Home Blood Pressure Variability Research Articles

Relationship between arterial stiffness and variability of home blood pressure monitoring.

Variability of blood pressure (BP) is known as a prognostic value for the subsequent target organ damage in hypertensive patients. Arterial stiffness is a risk factor for cardiovascular morbidity and mortality. The relationship between the arterial stiffness and the BP variability has been controversial. The objective of the present study was to investigate the relationship between arterial stiffness and home BP variability in patients with high normal BP and new onset hypertension (HTN).Four hundred sixty three patients (252 males, 49 ± 12 year-old) with high normal BP or HTN were enrolled. Using radial applanation tonometry, pulse wave analysis (PWA) was performed for evaluation of systemic arterial stiffness. All patients underwent both home BP monitoring (HBPM) and PWA. Home BP variability was calculated as the standard deviation (SD) of 7 measurements of HBPM. Multiple linear regression analysis was performed to estimate and test the independent effects of home BP variability on the arterial stiffness.Mutivariate analysis showed that both systolic and diastolic morning BP variabilities were correlated with arterial stiffness expressed as augmentation pressure (AP, β-coefficient = 1.622, P = .01 and β-coefficient = 1.07, P = .035). The SDs of systolic and diastolic BP of evening were also associated with AP (β-coefficient = 1.843, P = .001 and β-coefficient = 1.088, P = .036). The SDs of morning and evening systolic BP were associated with augmentation index (AI, β-coefficient = 1.583, P = .02 and β-coefficient = 1.792, P = .001) and heart rate (75 bpm) adjusted AI (β-coefficient = 1.592, P = .001 and β-coefficient = 1.792, P = .001).In present study, the variability of systolic BP was closely related with arterial stiffness. The home BP variability might be important indicator of arterial stiffness.

Association of home and ambulatory blood pressure variability with left ventricular mass index in chronic kidney disease patients.

Increased blood pressure (BP) variability is associated with the development of target organ damage. However, the optimal type and index of BP variability (BPV) regarding their prognostic significance is unclear. The aim of our study was to compare the association of ambulatory and home BPV with the left ventricular mass index (LVMI) in patients with chronic kidney disease (CKD). From a total of 1560 consecutive subjects, 137 hypertensive patients with CKD underwent home and ambulatory BP monitoring and echocardiographic measurements. The variability of home BP monitoring was quantified by using the standard deviation (SD), coefficient of variation (CV), and morning minus evening BP values. Ambulatory BPV was quantified using the SD, CV, and the time rate (TR) of BP variation. The univariate analysis demonstrated that day-to-day systolic SD and the 24-h TR of systolic BP (SBP) variation were significantly associated with the LVMI. The multivariate linear regression analysis showed a significant and independent association of the LVMI with the 24-h TR of SBP variation (B = 9.204, 95% CI: 1.735-16.672; p = 0.016). A 0.1-mmHg/min increase in the 24-h TR of SBP variation was associated with an increment of 9.204 g/m2 in the LVMI, even after adjustment for BP and other vascular risk factors. In conclusion, ambulatory BPV but not home BPV was associated with the LVMI in CKD patients. The 24-h TR of SBP variation was the only BPV index associated with the LVMI, independent of average BP values.

Associations Between Day-by-Day Home Blood Pressure Variability and Renal Function and Albuminuria in Patients With and Without Diabetes.

The phenotype of diabetic kidney disease represents a lower estimated glomerular filtration rate (eGFR) and albuminuria. We investigated the association between day-by-day home blood pressure (BP) variability and the eGFR in subjects with diabetes and compared this association with that in subjects without diabetes. We then attempted to determine whether the association is present in albuminuria. We analyzed 4,231 patients with risk factors of cardiovascular disease (24.4% with diabetes) from the J-HOP (Japan Morning Surge-Home Blood Pressure) study. Home BP was measured in the morning and evening for 14 days. We calculated the SD, coefficient of variation, average real variability (ARV), and variation independent of the mean of the subjects' morning and evening home systolic BP (SBP) as the indexes of day-by-day home BP variability. A multiple linear regression analysis adjusted for covariates showed both average morning and evening SBP were associated with the log-transformed urine albumin-to-creatinine ratio (UACR) with and without diabetes (all P < 0.05), but not with the eGFR except for an association of average evening SBP in the no-diabetes group. None of the indexes of day-by-day morning and evening home SBP variability were associated with the log-transformed UACR except for the association between the ARV of home morning SBP in the diabetes group. All of the indexes of day-by-day morning and evening home SBP variability were associated with the eGFR only in the diabetes group (all P < 0.05). The association between increased day-by-day home BP variability and impaired renal function was unique in diabetes.

