%. Mean for eGFR slope was −0.96 ± 1.5 ml/min/1.73 m2/year. There was significant relationship between BPV and slope of eGFR (SD of SBP r = −0.16, p < 0.001; CV of SBP r = −0.14, p < 0.001, using Pearson's correlation). In multiple regression analyses, BPV (SD and CV) for SBP and mean SBP for each individual was significantly associated with eGFR slope after adjustment for confounders. Using receiver operating characteristics curve (ROC) and maximum Youden index, the cutoff values as indicator for the onset of CKD for SD of SBP was 13.5 mmHg (sensitivity 69%, specificity 50%). and CV of SBP was 9.74% (sensitivity 68%, specificity 48%). Conclusions: Our study has demonstrated that long-term visit-to-visit variability of SBP is an independent determinant of renal deterioration in patients with hypertension. Hence, every efforts should be made to reduce the BPV in order to slow down the decline of renal function in patients with hypertension.

PS 17-51 VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES PATIENTS IN GHANA

Objective: Visit-to-visit blood pressure (BP) variability is an important predictor cardiovascular diseases. In this study, we investigated association between visit-to-visit BP variability and chronic kidney disease (CKD) in type 2 diabetes (T2DM) patients in Ghana. Design and method: An average of 6 BP measurements from 282 T2DM patients, measured within the previous 3 years, were used to compute BP variability as standard deviation (SD), coefficient of variation (CV) and average real variability (ARV) of systolic BP (SBP). Serum creatinine was used to estimate glomerular filtration rate (eGFR) using CKD-EPI algorithm. CKD was defined as eGFR < 60 ml/min/1.73m2. Results: The prevalence of CKD in our study population was 20.8%. CKD patients had higher maximum SBP (160 ± 20 vs 147 ± 23 mmHg, p = 0.028), SD of SBP (11 ± 4 vs 15 ± 7 mmHg, p = 0.016), CV of SBP (0.16 ± 0.04 vs 0.1 ± 0.02, p = 0.002) and ARV of SBP (19 ± 8 vs 14 ± 6 mmHg, p = 0.041). In multivariable logistic regression model, maximum SBP [OR (95% CI), 1.68 (1.12 – 3.1), p = 0.037], SD of SBP [1.21 (1.08 – 2.54), p = 0.031] and CV of SBP [1.31 (1.04 – 3.43), p = 0.023] were independently associated with CKD. ARV of SBP was not associated with CKD [1.48 (0.89 – 4.01), p = 0.11]. Conclusions: Visit-to-visit BP variability may be an independent determinant of CKD in T2DM patients in our study population.

OS 37-06 VISIT-TO-VISIT VARIABILITY OF BLOOD PRESSURE AND RISK OF STROKE

Objective: The aim of this study was to prospectively explore the association between visit-to-visit variability of blood pressure (BP) and the risks of stroke and its subtypes. Design and Method: A total of 57 927 participants from a Chinese urban community who have completed all 3 visits between 2006 and 2010 were included in this study. The variability of BP was defined as the coefficient of variation (CV) across 3 visits. Participants without BP information loss or a history of stroke event were then followed until the end of the study. The primary outcome was the first occurrence of stroke, which was diagnosed according to the World Health Organization criteria and classified into two main subtypes: ischemic and hemorrhage stroke. Results: Over a median of 3 years follow-up, we identified 582 first stroke cases, of which 489 (84.0%) were ischemic stroke, 94 (16.2%) were hemorrhagic stroke. After multivariable adjustment, including for mean BP, the hazard ratios (HR) (95% Confidence Intervals: CI) of comparing participants in the highest versus lowest quartile of CV of systolic blood pressure (SBP) was 1.44 (1.11, 1.87) for any stroke, 1.33 (1.00, 1.77) for ischemic stroke, 2.17 (1.09, 4.35) for hemorrhagic stroke. Similar results were also observed when CV of SBP was considered as a continuous exposure variable (per SD increase). Furthermore, higher variability of diastolic blood pressure (DBP) was also associated with hemorrhagic stroke but not ischemic stroke. Conclusions: Higher visit-to-visit variability of BP might be an important objective to reduce stroke risk, especially for hemorrhagic stroke.

