Blood Pressure Variability In Patients Research Articles

Abstract TMP55: Post-stroke Blood Pressure Variability In The Acute Phase Is Associated With Pre-stroke Blood Pressure Variability In Patients Undergoing Mechanical Thrombectomy

Introduction: High blood pressure variability (BPV) after endovascular thrombectomy is associated with post-stroke complications and poor neurological outcomes. However, whether BPV is an epiphenomenon of the stroke itself or causally related to the outcome remains unknown. Objective: In this study we aimed to evaluate if a relationship exists between pre-and post-stroke BPV in patients with large vessel occlusions (LVO). Methods: From our prospective stroke registry, we identified patients who had an anterior circulation LVO, underwent EVT, and had at least three blood pressure measurements recorded in the electronic medical record in the six months prior to their stroke admission. All patients had repeated time-stamped blood pressure data recorded for the first 72 hours after thrombectomy. Using the standard deviation of systolic BP, we calculated BPV for each patient and separated patients into tertiles based on their post-EVT BPV. The relationship between pre-stroke BPV and post-EVT BPV was analyzed using an ordinal logistic regression and Spearman’s rank correlation analysis. Results: Two hundred fifty-two patients were included in our analysis (mean age 70±16.2 years, mean admission NIHSS 15±7, median pre-stroke BP measurements 14.5 (IQR 5.0-55.8)). Pre-stroke BPV gradually increased for patients with higher post-EVT BPV tertiles (tertile 1 = 13.2(±5.2) mmHg, tertile 2 = 15.0(±5.5) mmHg, tertile 3 = 16.7(±7.0) mmHg, p=0.001). A positive correlation was observed between pre-stroke BPV and post-EVT BPV (p<0.001, R=0.21). After adjusting for age and admission NIHSS, pre-stroke BPV was significantly associated with post-EVT BPV tertile membership (OR 1.37, 95% CI 1.02-1.86, p=0.039). Conclusion: High pre-stroke BPV is correlated with high post-EVT BPV. Although larger, prospective studies are needed to provide definitive evidence of this relationship, our work suggests that high post-EVT BPV may be related to an underlying biological phenomenon and not merely a consequence of the stroke itself. Individuals with high BPV may benefit from more intensive blood pressure management in the acute phase after EVT.

E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes.

E-selectin is an endothelial cell adhesion molecule involved in vascular inflammation. Elevated E-selectin has been reported in patients with high blood pressure and diabetes. Given the increasing clinical relevance of parameters derived from ambulatory blood pressure monitoring, further investigation of their relationships with E-selectin is of interest. In this study, we aimed to investigate the association between serum E-selectin, office blood pressure and 24 h ambulatory blood pressure parameters in patients with type 2 diabetes. Blood pressure variability was assessed by computing the standard deviation of mean systolic and diastolic blood pressure separately for daytime and nighttime during 24 h ambulatory blood pressure monitoring in a cohort of patients with type 2 diabetes (n = 132). Additionally, were assessed nighttime systolic dipping and pulse pressure separately for daytime, nighttime, and 24 h. Serum E-selectin was measured using the enzyme-linked immunosorbent assay technique. We found that E-selectin was consistently associated with 24 h diastolic blood pressure variability (r = 0.238; p = 0.019) and daytime diastolic blood pressure variability (r = 0.258; p = 0.012), after adjustment for confounding factors. No association of E-selectin with office blood pressure and other 24 h ambulatory blood pressure parameters was observed. In conclusion, endothelial activation indicated by elevated serum E-selectin is associated with increased ambulatory diastolic blood pressure variability in patients with type 2 diabetes.

The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study.

BackgroundHypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability.ObjectiveThe objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP.MethodsThis retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05%) patients who received home BP surveillance for ≥56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated.ResultsTelehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2±9.2 to 133.7±10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8±3.4 to 7.3±3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3±2.5 to 5.9±2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95% CI 1.18-3.89).ConclusionsSynchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD.