P1298SEASONAL VRIABILITIES OF HOME AND CLINIC BLOOD PRESSURE IN HEMODIALYSIS PATIENTS ARE DPEND ON VOLUME STATUS AND TEMPERATURE CHANGE IN MULTICENTER OF VARIOUS DISTRICTS IN JAPAN

Abstract Background and Aims In general population, there are weekly and seasonal variabilities of blood pressure (BP) which are supposed to be the risk of cardiovascular disease. Home BP is well correlated to the cardiovascular risk compared to clinic BP. We already reported home and clinic BP of hemodialysis (HD) patients fluctuate seasonally partly due to temperature. The aim of this study is to determine in large number of HD patients whether the seasonal BP variability correlates to the volume status and temperature. Method One hundred sixty nine dialysis patients (93 male, 76 female) in ten Saiseikai hospitals in various districts in Japan were recruited. All patients were asked to measure BP at least four times a day in a sitting position, twice consecutively in the morning after urination before breakfast and medication and twice consecutively in the evening just before going to bed. The mean of twice measurements was defined as the data of measurement time. Data from Oct. 2015 to Oct. 2017 were analyzed. If the dialysis were performed 3 times a week (Mon, Wed, Fri), Monday was defined as 1st day. If the dialysis were performed on Tue. Thurs. and Sat., Tuesday was defined as 1st day. Seasonal variabilities in morning home BP and night home BP were evaluated. Seasonal changes in clinic BP just before and after HD were also evaluated in 61 patients. Results Weekly home BP variability in the morning, 1st day 153±16 / 78±13 mmHg, 2nd day 144±28 / 76±12, 3rd day 150±14 / 77±13, 4th day 142±26 / 75±13, 5th day 149±14 / 77±12, 6th day 144±24 / 76±13, 7th day 149±16 / 78±13. Systolic home BPs in 1st, 3rd and 5th days were significantly elevated compared with 2nd, 4th and 6th days. Morning home BP significantly elevated gradually from 6th, 7th and to 1st day. Lowest SBP in the morning was 4th day but not 6th day which was the same as the previous result (CJASN 3: 416-422, 2008). Seasonal variability of morning home BP in 1st day was evident with the rise in autumn and winter (spring 153±19 / 78±12, summer 146±17 / 77±12, autumn 158±16* / 80±12, winter 156±19* / 80±13, * p&amp;lt;0.05 vs summer) (figure). There was almost same seasonal morning home BP variability in 4th day which had the lowest value of morning home BP in a week. Seasonal changes of night home BP in 5th day were not significant through four seasons, which night was supposed to be the driest volume status in a week. Seasonal changes in clinic BP just before and after HD, in 1st day before HD: spring 147±19 / 74±13 mmHg, summer 144±20 / 71±11, autumn 150±19 / 74±13, winter 147±21 / 74±12. Systolic BP in autumn was significantly elevated compared to summer. In the other clinic BPs before and after HD in 3rd and 5th days, there were no significant seasonal changes observed. Seasonal changes of highest temperature were significant (spring 19.9±3.1*°C, summer 30.9±2.6, autumn 23.3±2.7*, winter 8.5±2.8*, *p&amp;lt;0.05 vs summer). Morning BP of 1st day in a randomly selected patient was correlated with highest temperature (r=-0.397 p&amp;lt;0.0001). Discussion There is seasonal home BP variability probably due to temperature change because BP was correlated well with temperature. Seasonal morning BP variability was evident in the 1st day of the HD week, but this seasonal home BP variability was disappeared measuring BP in the night without volume overload. We assumed that vasoconstriction due to change in temperature was enhanced by volume overload and sympathetic activation in the morning. Conclusion In the large number of HD patients in multicenter of various districts in Japan, seasonal BP variabilities were affected by the volume status and temperature.

Increased Arterial Stiffness Amplifies the Association Between Home Blood Pressure Variability and Cardiac Overload: The J-HOP Study.