Abstract WMP76: Increased Systolic Blood Pressure Variability is Associated With Symptomatic Intracerebral Hemorrhage After Endovascular Treatment for Stroke

Introduction: Hemorrhagic transformation is a serious complication of endovascular treatment (IAT) for acute ischemic stroke. Increased systolic blood pressure variability (SBPV) is associated with symptomatic intracerebral hemorrhage (sICH) after intravenous rt-PA, however the association with IAT is unknown. Hypothesis: Increased SBPV will be associated with sICH after IAT for acute ischemic stroke. Methods: We retrospectively reviewed ischemic stroke patients from 2005-2013 who received IAT at a single center. SBPV was measured by standard deviation (SD) and coefficient of variation (CV) for all readings documented within 48 hours of hospital arrival (7,117 readings). A multivariable ordinal logistic regression model with the dichotomous outcome of sICH was used. Results: There were 156 patients identified, 49% male, mean age 64±15 years, and mean presenting NIHSS 16±8. Only 13/156 patients were treated with second-generation retrievable stent devices. sICH was identified in 18/156 patients (11.5%). Mean blood pressure was not significant at 24 or 48 hours. After controlling for potential confounders, a one quartile increase of SBP SD or CV was associated with a 1.8 to 2.3 fold increased risk of sICH (see Table and Figure). Conclusions: In acute ischemic stroke patients who undergo IAT, increased SBPV in the first 24 and 48 hours is associated with an approximately 80% increased risk of sICH. This association warrants prospective investigation, particularly in populations with predominant use of new generation stentrievers.

Blood pressure variability and its association with echocardiographic parameters in hypertensive diabetic patients.

BackgroundBlood pressure (BP) variability is associated with target organ damage in hypertension and diabetes. The 24 h ambulatory blood pressure monitoring (24 h-ABPM) has been proposed as an evaluation for BP variability using several indexes [standard deviation (SD) of mean BP, coefficient of variation (CV), BP variation over time (time-rate index)].MethodsWe evaluated the association between BP variability measured by 24 h-ABPM indexes and echocardiographic variables in a cross-sectional study in 305 diabetic-hypertensive patients.ResultsTwo groups were defined by the median (0.55 mmHg/min) of time-rate systolic BP (SBP) index and classified as low or high variability. Age was 57.3 ± 6.2 years, 196 (64.3 %) were female. Diabetes duration was 10.0 (5.0–16.2) years, HbA1c was 8.2 ± 1.9 %. Baseline clinical characteristics were similar between low (n = 148) and high (n = 157) variability groups. Office SBP and systolic 24 h-ABPM were higher in the high variability group (139.9 mmHg vs 146.0 mmHg, P = 0.006; 128.3 mmHg vs 132.9 mmHg, P = 0.019, respectively). Time-rate index, SD and CV of SBP, were higher in high variability group (P < 0.001; P < 0.001 and P = 0.003, respectively). Time-rate index was not independently associated with the echocardiography’s variables in multiple linear model when adjusting for age, 24 h-ABPM, diabetes duration and HbA1c. The multiple linear regression model revealed that the significant and independent determinants for septum thickness, relative wall thickness and posterior wall thickness (parameters of left ventricular hypertrophy) were: age (p = 0.025; p = 0.010; p = 0.032, respectively) and 24 h-SBP (p < 0.001 in the three parameters).ConclusionBP variability estimated by 24 h-ABPM is not independently associated with echocardiographic parameters in diabetic-hypertensive patients.

