Short-term Blood Pressure Variability Research Articles

Circadian rhythm of blood pressure and its correlations with short-term variability

Background. Arterial hypertension (AH) is the main risk factor for cardiovascular (CV) and cerebrovascular diseases. To effectively prevent damage to target organs and reduce morbidity and mortality, adequate control of blood pressure (BP), including its variability (VAR), is important. The latter includes circadian, short-term, and long-term components, and VAR is best documented with out-of-office BP monitoring methods such as ambulatory BP monitoring (ABPM). The morning rise (MR) of BP is one of the components of variability, its disturbances are associated with an increased risk of stroke and CV events, regardless of the level of BP. Purpose – the aim of the study was to study the relationship between the morning rise in blood pressure and the short-term blood pressure variability in patients with arterial hypertension. Materials and Methods. The study included 169 patients with hypertension aged 43 to 78 years. Based on the results of ABPM, an assessment of the morning dynamics and short-term BP VAR were carried out. To assess the morning dynamics of blood pressure, the speed and amplitude of MR of systolic BP (SBP) and diastolic BP (DBP) were studied. SBP and DBP VAR were evaluated separately for day, night, and 24-hour periods using the SD, SDcorr, and ARV indices. Results. In this open, non-randomized, cross-sectional study of patients with hypertension, a direct relationship between BP VAR and its morning dynamics was revealed – the increase in VAR was associated with greater amplitude and speed of BP MR. The established correlations were closer for MR amplitude than for MR speed, which allows to draw a conclusion about different pathogenesis mechanisms of their disorders and requires further study of this phenomenon. An increase in VAR SBP was associated not only with changes in the morning dynamics of SBP, but also with changes in the morning dynamics of DBP, and vice versa Conclusions. ABPM should be an essential part of the management of hypertensive patients with an individualized approach to pharmacotherapy to achieve not only optimal 24-hour BP control, but also correction of elevated BP and excessive morning rise for the best cardiovascular and cerebrovascular protection.

Abstract 4123826: Very Short-Term Blood Pressure Variability Determined by Pulse Transit Time Predicts Major Adverse Cardiac and Cerebrovascular Event in Patients with Heart Failure

Introduction: It has been reported that day-to-day blood pressure (BP) variability (BPV) is associated with major adverse cardiac and cerebrovascular events (MACCE) in patients with heart failure (HF). However, the clinical significance of beat-to-beat BPV is unclear. Methods and Results: We recruited data on patients with HF who underwent nighttime pulse transit time (PTT)-based continuous beat-to-beat BP measurement (n = 379, median age 71, male sex 53.6%). Standard deviation (SD) of PTT-based BP was considered as BPV. The primary outcome was MACCE defined as coronary artery disease, stroke, or death due to HF, acute coronary syndrome or ventricular fibrillation. Median values (25th and 75th percentiles) of SD of PTT-based systolic, diastolic, and mean BP were 4.2 (3.5, 5.3), 3.3 (2.7, 4.1), and 3.4 (2.8, 4.1) mmHg, respectively. During the follow-up period of median 1,083 days after BPV evaluation, 43 patients experienced MACCE. When patients were divided into three tertiles based on the systolic, diastolic, and mean BPV, MACCE occurred more frequently in those with higher tertiles of BPV ( Figure ). In the Cox proportional hazard analysis, systolic, diastolic, and mean BPV as continuous variables were associated with MACCE (hazard ratio, 1.191, 1.228, and 1.243, respectively). Conclusion: Beat-to-beat BPV was associated with MACCE in patients with HF.

Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study.

Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibit an increased cardiovascular risk compared to hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. In a randomized cross-over manner, 29 IDH patients underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice versa. 48h ambulatory BP measurement was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48 h, 24 h, day-time and night-time periods were calculated. Mean 48h BP was 5.3/2.6 mmHg lower with low compared to standard dialysate sodium concentration, (p = 0.005/p = 0.007 respectively). All 48 h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg, p = 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p = 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p = 0.392; SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p = 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some comparisons with a trend for lower BPV during day-time 2 and higher BVP during night-time 2 with low dialysate sodium. In conclusion, low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should explore alternative interventions to reduce BP and BPV in this high-risk population.