Increased blood pressure (BP) variability, an index of hemodynamic stress, leads to cardiac overload and worse cardiovascular prognosis. The association between day-by-day home BP variability and NT-proBNP (N-terminal pro-B-type natriuretic peptide) as an index of cardiac overload may be amplified by increased arterial stiffness as assessed by brachial-ankle pulse wave velocity (baPWV). J-HOP (Japan Morning Surge-Home Blood Pressure) Study participants who were selected from a practitioner-based population with at least one cardiovascular risk factor underwent home BP monitoring, and their BP levels and SD, coefficient of variation, and average real variability as indexes of systolic BP variability were assessed. We analyzed 2115 individuals without prevalent heart failure and divided them into lower (<1800 cm/s, n=1464) and higher (≥1800 cm/s, n=651) baPWV groups. The higher baPWV group had significantly higher SDSBP, CVSBP, ARVSBP values, and NT-proBNP levels than the lower baPWV group (all P<0.001). In the higher baPWV group, a multiple linear regression analysis revealed that the SDSBP was associated with the NT-proBNP level after adjustment for traditional cardiovascular risk factors including the average home systolic BP (coefficient per 1 SD increase, 0.049 [95% CI, 0.018-0.081]; P=0.002). Similar trends were found for CVSBP (P=0.003) and ARVSBP (P=0.004). However, these associations were not found in the lower baPWV group. There was an interaction between all indexes of systolic BP variability and the NT-proBNP level according to lower or higher baPWV group (all P<0.05). Arterial stiffness amplified the association between home BP variability and cardiac overload.

Comparison of Blood Pressure Variability Between Losartan and Amlodipine in Essential Hypertension (COMPAS-BPV)

Antihypertensive therapy using renin-angiotensin system blockers and calcium channel blockers to target blood pressure variability (BPV) has not yet been established. We aimed to compare the ability of losartan and amlodipine to lower BPV and systolic blood pressure (SBP) in essential hypertensive patients. Patients were randomly assigned either losartan 50 mg or amlodipine 5 mg. Medications were uptitrated and hydrochlorothiazide was added according to protocol for 6 months. The primary endpoint was the office visit-to-visit SD of SBP. The secondary endpoints included average real variability (ARV), office SBP, and home SBP. The losartan group (n = 71) and amlodipine group (n = 73) finished the scheduled visits between April 2013 and May 2017. The office visit-to-visit SD of SBP was comparable between the losartan and amlodipine groups (11.0 ± 4.2 vs. 10.5 ± 3.8, P = 0.468). The office visit-to-visit ARV of SBP was significantly elevated in the losartan group (10.6 ± 4.3 vs. 9.1 ± 3.4, P = 0.02). The absolute SBP decrement from baseline to 6 months was similar between groups, although the office mean SBP at 6 months was higher in the losartan group (132.3 ± 12.9 vs. 127.5 ± 9.0 mm Hg, P = 0.011). In home blood pressure analysis, evening day-to-day BPV indexes (SD and ARV) were significantly higher in the losartan group at 6 months. The lowering effect of the office visit-to-visit SD of SBP was similar between losartan and amlodipine. However, the losartan group showed a higher office visit-to-visit ARV of SBP and evening day-to-day home BPV indexes. Therefore, amlodipine may be better to lower BPV in essential hypertensive patients.

Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population.

Background:High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-to-day BPV also relates to cSVD has not been investigated.Objective:To investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden in older memory clinic patients.Methods:We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0–4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP.Results:For 82 patients (aged 71.2±7.9 years), mean home BP was 140/79±15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04–1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden.Conclusion:Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints.

Day-to-day blood pressure variability is associated with lower cognitive performance among the Japanese community-dwelling oldest-old population: the SONIC study.