Abstract 17020: Visit-to-visit Variability of Systolic Blood Pressure Predicts All-cause Mortality in Patients Received Percutaneous Coronary Intervention With Drug Eluting Stents

Background: Blood pressure (BP) and its variability are associated with atherosclerotic disease and cardiovascular events. The prognostic implications of outpatient clinic visit-to-visit blood pressure variability (BPV) are unknown in patients received percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods: Patients who PCI from January 2009 to December 2013 were consecutively corrected. We analyzed the 1,234 patients, who measured clinic BP more than three times during follow up. The BPV is determined by standard deviation (SD) of systolic and diastolic BP, and coefficient of variation (SD*100/mean BP). Results: Median follow up duration was 905 days (interquartile range 529 to 1,310 days). The clinic measured BP were recorded mean 9.9 ± 4.7 times. All patients were divided into two groups according to the coefficient of variation of systolic BP (CVSBP); high CVSBP group (&gt; 8.77, n=617) and low CVSBP group (&lt;8.77, n=617). High CVSBP group had significantly higher all-cause mortality (7.9 versus 3.1%, p&lt;0.001). In multivariate logistic regression analysis for prediction of all-cause mortality after PCI with DES, hazard ratio of high CVSBP group was 2.090 (95% of confidence interval 1.012-4.318, p = 0.046). Conclusion: The higher visit-to-visit BPV is associated higher mortality in patients performed PCI with DES. The clinic measured visit-to-visit BPV may serve as a predictor of mortality after PCI with DES.

Relationship of short-term blood pressure variability with carotid intima-media thickness in hypertensive patients.

BackgroundHigh blood pressure (BP) is among significant risk factor for stroke and other vascular occurrences, it experiences nonstop fluctuations over time as a result of a complex interface among cardiovascular control mechanisms. Large blood pressure variability (BPV) has been proved to be promising in providing potential regulatory mechanisms of the cardiovascular system. Although the previous studies also showed that BPV is associated with increased carotid intima-media thickness (IMT) and plaque, whether the correlation between variability in blood pressure and left common carotid artery-intima-media thickness (LCCA-IMT) is stronger than right common carotid artery-intima-media thickness (RCCA-IMT) remains uncertain in hypertension.MethodsWe conduct a study (78 hypertensive subjects, aged 28–79) to evaluate the relationship between BPV and carotid intima-media thickness in Shenzhen. The blood pressure was collected using the 24 h ambulatory blood pressure monitoring, and its variability was evaluated using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) during 24 h, daytime and nighttime. All the IMT measurements are collected by ultrasound.ResultsAs the results showed, 24 h systolic blood pressure variability (SBPV) evaluated by SD and ARV were significantly related to LCCA-IMT (r1 = 0.261, P = 0.021; r1 = 0.262, P = 0.021, resp.). For the daytime diastolic blood pressure variability (DBPV), ARV indices were significantly related to LCCA-IMT (r1 = 0.239, P = 0.035), which differed form BPV evaluated by SD and CV. For the night time, there is no significant correlation between the BPV and IMT. Moreover, for all the subjects, there is no significant correlation between the BPV and RCCA-IMT/number of plaques, whereas, the SD, CV, and ARV of daytime SBP showed a positive correlation with LCCA-IMT (r1 = 0.312, P = 0.005; r1 = 0.255, P = 0.024; r1 = 0.284, P = 0.012, resp.). Moreover, the ARV of daytime SBPV, 24 h SBPV and nighttime DBPV showed a positive correlation with the number of plaques of LCCA (r1 = 0.356, P = 0.008; r1 = 0.297, P = 0.027; r1 = 0.278, P = 0.040, resp.). In addition, the number of plaques in LCCA had higher correlation with pulse pressure and diastolic blood pressure than that in RCCA. And multiple regression analysis indicated LCCA-IMT might not only be influenced by age or smoking but also by the SD index of daytime SBPV (p = 0.035).ConclusionsThe results show that SBPV during daytime and 24 h had significant correlation with IMT, for the hypertensive subjects from the southern area of China. Moreover, we also found the daytime SBPV to be the best predictor for the progression of IMT in multivariate regression analysis. In addition, the present study suggests that the correlation between BPV and left common carotid artery—intima-media thickness/number of plaques is stronger than right common carotid artery-intima-media thickness/number of plaques.