Intraoperative short-term blood pressure variability and postoperative acute kidney injury: a single-center retrospective cohort study using sample entropy analysis

BackgroundTo investigate if intraoperative very short-term variability in blood pressure measured by sample entropy improves discrimination of postoperative acute kidney injury after noncardiac surgery.MethodsAdult surgical patients undergoing general, thoracic, urological, or gynecological surgery between August 2016 to June 2017 at Seoul National University Hospital were included. The primary outcome was acute kidney injury stage 1, defined by the Kidney Disease: Improving Global Outcomes guidelines. Exploratory and explanatory variables included sample entropy of the mean arterial pressure and standard demographic, surgical, anesthesia and hypotension over time indices known to be associated with acute kidney injury respectively. Random forest classification and L1 logistic regression were used to assess four models for discriminating acute kidney injury: (1) Standard risk factors which included demographic, anesthetic, and surgical variables (2) Standard risk factors and cumulative hypotension over time (3) Standard risk factors and sample entropy (4) Standard risk factors, cumulative hypotension over time and sample entropy.ResultsTwo hundred and thirteen (7.4%) cases developed postoperative acute kidney injury. The median and interquartile range for sample entropy of mean arterial pressure was 0.34 and [0.26, 0.42] respectively. C-statistics were identical between the random forest and L1 logistic regression models. Results demonstrated no improvement in discrimination of postoperative acute kidney injury with the addition of the sample entropy of mean arterial pressure: Standard risk factors: 0.81 [0.76, 0.85], Standard risk factors and hypotension over time indices: 0.80 [0.75, 0.85], Standard risk factors and sample entropy of mean arterial pressure: 0.81 [0.76, 0.85] and Standard risk factors, sample entropy of mean arterial pressure and hypotension over time indices: 0.81 [0.76, 0.86].ConclusionAssessment of very short-term blood pressure variability does not improve the discrimination of postoperative acute kidney injury in patients undergoing non-cardiac surgery in this sample.

Beat-to-beat analysis of hemodynamic response to mental and psychological stress in sickle cell anemia

Abstract Objectives Vaso-occlusive crises are a hallmark symptom of SCD. Physical stressors can trigger decreased microvascular blood flow and increase the risk for vaso-occlusive crises. However, the effect of mental and psychological stressors on vascular physiology in SCD is not well-established. We hereby examined fluctuations in continuous blood pressure to evaluate hemodynamic changes in SCD patients during mental and psychological stress. Methods Thirteen SCD subjects from the Children’s Hospital Los Angeles and 11 healthy volunteers were recruited. Continuous blood pressure was recorded during 2 mental tasks and 1 psychological stress task. Systolic beat-to-beat blood pressure variability measurements were calculated for each subject. Three very short-term blood pressure variability metrics served as outcome measures: SD, coefficient of variation, and average real variability. Peripheral augmentation index was calculated from arterial waveforms. Linear mixed effects models evaluated associations between patient factors and outcome measures. Results SCD patients exhibit increased systolic blood pressure variability in response to psychological stress. All subjects exhibited a decrease in systolic blood pressure variability in response to mental stress tasks. During mental stress, both groups displayed increased augmentation index, reflective of stress-induced vasoconstriction, while psychological stress in SCD patients led to both decreased mean arterial pressure and increased augmentation index, suggestive of uncompensated vasoconstriction. Conclusion These findings emphasize the impact of mental and psychological stressors on vascular function in SCD and the potential for monitoring physiological signals to predict vaso-occlusive crisis events.