Although high blood pressure (BP) and BP variability have been reported to be associated with cognitive impairment, few studies have investigated the association between home BP (HBP) and cognitive function in the oldest-old. The aim of this study was to evaluate whether the value of and the day-to-day variability in HBP was associated with cognitive function in a Japanese community-dwelling oldest-old population. Among 111 participants aged 85-87 years, cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). HBP was measured two times every morning for a median of 30 days. The value of and variability in HBP were calculated as the average and coefficient of variation (CV) of the measurements, respectively. The associations of HBP variability with MoCA-J were examined using multiple linear regression models. Of 111 participants, 47.7% were men, and 64.0% were taking medications for hypertension. The mean HBP was 141.9 ± 14.8/72.2 ± 8.4 mmHg, and the mean CV of HBP was 6.7 ± 1.9/6.8 ± 2.4. The mean total MoCA-J score was 22.9 ± 3.5. The MoCA-J score was significantly lower with increasing CVs of both systolic BP (b = -0.36, p = 0.034) and diastolic BP (b = -0.26, p = 0.046) after adjustment for possible confounding factors. The value of HBP was not associated with MoCA-J. In the community-dwelling oldest-old population, higher day-to-day HBP variability, but not the value of HBP, was associated with cognitive impairment. When measuring HBP, attention should be paid not only to the values but also to their variations.

Effect of Improving Volume Overload on Home Blood Pressure Variability in Hemodialysis Patients

Blood pressure variability is an independent predictor of adverse clinical events in hemodialysis patients. Volume overload is one of the most important factors affecting blood pressure homeostasis. In the present study, we explored the effects of dry weight reduction on home blood pressure variability in volume overload hemodialysis patients. Hemodialysis patients with volume overload had their dry weight gradually decreased under the guidance of bioimpedance methods, which was represented by calf-bioimpedance ratio (Calf-BR). Home blood pressure was measured on waking up and at bedtime for 1 week at baseline and at the end of the two-month study. Coefficient of variation was used to define home blood pressure variability. Thirty-eight hemodialysis patients had their dry weight significantly decreased from 60.7 ± 11.3 to 59.6 ± 10.7 kg (P = 0.003) accompanied with a significant reduction in calf-BR (0.828 ± 0.023 vs. 0.786 ± 0.020, P<0.001). The systolic and diastolic blood pressure decreased significantly. Moreover, the whole-day, morning, and evening systolic blood pressure variability gradually and significantly decreased by the end of the study (5.6 ± 2.1% versus 4.0 ± 1.7%, P<0.001; 7.7 ± 3.5% vs. 6.3 ± 2.7%, P = 0.005; 7.5 ± 2.8% vs. 5.9 ± 2.3%, P = 0.002, respectively). Diastolic blood pressure variability parameters were unchanged. The interdialytic weight gain and the incidence of adverse events were similar throughout the study period. Gradual dry weight reduction by bioimpedance methods improved home blood pressure variability in hemodialysis patients with chronic fluid overload.

MON-149 SEASONAL AND WEEKLY VARIABILITY OF BLOOD PRESSURE IN HEMODIALYSIS PATIENTS IN MULTICENTER OF VARIOUS DISTRICT IN JAPAN

In general population, there are weekly and seasonal variabilities of blood pressure (BP) which are supposed to be the risk of cardiovascular disease. Home BP is well correlated to the cardiovascular risk compared to office BP. The aims of this study are to determine whether home BP in large number of hemodialysis (HD) patients fluctuate seasonally and weekly and whether the seasonal BP variability correlate to the temperature. 169 dialysis patients (93 male, 76 female) in ten Saiseikai hospitals in various districts in Japan were recruited. All patients were asked to measure BP at least twice a day in a sitting position, once in the morning after urination before breakfast and medication and once in the evening just before going to bed. Data from Oct. 2015 to Oct. 2017 were analyzed. If the dialysis were performed 3 times a week (Mon, Wed, Fri), Monday was defined as 1st day. If the dialysis were performed on Tue. Thurs. and Sat., Tuesday was defined as 1st day. Seasonal variabilities in morning home BP of 1st day and night home BP of 5th day were evaluated. Seasonal changes in clinic BP just before and after HD were also evaluated in 61 patients. Weekly home BP variability in the morning, 1st day 153±16 / 78±13 mmHg, 2nd day 144±28 / 76±12, 3rd day 150±14 / 77±13, 4th day 142±26 / 75±13, 5th day 149±14 / 77±12, 6th day 144±24 / 76±13, 7th day 149±16 / 78±13. Systolic home BPs in 1st, 3rd and 5th days were significantly elevated compared with 2nd, 4th and 6th days. Morning home BP significantly elevated gradually from 6th, 7th and to 1st day. Lowest SBP in the morning was 4th day but not 6th day which was the same as the previous result (CJASN 3: 416-422, 2008). Seasonal variability of morning home BP in 1st day was evident with the rise in autumn and winter (spring 153±19 / 78±12, summer 146±17 / 77±12, autumn 158±16* / 80±12, winter 156±19* / 80±13, * p<0.05 vs summer) (figure). Seasonal changes of highest temperature were significant (spring 19.9±3.1*℃, summer 30.9±2.6, autumn 23.3±2.7*, winter 8.5±2.8*, *p<0.05 vs summer) (figure). Morning BP of 1st day in a randomly selected patient was correlated with highest temperature (r=-0.397、p<0.0001). Seasonal changes of night home BP in 5th day were not significant through four seasons. Seasonal changes in clinic BP just before and after HD, in 1st day before HD: spring 147±19 / 74±13 mmHg, summer 144±20 / 71±11, autumn 150±19 / 74±13, winter 147±21 / 74±12. Systolic BP in autumn was significantly elevated compared to summer. In the other clinic BPs before and after HD in 3rd and 5th days, there were no significant seasonal changes observed. Even in the large number of HD patients, there is weekly home BP variability probably due to volume status. Seasonal morning BP variability was evident in the 1st day of the HD week, but this seasonal home BP variability was disappeared measuring BP in the night without volume overload.