LB01.06

Abstract Many antihypertensive outcome trials have shown that visit-to-visit blood pressure variability is correlated closely with clinical outcomes in hypertensive patients. The objective of the study was to investigate the relationship between visit-to-visit blood pressure variability (BPV) and the major cardiovascular outcomes in the Chinese hypertensive patients. Felodipine Event Reduction (FEVER) study was a double-blind, randomized trial on 9711 Chinese hypertensive patients, in whom cardiovascular outcomes were significantly reduced by more intense therapy achieving a mean of 138 mmHg SBP compared with less-intense therapy achieving a mean of 142 mmHg. Visit-to-visit BPV during the follow-up period [defined as standard deviation (SD), coefficient of variation (CV), and average real variability(ARV)] was derived from casual cuff BP measures after six months follow-up until the end of the study. Hazard ratios (HRs), for the incidence of CVD associated with SD, CV, and ARV of SBP and DBP were calculated using Cox proportional hazard models. Overall predictive power [area under receiver operating characteristic (AUC ROC) curve] of the level of blood pressure, blood pressure variability and other baseline characteristics was calculated. In FEVER study, visit-to-visit variability in SBP were significant predictors of subsequent stroke [eg, hazard ratios [HR] for ARV, SD and CV was 1.071 (95% CI: 1.025-1.118), 1.373 (95% CI: 1.159-1.626) and 0.572 (95% CI: 0.451-0,726)]. Visit-to-visit variability in DBP were also showed similar trend [eg, HR for ARV, SD and CV was 1.066 (95% CI: 0.992-1.145), 1.931 (95% CI: 1.435-2.598) and 0.558 (95% CI: 0.438-0,710)]. However, using the analysis of AUC ROC analysis, the risk importance sequence of the stroke events in this cohort was level of SBP, age, level of DBP ARV, SD, sex, CV and treatment. Visit-to-visit blood pressure variability has some effects on the cardiovascular outcomes in the Chinese hypertensive patents in the cohort in FEVER Study. However, blood pressure per se is even more important for the development of stroke in this group of patients.

Refined assessment of blood pressure instability after spinal cord injury.

This study determined whether the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire, a measure of self-reported frequency and severity of symptoms during hypo- and hypertensive episodes, correlates with blood pressure (BP) instability. In addition, test-retest reliability of the ADFSCI questionnaire was assessed. Thirty individuals with spinal cord injury (SCI) (aged 42±12 years; level of lesion = C3-L1; American Spinal Injury Association Impairment Scale = A-C; lesion duration = 1 month to 30 years after injury) participated in this study. Twenty-four-hour ambulatory BP monitoring (ABPM) was used to assess BP instability. ABPM recorded systolic BP (SBP), diastolic BP (DBP), and heart rate at 15-minute intervals during the daytime and 1-hour intervals during the nighttime. Test-retest reliability was performed by completion of the ADFSCI questionnaire on 2 occasions (i.e., 9±4 days in between). Individuals with SCI who self-reported autonomic dysreflexia (AD) episodes showed significantly higher SBP coefficient of variation (CV) (14%) and more AD events (n = 11) than individuals who reported never having AD symptoms (CV = 9%; AD events = 1). Both the number of AD events over the 24-hour period and the BP variability (SBP CV) were significantly related to the patients' self-reported total AD score (rho = 0.522, P = 0.005; rho = 0.584, P = 0.001, respectively) and daily AD frequency (rho = 0.553, P = 0.003; rho = 0.586, P = 0.001, respectively). Conversely, no significant correlations existed between the number of hypotensive events over the 24-hour period and self-reported frequency and severity in the ADFSCI questionnaire. This study provides evidence that ABPM offers a strong clinical basis for documenting and understanding BP instability, such as AD, and related symptoms in individuals with SCI.