Relationships among intensive blood pressure control, morning blood pressure surge and 24-hour blood pressure variability

Abstract Objectives This study aimed to investigate the relationships between cardiovascular outcomes and blood pressure (BP) reduction, 24-hour BP variability (BPV), morning BP surge (MBPS), and visit-to-visit BPV. Methods This study involved 897 participants from the Systolic Blood Pressure International Trial (SPRINT), for whom biochemical and demographic data, medication history, and various blood profile information were collected. Univariate and multivariate linear regression models were used to assess the impact of intensive BP management on 24-hour BPV and the MBPS. Results Among the 897 participants (average age 71.48 ± 9.42 years; 640 males), 453 received intensive treatment. Those in the intensive group were more likely to be on ACE inhibitors, CCBs, or diuretics. This group showed significant reductions in 24-hour systolic and diastolic BP, as well as in both short-term and long-term BPVs, such as average real variability (ARV) and MBPS. The analysis demonstrated strong associations between intensive BP management and improvements in various BPV measures, including systolic ARV, diastolic BP ARV, and cumulative BP loads. A significant correlation was also found between intensive BP lowering and the primary composite outcome of the SPRINT study. Conclusions This study highlighted the significant associations between intensive BP management and reductions in the MBPS and 24-hour BPV, which affect both short-term and long-term health outcomes. The primary benefits of intensive BP control appear to stem from direct BP reduction rather than changes in BPV. However, further extensive randomized controlled trials are needed to confirm these findings.

Very short-term blood pressure variability by pulse transit time-based measurements during night-time predicts future cardiovascular events in patients with ischemic heart disease

Very short-term blood pressure variability by pulse transit time-based measurements during night-time predicts future cardiovascular events in patients with ischemic heart disease

O94 MOST EFFECTIVE EXERCISE INTERVENTIONS FOR REDUCING SHORT-TERM BLOOD PRESSURE VARIABILITY: A META-ANALYSIS

Objective: Blood pressure variability (BPV) is a risk factor for cardiovascular disease. Growing evidence suggests that exercise plays a critical role in reducing BPV. Hence, this study aimed to examine the specific types of exercise that are most effective in reducing BPV. Design and Method: A literature search was conducted across electronic databases including MEDLINE, Embase, and PsycINFO from their inception to February 2024. The assessment of short-term BPV involved the utilization of diverse equations, such as standard deviations, coefficient of variation, and average real variability, as reported in the included studies. Regarding the heterogeneity arising from the varied calculation methods, standardized mean differences were employed. The heterogeneity was carried out using the I2 statistic, with a fixed-effect Mantel-Haenszel model applied in cases where I2 < 50%, and a random-effect model employed when I2 > 50%. Results: A total of 8,359 literature records were identified from the electronic databases, 21 articles met the inclusion criteria and were included in this study. Among these, 12 articles were randomized controlled trials (RCTs), 4 were pre-post clinical trials, 2 were cross-sectional studies, and 3 were cohort studies. Among the RCTs, 11 studies focused on short-term blood pressure variability (BPV) as the primary outcome, while the remaining 2 RCTs examined long-term BPV. The collective analysis of 529 participants revealed that exercise interventions resulted in significant improvements in short-term SBPV (standardized mean difference [SMD] [95% CI] = -0.56 [-1.04 to -0.09]) and DBPV (-0.62 [-1.02 to -0.22]). Specifically, resistance exercise demonstrated notable reductions in SBPV (-0.62 [-1.15 to -0.10]), while no significant effects were observed on DBPV (0.04 [-0.54 to 0.62]). Conversely, aerobic exercise exhibited beneficial effects on both SBPV (-0.57 [-1.16 to 0.01]) and DBPV (-0.82 [-1.43 to -0.21]) (Table 1). Conclusion: Exercise interventions showed significant improvements in short-term SBPV and DBPV, with resistance exercise specifically reducing SBPV and aerobic exercise benefiting both SBPV and DBPV.