SEASONAL VARIATION OF DAY-TO-DAY VARIABILITY IN HOME BLOOD PRESSURE IN GENERAL PRACTICAL OUTPATIENTS

Objective:We previously reported day-to-day variability of home blood pressure (HBP) was a cardiovascular disease (CVD) risk independent of each HBP level in the J-HOP study (Japan Morning Surge-Home Blood Pressure). However, there are few reports of seasonal variation of day-to-day variability of H

Blood Pressure Variability Is Associated With White Matter Lesion Growth in Intracranial Atherosclerosis.

High blood pressure variability (BPV) is associated with recurrent stroke. We investigated the association between BPV, new ischemic lesions (NILs), and white matter lesion (WML) growth in patients with ischemic stroke due to intracranial atherosclerosis (ICAS). This study was performed as a post-hoc analysis of the STABLE-ICAS trial, which enrolled subacute ischemic stroke patients with symptomatic ICAS (>50% stenosis) and hypertension. BPV was measured at the office (visit by visit) and at home (day by day). Patients were divided into 3 groups (tertiles) according to their home BPV. WML growth and the occurrence of NILs were compared among the 3 groups. Multivariable analyses were performed to identify the independent risk factors of WML growth and NILs. Of the 111 enrolled patients, 69 patients (67.6%) demonstrated WML growth and 15 patients (13.7%) had NILs. Patients with higher BPV demonstrated a more WML growth (50% vs. 61.8% vs. 83.8; P = 0.02, by tertiles) and more NILs (5.4% vs. 5.4% vs. 29.7%; P = 0.002, by tertiles). In multivariable analyses, old age [odds ratio (OR) = 1.052 (95% confidence interval (CI) = 1.005-1.101); P = 0.03] and home BPV [OR = 1.149 (95% CI = 1.013-1.304); P = 0.02] were independently associated with WML growth. Low mean diastolic blood pressure [OR = 0.913 (95% CI = 0.874-0.984); P = 0.02] and high home BPV [OR = 1.287 (95% CI = 1.086-1.526); P = 0.004] were independently associated with NILs at follow-up. High BPV is associated with WML growth and NIL in ischemic stroke patients with symptomatic ICAS. BPV monitoring at home may be helpful.

Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients.