Visit-to-visit variability in systolic blood pressure: correlated with the changes of arterial stiffness and myocardial perfusion in on-treated hypertensive patients

Background: Visit-to-visit variability in blood pressure (BP) was demonstrated to correlate with cardiovascular events independent of mean BP. The goal of the present study was to investigate the correlation of visit-to-visit BP variability with artery stiffness and myocardial perfusion in on-treated hypertensive patients.Methods: BP was measured in 271 hypertensive patients at every visit over the course of the antihypertensive treatment, and the standard deviation (SD), coefficient of variation (CV), maximum, and minimum in serial BP were calculated. Non-invasive pulse wave analysis was performed in all patients.Results: Compared with baseline, carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index (Aix) and Aix adjusted to a “standard heart rate” of 75 beats/min (Aix@HR75) were markedly declined, and sub-endocardial viability ratio (SEVR) was obviously increased in each group (p < 0.001). The changes of cfPWV, SEVR, Aix and Aix@HR75 in patients with lower SD of systolic blood pressure (SBP) were significantly greater than those in patients with higher SD of SBP. And the changes were statistically correlated with both SD and CV of serial SBP during follow-up, even after adjusted for mean SBP and mean diastolic blood pressure (DBP).Conclusion: Visit-to-visit SBP variability is independently correlated with changes of artery stiffness and myocardial perfusion in on-treated hypertensive patients.

Abstract W P116: Association Between Blood Pressure And Short-Term Prognosis of Symptomatic Intracranial Atherosclerotic Stenosis

Background and Purpose: Optimal blood pressure (BP) management for the patients with intracranial atherosclerotic stenosis (ICAS) has not been clearly defined. We investigated whether BP parameters during poststroke 7 months would affect the prognosis of symptomatic ICAS. Methods: Patients with acute symptomatic stenosis in the middle cerebral artery or the basilar artery were enrolled in Trial of cilOstazol in Symptomatic intracranial Stenosis 2 (TOSS-2). We included patients whose BP were measured 5 time points at baseline, 1, 3, 5 and 7 months during trial. Mean, maximum, maximum-minimum, standard deviation (SD), and coefficient of variation (CV) of systolic BP (SBP) and diastolic BP (DBP) were determined. The progression of symptomatic ICAS and the occurrence of new MRI lesions were investigated as the primary outcome by 7-month follow-up MR angiogram and MRI. Results: Of the 409 participants in TOSS-2 trial, 50 patients were excluded due to insufficient blood pressure value. Comparing 48 patients with the progression of symptomatic ICAS with 311 nonprogression group, no difference in mean SBP was observed. Values of maximum, maximum-minimum, SD and CV of SBP and DBP were not different between two groups either. All BP parameters were not different regarding the presence of new ischemic lesions on follow-up MRI. Patients with mean SBP below and above 140 mmHg during trials did not show different results in primary outcome (ICAS progression 11.6% vs. 17.6%, p=0.123; new MRI lesions 13.8% vs. 14.5%, p=0.890). Multivariable analysis revealed no specific BP parameters for the progression of ICAS or new ischemic MRI lesions during 7 months. Conclusions: No specific BP parameters were associated with the progression of ICAS and new lesion development on MRI during 7 months after stroke. Otherwise, no additional risks were noted in patients with symptomatic ICAS by mean BP below 140 mmHg.

Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis

Visit-to-visit blood pressure variation (VTV-BPV) is an independent risk factor for cardiovascular events and death in the general population. We sought to determine the association of VTV-BPV with outcomes in patients on hemodialysis, using data from a National Institutes of Health-sponsored randomized trial (the HEMO Study). We used the coefficient of variation (CV) and the average real variability (ARV) in systolic blood pressure (SBP) as metrics of VTV-BPV. 1844 of 1846 randomized subjects had at least three visits with SBP measurements and were included in the analysis. Median follow-up was 2.5 years (interquartile range [IQR] 1.3 to 4.3 years), during which time there were 869 deaths from any cause and 408 (adjudicated) cardiovascular deaths. The mean pre-dialysis SBP CV was 9.9% ± 4.6%. In unadjusted models, we found a 31% higher risk of death from any cause per 10% increase in VTV-BPV. This association was attenuated after multivariable adjustment but remained statistically significant. Similarly, we found a 28% higher risk of cardiovascular death per 10% increase in VTV-BPV, which was attenuated and no longer statistically significant in fully adjusted models. The associations among VTV-BPV, death and cardiovascular death were modified by baseline SBP. In a diverse, well-dialyzed cohort of patients on maintenance hemodialysis, VTV-BPV, assessed using metrics of variability in pre-dialysis SBP, was associated with a higher risk of all-cause mortality and a trend towards higher risk of cardiovascular mortality, particularly in patients with a lower baseline SBP.