Abstract P329: Mycophenolate Mofetil Enhances Short-Term Blood Pressure Variability During Recovery in Salt-Sensitive Hypertensive African Americans

Elevated blood pressure variability (BPV) is an independent risk factor for cardiovascular disease (CVD), kidney disease, dementia, and stroke. High BPV is thought to be caused by arterial stiffness, vascular remodeling, inflammatory cascades, and neurohormonal mechanisms. This study aims to investigate the potential impact of mycophenolate mofetil (MMF) on short-term BPV in the context of salt-sensitive hypertension among African Americans (AA). MMF’s anti-inflammatory properties hold promise as a potential intervention for hypertension management by modulating short-term BPV. AA participants,18-50 years, normotensive, not pregnant, and not on prescription medications were recruited. In this crossover study, 51 participants received either MMF or a placebo daily. Physiological parameters were monitored every 15 minutes during a 3-hour psychosocial stressor assessment with rest, stress, and recovery periods. BPV was assessed using coefficient of variation (CV), standard deviation (SD), and average real variability (ARV). The treatment group showed a significant decrease in SBP CV (p < 0.05) during stress. During recovery, SBP SD (p, 0.05) and SBP ARV (p < 0.05) significantly increased in individuals receiving MMF treatment. Age-stratified analysis maintained significant effects of MMF on BPV during stress. Gender did not significantly alter the observed effects of MMF on BPV. Our study highlights the effectiveness of MMF in reducing BPV during acute stress, potentially lowering adverse cardiovascular events. MMF-treated groups showed increased BPV during recovery, indicating a quicker BP recovery to baseline. While a decrease in BPV during the stress period was observed, it was supported only by CV. The significant increase in BPV in the treatment group during recovery indicates MMF's ability to expedite the inflammatory stress response. The observed decrease in BPV during stress suggests a swifter return to baseline BP, potentially offering benefits for non-stress baseline physiology. Further research is warranted to clarify the mechanisms and clinical significance of these findings, impacting hypertension assessment and management. MMF treatment induces distinct changes in BPV during recovery, suggesting that MMF may positively influence BP regulation through a variety of inflammatory pathways. The alterations in SBP BPV underscore MMF's therapeutic potential for managing BPV and reducing cardiovascular risk in salt-sensitive, hypertensive AAs.

Short-Term Blood Pressure Variability among Young Adults at High or Low Risk for Depression.

Background: Depression has been shown to have adverse effects on blood pressure (BP) and is associated with high blood pressure variability (BPV). In turn, high short-term BPV has been related to eventual cardiovascular risk. But it is not clear how early in adulthood the detrimental effects of depression on BPV may be discerned, if being at high risk for depression also compromises BPV, and whether the clinical features of depression moderate its adverse effects. We investigated these three issues among young adults using an office-like setting. Methods: In total, 218 subjects with a history of childhood-onset major depressive episodes (probands), 206 never-depressed full biological siblings of the probands (high-risk siblings), and 166 emotionally healthy unrelated controls received a psychiatric evaluation and three standardized-sitting BP measurements 5 min apart. Short-term BPV was defined as the maximum difference between measures (range) for each case. The statistical methods included analyses of variance/covariance, chi-square tests, and multiple regression. Results: Systolic and diastolic BP decreased over consecutive measurements (p < 0.001). After controlling for age, the probands, siblings, and controls did not differ significantly in terms of BPV. However, the number of lifetime depressive episodes did predict the diastolic BP range (p = 0.005): probands with the highest number of depressive episodes had the largest short-term diastolic BPV. Conclusions: On a group level, the adverse effects on BPV of having experienced or being at high risk for depression are not yet evident during young adulthood. However, the number of major depressive episodes, which is an index of lifetime depression burden, predicts higher BPV. Thus, BPV monitoring for young adults with clinical depression histories could be part of an early intervention program to reduce the risk of eventual cardiovascular disease.

Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-mediated Chronic Inflammation.