Blood pressure variability is an independent risk factor for mortality and cardiovascular events in hemodialysis patients. Dialysate sodium concentration may not only have effects on blood pressure but also on blood pressure variability. We investigated whether dialysate sodium concentration lowering could decrease home blood pressure variability in hemodialysis patients. Forty-three hemodialysis patients at their dry weight assessed by bioimpedance methods with pre-dialysis serum sodium >136 mmol/L were recruited. Firstly, patients underwent a 1-month standard dialysis with dialysate sodium concentration of 138 mmol/L, and then the dialysate sodium concentration was decreased to 136 mmol/L for 8 weeks. Home blood pressure was assessed on waking up and at bedtime for 1 week. Coefficient of variation was used to define home blood pressure variability. After the intervention, whole-day systolic blood pressure variability decreased from 5.7 ± 2.6% to 4.3 ± 1.7% and evening systolic blood pressure variability decreased from 7.9 ± 4.1% to 6.2 ± 3.1%. Morning systolic blood pressure variability had a reduction from 7.8 ± 2.4% to 5.9 ± 3.3% but did not achieve statistical significance (P = 0.077). Whole-day, morning and evening systolic blood pressure were decreased significantly. Less changes were observed in diastolic blood pressure parameters. Interdialytic weight gain mildly but significantly decreased. Volume parameters, dietary sodium intake and incidence of adverse events were similar throughout the study period. Lowering dialysate sodium concentration could improve home blood pressure variability among hemodialysis patients who had achieved their dry weight.

Cross-sectional study of the association between day-to-day home blood pressure variability and visceral fat area measured using the dual impedance method.

BackgroundThe blood pressure (BP) variability (BPV) is a predictor of cardiovascular disease, independently of the BP itself. In addition, visceral fat accumulation can trigger atherosclerotic disease through various mechanisms.Methods and resultsWe examined the association between fat accumulation and day-to-day BPV in 61 adult hypertensive patients. Visceral fat area (VFA) was measured using the dual bioelectrical impedance analysis method. Participants were divided into three groups based on VFA. The standard deviation (SD) in home systolic BP (SBP) for 7 consecutive days was significantly lower in the high VFA tertile (low VFA, 8.40±4.15 mmHg; intermediate VFA, 8.47±2.80 mmHg; and high VFA, 5.84±2.37 mmHg, p of One-way ANOVA = 0.017, p for trend = 0.0126). A similar association was observed between the coefficient of variance (CV) of home SBP and the VFA tertile. Multiple-regression analysis adjusted for age, sex, antihypertensive drug, diabetes, habitual drinking, and SBP level also showed a significant association between the VFA tertile and the SD or CV of home SBP. The adjusted coefficient of regression for the SD of home SBP was -3.28 (95%CI: -5.60 to -0.97, p = 0.008) and the CV of home SBP was -2.51 (95%CI: -4.31 to -0.71, p = 0.008) for the highest VFA tertile as compared to the lowest VFA tertile.ConclusionsThese results show for the first time negative correlation between VFA and day-to-day BPV. The degree of obesity should be taken into account when evaluating the value of BPV.

Home blood pressure variability and subclinical atherosclerosis in multiple vascular beds: a population-based study.

The mechanism by which higher blood pressure (BP) variability causes cardiovascular events remains unclear. Experimental results indicate that alterations in vessel wall tension related to BP variability may initiate atherosclerosis through oscillatory shear stress. We examined associations of home BP variability with subclinical atherosclerosis at four anatomically distinct vascular beds. In a cross-sectional population-based study of 1033 Japanese (mean age, 64.0 years; men, 88.7%) without known cardiovascular disease, we defined SBP and DBP variability as variability independent of the mean (VIM) across self-measured home BP values during seven consecutive days and quantified coronary and aortic artery calcification (CAC and AAC) by computed tomography, carotid intima-media thickness (CIMT) by ultrasonography, and ankle-brachial index (ABI). In multivariable adjusted models including mean SBP, higher VIM of SBP was associated with CIMT greater than1.0 mm [relative risk (95% confidence interval) fourth versus first quartile, 1.71 (1.15-2.54)], AAC score greater than 0 [1.08 (1.02-1.15)], and ABI less than 1.1 [1.49 (1.12-1.97)], and linear trends were also statistically significant. However, there was no significant association between VIM of SBP and CAC score greater than 0. Meanwhile, higher VIM of DBP was associated only with AAC score greater than 0. The associations were similar when modeling subclinical atherosclerosis severity as continuous outcomes and were consistent across subgroups based on demographics, behavioural, and cardiovascular risk factors. Higher variability in home BP, particularly in home SBP, was associated with greater carotid, aortic, and peripheral but not coronary atherosclerosis burdens independent of the mean home BP.