Visit-to-Visit Blood Pressure Variability Is a Novel Risk Factor for the Development and Progression of Diabetic Nephropathy in Patients With Type 2 Diabetes

OBJECTIVERecent study has suggested that not only the presence of hypertension but also the variability in systolic blood pressure (SBP) are risk factors for vascular disease and organ damage. The aim of this study was to investigate the relationship between visit-to-visit variability in SBP and change in urinary albumin excretion (UAE) or development of albuminuria in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSWe measured SBP in 354 consecutive patients at every visit during 1 year and calculated the coefficient of variation (CV) of SBP. We performed a follow-up study to assess change in UAE or development of albuminuria, the mean interval of which was 3.76 ± 0.71 years. Then, we evaluated relationships of variability of SBP to diabetic nephropathy using multiple regression analysis and multiple Cox regression model.RESULTSMultiple regression analysis demonstrated that CV of SBP was independently associated with change in UAE (β = 0.1758; P = 0.0108). Adjusted Cox regression analyses demonstrated that CV of SBP was associated with an increased hazard of development of albuminuria; hazard ratio was 1.143 (95% CI 1.008–1.302).CONCLUSIONSVisit-to-visit variability in SBP could be a novel risk factor for the development and progression of diabetic nephropathy in patients with type 2 diabetes.

Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney disease

An association between visit-to-visit variability (VVV) of blood pressure (BP) and renal damage was recently reported in a cross-sectional study. We aimed to clarify the longitudinal effect of VVV of BP on deterioration of renal function in patients with non-diabetic chronic kidney disease (CKD). We retrospectively studied 56 patients with non-diabetic CKD (stage 3 or 4) who visited our nephrology clinic between September 1994 and May 2011. VVV of BP was defined as the standard deviation and coefficient of variation (CV) of office BP measured at 12 consecutive visits. Main outcomes were the annual decline in the estimated glomerular filtration rate (eGFR) and the composite renal end point defined as a doubling of serum creatinine or the need for dialysis. The median observation period was 83 months. Standard deviation and CV of office systolic BP (SBP) were significantly associated with the slope of the eGFR after adjustments for confounders. The adjusted risk for composite renal end points more than doubled for each increment of 1-standard deviation of the standard deviation of office SBP (hazard ratio (HR) 2.20, P=0.001), and for each increment of 1-standard deviation of the CV of office SBP (HR 2.12, P=0.002). The present study demonstrated that the visit-to-visit variability of BP is an independent determinant of deterioration of renal function in patients with non-diabetic CKD.

Variability of Home Blood Pressure Measurements Between First and Second Measurements on One Occasion, and Factors Related to Variability

The number of home blood pressure (BP) measurements on one occasion has continued to be discussed. Therefore, we evaluated the variability of the first and second measurements on one occasion. The subjects except hypertensive patients (393 males, 212 females; mean age 38.7 y) were recruited from one company. Home blood pressure was measured with a semiautomatic device, and subjects were instructed to perform triplicate morning and evening measurements on 7 consecutive days. The standard deviation of systolic blood pressure (SBP) was significantly greater in the first measurement than in the second measurement, but there was no significant difference in standard deviation of diastolic blood pressure. As for the coefficient of variation (CV), CV of morning SBP alone was significantly greater in the first measurement (5.3% ± 0.1%) than in the second measurement (4.9% ± 0.1%). Therefore, factors related to CV of morning SBP in the first measurement were studied, which indicated that it was significantly greater in smokers (5.8% ± 0.1%) than in nonsmokers (5.2% ± 0.1%), and in women (5.6% ± 0.1%) than in men (5.2% ± 0.1%). In conclusion, CV of morning SBP was significantly greater in the first measurement than in the second measurement. The coefficient of variation of morning SBP in the first measurement might be influenced to some extent by the presence or absence of smoking habit and gender. Therefore, physicians should pay special attention to the above-mentioned fact in the future.