Blood pressure (BP) variability (BPV) has emerged as an indicator of subclinical organ damage and an independent predictor of cardiovascular disease (CVD) morbidity and mortality in high-risk populations. We aimed to assess short-term variability of both brachial and aortic BP in psoriasis, a common immune-mediated inflammatory disorder characterized by increased CVD risk. Psoriasis patients and non-psoriasis individuals had their BP assessed throughout a 24h period (Mobil-O-Graph device). Brachial and aortic BPV during the 24h and the respective daytime and nighttime periods was calculated from relevant ambulatory BP profiles. In-house software was applied to automatically calculate average real variability (ARV) of brachial and aortic systolic (bSBP, aSBP) and diastolic BP (bDPB, aDBP), and the weighted standard deviation (wSD) of 24h bSBP/aSBP. 24h pulse wave velocity (PWV) and augmentation index (AIx) were used as widely applied markers of arterial stiffness. Psoriasis patients (n = 74) presented increased ARV of 24h and daytime bSBP/aSBP, and increased ARV of 24h and daytime bDBP/aDBP, compared to controls (n = 40). PWV and AIx correlated with ARV of 24h bSBP/aSBP, daytime bSBP/aSBP, while PWV further correlated with ARV of nighttime aSBP. The observed associations with PWV, yet not AIx, with indices of BPV remained significant after adjusting for CVD risk factors. This is the first study reporting increased 24h variability of both brachial and aortic BP in psoriasis. The association of short-term BPV with arterial stiffness implies a potential role of BPV in terms of CVD risk stratification in patients with chronic immune-mediated inflammation.

Commentary on "Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-Mediated Chronic Inflammation".

Commentary on "Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-Mediated Chronic Inflammation".

#1488 Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study

Abstract Background and Aims Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibited an increased cardiovascular risk than hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137 mEq/L) compared to standard (140 mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. Method In a randomized cross-over manner, 29 patients with IDH underwent 4 hemodialysis sessions with low (137 mEq/L) followed by 4 sessions with standard (140 mEq/L) dialysate sodium or vice versa according to randomization arm. 48-h ABPM was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48-h, 24-h, day-time and night-time periods were calculated with validated formulas. Results Mean 48-h BP was lower by 5.3/2.6 mmHg with low compared to standard dialysate sodium concentration, (p = 0.005/p = 0.007) respectively). All 48-h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg; p = 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p = 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p = 0.392 and SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p = 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some further comparisons relevant to a trend for lower BPV during daytime 2 and higher BVP during nighttime 2 during treatment with low dialysate sodium. Conclusion Low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should further explore alternative interventions to reduce BP and BPV in this high-risk population.

A Single Bout of Prolonged Sitting Augments Very Short-Term Blood Pressure Variability.

More habitual time spent engaging in prolonged sedentary behaviors increases the risk of developing hypertension. Beat-by-beat systolic (SBPV) and diastolic blood pressure variability (DBPV) are more pronounced in persons with hypertension and may be an early manifestation of blood pressure dysregulation. We tested the hypothesis that a single bout of prolonged sitting augments very short-term SBPV and DBPV. The secondary aim was to explore sex differences in prolonged sitting-induced increases in SBPV and DBPV. Thirty-three adults (22.9 ± 1.9 years; 17 females) completed a single, 3-hour bout of prolonged sitting with beat-by-beat arterial pressure determined at baseline, 1.5-hour, and 3-hour via finger photoplethysmography. There were no sex differences observed for baseline brachial SBP (males: 122 ± 10 mm Hg; females: 111 ± 9 mm Hg), SBPV (males: 1.87 ± 0.63 mm Hg; females: 1.51 ± 0.38 mm Hg), DBP (males: 68 ± 6 mm Hg; females: 66 ± 8 mm Hg), or DBPV (males: 1.40 ± 0.41 mm Hg; females: 1.27 ± 0.32 mm Hg) (all, P > 0.41). In the pooled sample, baseline SBPV (1.68 ± 0.54 mm Hg) remained unchanged after 1.5 hours (1.80 ± 0.60 mm Hg; P = 0.59) but increased after 3.0 hours (1.84 ± 0.52 mm Hg; P = 0.01). This post-sitting increase was driven by males (P = 0.009), with no difference observed in females (P = 1.00). Similarly, baseline DBPV (1.33 ± 0.36 mm Hg) was similar after 1.5 hours (1.42 ± 0.41 mm Hg; P = 0.72) but was increased at 3 hours (1.50 ± 0.34 mm Hg; P = 0.02). However, no sex differences in DBPV (all, P > 0.07) were observed across the time points. In young, normotensive adults, a single bout of prolonged sitting augmented beat-by-beat blood pressure variability, which may provide a link between uninterrupted sitting and the development of blood pressure dysregulation.