A0623 Effects of empagliflozin on day-to-day variability of home blood pressure and heart rate in patients with type 2 diabetes

Objectives: The effects of empagliflozin in addition to standard care, on day-to-day variability of self-measured home blood pressure (BP) and heart rate (HR) at home in patients with type 2 diabetes (T2DM) at high cardiovascular risk are not known. Methods: We followed twenty-three consecutive T2DM patients (mean age: 69 years old, 12 men, mean BMI: 29.0 kg/m2) with cardiovascular risk to add 10 mg of empagliflozin once daily for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. Results: For home BP, empagliflozin significantly reduced systolic blood pressure (SBP) from 130 ± 11 mmHg at baseline to 126 ± 11 mmHg at the first week (1W) of the administration (P < 0.05). SBP achieved the target home BP goal (125 ± 11 mmHg) at the second week (2W) and was maintained during the study (12W: 124 ± 10 mmHg, P < 0.01). As regards day-to-day variability of SBP, SD mmHg and coefficient of variation (CV) %: SD/mean SBP decreased from 7.3 ± 3.5 mmHg and 5.6 ± 2.7 % at baseline to 6.7 ± 2.5 mmHg and 5.4 ± 1.9 %, respectively, at 1W (8W: 5.2 ± 2.3 mmHg and 4.2 ± 1.9 %, P < 0.05). In diastolic blood pressure (DBP), there was a significant reduction of SD and CV compared with that at baseline (4.9 ± 1.6 mmHg and 6.9 ± 2.3 % at baseline, 8W: 3.9 ± 1.8 mmHg and 5.5 ± 2% P < 0.05); however, there was no change of DPB (71 ± 10 mmHg at baseline). Similarly, there was a decreasing trend in SD and CV of HR (3.9 ± 1.2 beats per minute (bpm) and 6.3 ± 1.9 % at baseline, 4W: 3.3 ± 1.3 bpm and 5.4 ± 2.1 % p < 0.1), although there was no significant change in HR (62 ± 13 bpm at baseline). Conclusion: 1, Empagliflozin significantly reduced systolic home BP, without increasing HR in T2DM patients. 2, Empagliflozin tended to reduce the day-to-day variability of self-measured morning home BP and HR in T2DM patients.

A1477 The Association of Intracranial Arterial Stenosis with Home Blood Pressure Level and Variability

Objectives: Intracranial arterial stenosis (ICAS) is a major cause of ischemic stroke. However, the associations of ICAS with home blood pressure (BP) and variability remains unclear. Methods: Outpatients not on antihypertensive medications were recruited from 2009 to 2013. ICAS was defined if the peak systolic flow velocities measured with transcranial Doppler sonography were respectively of at least 140 cm/s, 120 cm/s, or 100 cm/s at middle, anterior, or posterior and vertical cerebaral arteries. Home BP was self-measured by Omron HEM-7051 device for seven days. BP variability was assessed as variability independent of the mean, standard deviation, maximum–minimum difference, and average real variability. Results: The prevalence of ICAS in the 801 participants (average age 51 years, 50% males) was 7.9% (63 cases). Patients with ICAS compared to those without had significantly higher clinic (135.8 vs 131.9 mmHg, P = 0.01) and home systolic BPs (134.8 vs 128.6 mmHg, P < 0.001). In multivariate-adjusted regression model, home systolic BPs, irrespective of at morning or evening, were associated with ICAS independently of other risk factors including any BP variability indices (OR, 1.47 to 1.82; P ≤ 0.005). However, after similar adjustment including home systolic BP, ICAS was only associated with seven-day morning systolic BP variability (OR, 1.35 to 1.47; P < 0.02), neither with evening BP variability (P ≥ 0.47), nor any day-to-day BP variability indices (P ≥ 0.07). Conclusion: Asymptomatic ICAS was moderately prevalent in Chinese untreated patients. Both home morning and evening systolic BPs were important determinants of ICAS, and BP variability in the morning was also associated with ICAS.

A3322 Association of day-by-day blood pressure variability with cardiovascular event in Japanese population with diabetes

Objectives: Increased day-by-day blood pressure (BP) variability assessed by home BP measurement has been associated with cardiovascular events in general and clinical population. However, few studies have examined these associations in patients with diabetes. The aim of this study is to investigate the association of day-by-day home BP variability of cardiovascular events in patients with diabetes enrolled in Japan Morning Surge-Home Blood Pressure (J-HOP) Study. Methods: Of 4,310 participant enrolled in J-HOP study, 1015 had diabetes. They underwent home BP monitoring in the morning and evening over a 14-day period, and their BP levels and BP variability independent of the mean (VIM) were assessed. Incident cardiovascular (CV) events included cardiovascular morbidity and mortality. Results: Mean (SD) home systolic BP (SBP) levels over time and VIMSBP were 136.2 (14.7) mmHg and 6.7 (2.3) unit, respectively. During a 4-year follow-up period, 69 CV events occurred. Mean home SBP per 1SD was not associated with CV events (Hazard ratio, 1.22; 95% CI, 0.95, 1.58), whereas VIMSBP per 1SD was associated with CV events independently of cardiovascular risk included mean home SBP (HR, 1.44; 95% CI, 1.15, 1.79, P = 0.001). Conclusion: In Japanese population with diabetes, day-by-day BP variability was independently associated with cardiovascular events.

Day-to-Day Home Blood Pressure Variability and Orthostatic Hypotension: The Nagahama Study

The aim of this study is to clarify associations between orthostatic blood pressure (BP) change, as well as possible physiological factors, and day-to-day home BP variability, a promising risk factor for cardiovascular outcomes. Study participants were 6,465 community residents (age 58.3 years). Home BP was measured every morning and evening for 7 days. Orthostatic BP was calculated as the maximum difference between BP measured while sitting and remeasured after 1 and 3 minutes standing. Frequency of individuals who showed orthostatic BP decline was as follows: systolic BP (SBP) change ≥-20 mm Hg: 2.6%, ≥-10 mm Hg: 14.1%. These subgroups showed larger home SBP variability (average real variability: 11.3 ± 5.3, 8.7 ± 3.9 mm Hg) when compared with orthostatic normotensives (7.6 ± 3.7 mm Hg) (all P < 0.001). Multiple linear regression analysis adjusted for major covariates, including seated BP, identified orthostatic BP drop as an independent determinant for morning BP variability (≥-20 mm Hg: β = 0.037, P = 0.003; ≥-10 mm Hg: β = 0.026, P = 0.036) but not for evening BP variability. Carotid hypertrophy was significantly associated with home BP variability (morning: β = 0.052, P = 0.001; evening: β = 0.065, P < 0.001) and showed a U-shaped association with orthostatic BP change. Plasma B-type natriuretic peptide level, a previously suggested factor for BP variability, did not show significant association with morning and evening BP variability. Orthostatic BP decline was significantly associated with morning BP variability. Large artery atherosclerosis was a common risk factor.

HOME BLOOD PRESSURE VARIABILITY AND PRECLINICAL TARGET-ORGAN DAMAGE IN UNTREATED HYPERTENSION

Objective: To assess the relationship between different indices of home blood pressure (HBP) variability with preclinical target-organ damage in untreated hypertensives. Design and method: Untreated hypertensives were subjected to HBP monitoring (duplicate morning and evening measurements; 6–7 days; automated devices), as well as to assessment of echocardiographic left ventricular mass index (LVMI) and urine albumin excretion (UAE). Results: A total of 276 subjects (mean age 51.8 ± 11 [SD] years, men 58%, body mass index [BMI] 29 ± 4.8 [SD] kg/m2, HBP systolic/diastolic 139.9 ± 13.1/88.7 ± 8.6 mmHg) were analyzed. Average HBP was correlated to LVMI (n = 263; r = 0.37/0.15, systolic/diastolic, p < 0.01/ < 0.05 respectively) and UAE (n = 230; r = 0.31/0.21, p < 0.01 for both). Maximum systolic HBP was associated with LVMI (r = 0.34, p < 0.01) and UAE (r = 0.31, p < 0.01). Other indices of systolic or diastolic HBP variability (standard deviation, coefficient of variation, average real variability, variability independent of the mean) did not present significant associations with LVMI or UAE (r range from − 0.04 to 0.13, all p = NS). In stepwise multivariate regression analyses (age, gender, BMI, systolic/diastolic HBP, maximum systolic HBP as independent variables), LVMI was determined (R2 = 0.40) by systolic HBP and age, whereas UAE (R2 = 0.36) by maximum systolic HBP and male gender. Conclusions: These data suggest that average HBP and maximum systolic HBP, but no other HBP variability indices, appear to determine preclinical target-organ damage in untreated hypertensives.