ASSOCIATION OF OFFICE AND AMBULATORY BLOOD PRESSURE MONITORING WITH COGNITIVE FUNCTION AND DEMENTIA PREVALENCE

Objective: Blood pressure (BP) is an important risk factor for cognitive decline and dementia. However, it is unclear which measures of BP obtained from office and ambulatory BP monitoring assessments are better related with cognition and dementia. Therefore, we evaluated the association of office and ambulatory BP measures with cognitive function and dementia at baseline. Design and method: We included baseline information of 1435 participants aged 50y or older from a population-based study whom underwent 24-h ambulatory BP monitoring, cognitive function, and neurological assessments. Office and ambulatory BP monitoring measures included systolic BP level and short-term variability quantified using the average real variability (ARV) index. Cognitive function examination included the minimental state examination (MMSE) and selective reminder tests ([SRL], total retrieval, long-term retrieval, and delayed recall). Dementia was a clinical dementia rating scale equal or higher than 1. We performed adjusted logistic and linear regression models to evaluate the association of office and ambulatory BP monitoring measures with cognitive function and dementia. Results: The mean age was 63.8±10.3 and 69.1% (n=963) were women. The prevalence of dementia was 3.21 (n=46). In adjusted logistic regression models, only ARV of the 24-h (odds ratios [OR] per +1-standard deviation [SD] increase in ARV, 1.42; 95% confidence interval [CI], 1.07-1.88) and nighttime (OR, 1.37; 95% CI, 1.05-1.78) systolic BP were associated with dementia at baseline. In adjusted linear regression models, only ARV was associated with lower scores in the MMSE and the SRL tests (adjusted-mean scores per +1SD increase in ARV ranged from -0.09 to -0.06 points; P values below 0.027). These associations remained after models were additionally adjusted by the BP level (P values below 0.033) Conclusions: Among office and ambulatory BP monitoring measures, higher short-term variability in the 24-h and nighttime systolic BP was associated with lower cognitive function and dementia independent of the BP level. This is the first epidemiological study showing an association between short-term BP variability and dementia. Future longitudinal studies need to address whether short-term BP variability could be a potential marker for cognitive decline and might help in assessing the risk of dementia.

BLOOD PRESSURE VARIABILITY AS PREDICTOR OF CANCER THERAPY-RELATED CARDIOVASCULAR TOXICITY IN PATIENTS WITH MULTIPLE MYELOMA

Objective: Blood pressure variability (BPV) is an independent predictor of cardiovascular (CV) events and overall mortality. The potential role of BPV in defining CV risk of patients undergoing anticancer therapy with a potential cancer therapy-related cardiovascular toxicity (CTR-CVT) is currently unknown. The aims of this study were: (i) to assess the predictive value of BPV indexes for CTR-CVT development and defining the corresponding cut-off values; (ii) to identify subgroups of subjects based on BPV, through clustering analysis. Design and method: Patients with Multiple Myeloma, who were eligible to anticancer therapy with Carfilzomib, were consecutively enrolled and underwent a baseline evaluation, including office blood pressure (BP) measurement, 24h-Ambulatory Blood pressure Monitoring (ABPM), PWV, and Echocardiography. Short-term BPV was assessed through standard deviation (SD), weighted standard deviation (wSD), coefficient of variation (CoV), average real variability (ARV), and variability independent of the mean (VIM), evaluated on ABPM measurements. Results: The study population included 124 patients (50% female). During follow-up, CTR-CVT occurred in 70 subjects (56.5% of the total population), including both BP and CV events. Night-time BPV was associated to CTR-CVT, independently by BP, age, smoking, and comorbidities as diabetes and renal dysfunction (night-time systolic CoV: adjusted OR 1.11 [1.01-1.22]; night-time systolic VIM adjusted OR 1.17 [1.03-1.35]; night-time diastolic VIM adjusted OR 1.18 [1.01-1.40]). Cut-off for these BPV parameters were identified as predictor of CTR-CVT occurrence: 10.5 for night-time systolic CoV (sensibility 73%, specificity 47%); 7.8 and 6.4 for systolic and diastolic night-time VIM (sensibility 85% for both; specificity 35% and 39%, respectively). Clustering analysis identified a subgroup of subjects characterized by the highest BPV, who had a greater prevalence of events during follow-up, but no differences in other conventional CV risk factors, as BP, dyslipidaemia, diabetes, renal function, and smoking habit, as well as left ventricular mass and global longitudinal strain. Conclusions: Short-term BPV is an independent predictor of CTR-CVT in patients with Multiple Myeloma undergoing therapy with Carfilzomib. The inclusion of these indexes improves CV risk prediction in these subjects and higher BPV is a distinctive feature predicting adverse events, on top of conventional CV risk factors.

The impact of short-term blood pressure variability on dementia in Parkinson’s disease in relation to the renin-angiotensin system

The impact of short-term blood pressure variability on dementia in Parkinson’s disease in relation to the renin-angiotensin system

Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study.

Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span.

Association between short-term blood pressure variability and target organ damage in non-dialysis patients with chronic kidney disease

BackgroundIt is unclear whether short-term blood pressure variability (BPV) is associated with target organ damage in patients with non-dialysis chronic kidney disease (CKD).MethodsA cross-sectional, single-center study was conducted among 3442 non-dialysis CKD patients hospitalized in the department of Nephrology of the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2022 and collected the demographic, laboratory, clinic blood pressure, ambulatory blood pressure data, and short-term BPV assessed by the weighted standard deviation (wSD) derived from ambulatory blood pressure monitoring (ABPM). Multivariate logistic analyses were used to evaluate the independent effects between short-term BPV and subclinical target organ damage, including left ventricular hypertrophy (LVH), abnormal carotid intima-media thickness (CIMT), low estimated glomerular filtration rate (eGFR), and albuminuria.ResultsThe average age of the participants was 47.53 ± 14.06 years and 56% of participants were male. The baseline eGFR was 69 mL/min/1.73 m2. Based on the tertile distribution of wSD according to equal numbers, patients were divided into three categories with T1(< 9.66 mmHg), T2(9.66–12.23 mmHg), and T3(> 12.23 mmHg) of SBPV; T1(< 8.17 mmHg), T2(8.17–9.93 mmHg), and T3(> 9.93 mmHg) of DBPV. The participants with the higher wSD group had a higher prevalence of target organ damage than their counterparts (P-trend < 0.05). An increasing trend in short-term variability was present with advancing CKD stages (P-trend < 0.001). Multivariate logistic analyses results showed that the odds ratio (OR) of SBP wSD was (1.07 [1.03,1.11], P < 0.001) for LVH, (1.04 [1.01,1.07, P = 0.029) for abnormal CIMT, (1.05 [1.02,1.08], P = 0.002) for low eGFR, and (1.06 [1.02,1.09], P = 0.002) for albuminuria; The OR of DBP wSD was (1.07 [1.02,1.12], P = 0.005) for LVH, (1.05 [1.01,1.09], P = 0.028) for abnormal CIMT, (1.05 [1.01,1.09], P = 0.022) for low eGFR, and (1.05 [1.01,1.10], P = 0.025) for albuminuria when adjusted for confounding factors and mean BP.ConclusionsIn conclusion, short-term BPV is associated with target organ damage, and irresponsible of average blood pressure levels, in Chinese non-dialysis CKD participants.

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

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