Blood Pressure Variability Among Patients Taking Antihypertensive Drugs in a Tertiary Care Centre in North Kerala

Introduction: In India, every one in four adults suffers from high blood pressure but a very small percentage of them get properly diagnosed and treated and very few of them go for regular follow-up and monitoring. This is mainly because most people are unaware of the menacing consequences of high BP. Constant monitoring and regular follow-up are crucial to understanding the appropriateness of the provided treatment and making necessary modifications to prevent end organ damage. Aim/Objective: Aim of the study is to evaluate blood pressure variation in patients taking antihypertensive drugs admitted in General Medicine Department of Government Medical College, Kannur. Following are the 2 main objectives; 1. To evaluate and determine the effect of antihypertensive drugs on blood pressure variation. 2. To determine factors associated with variation in BP in hypertensive patients. Methodology: A prospective observational study was done including 33 study subjects, conducted over six months in the Department of General Medicine, Government Medical College, Kannur. All the data was documented and analyzed based on a standard protocol. Results: A total of 33 patients were included in the study, 20 were above the age of 60, and 13 were below the age of 60. Among them 24 were male and 9 were female out of which more than half were classified under stage1 hypertension. It was observed that 24 patients had one or more comorbid conditions like diabetes mellitus, chronic kidney disease, cardiovascular disease, etc., and a majority of the patients were on beta blockers (63.6%) followed by calcium channel blockers (57.6%). Conclusion: Metoprolol in BD dosing and amlodipine in OD dosing provided better control of BP in patients without any comorbidities while they failed to achieve normal BP in patients with comorbid conditions. Comorbid conditions have a significant influence over BPV patterns, hence constant monitoring of BP must be carried out in these patients along with an appropriate treatment plan for better control of BP and to improve the patient’s quality of life.

AMINO ACIDS METABOLOMIC SIGNATURE OF BLOOD PRESSURE VARIABILITY In Type 2 Diabetes.

Accumulating data supports the key role of disrupted amino acids (AAs) metabolism in diabetes. Conflicting data regarding the relevance of serum AAs in diabetes and hypertension suggest that their relationship needs further investigation. To investigate serum AAs as biomarkers of increased BP variability evaluated during 24-hour ambulatory BP monitoring in the presence of type 2 diabetes. Cross-sectional. We analyzed serum AAs using targeted metabolomics (ultrahigh-performance liquid chromatography/mass spectrometry) in patients with type 2 diabetes (n=80). BP variability was assessed using 24-hour ambulatory BP monitoring. Participants were divided into two groups based on the 24-hour diastolic BP variability median value. Aspartic acid, isoleucine, leucine, and phenylalanine were significantly lower, while glutamine was significantly higher in the group with higher diastolic BP variability (p-value <0.05 and variable importance in the projection >1). Corresponding pathways identified as disrupted in patients with diabetes and a higher 24-hour diastolic BP variability were phenylalanine, tyrosine, and tryptophan biosynthesis, phenylalanine metabolism, and alanine, aspartate, and glutamate metabolism (pathway impact value >0). We identified specific changes in serum AAs and target AAs pathways in relation to increased 24-hour diastolic BP variability in patients with type 2 diabetes.

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

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

Relationship between transient symptomatic hypotensive episodes and 24-hour blood pressure variability in patients with arterial hypertension

Abstract Purpose Low blood pressure may be as harmful as high. Symptomatic hypotensive episodes should be a manifestation of circulatory disorders of hypertension – mediated organs especially among hypertensive patients. However, the association of such episodes with blood pressure variability is unknown. Aim To study the relationship between the symptomatic hypotensive episodes and the daily blood pressure variability according to the ambulatory blood pressure monitoring (ABPM) in patients with hypertension. Materials and methods 106 patients aged between 40 and 65 years with hypertension were studied. A questionnaire developed by the authors was used to identify symptomatic hypotension. During the study all the subjects had ABPM. Daily blood pressure variability was defined as standard deviation. Results Among all patients, symptomatic hypotensive episodes were observed in 60.6%. Among patients without myocardial infarction or stroke in anamnesis - 52.4%, with ones - 75% participants (p=0.05). Among patient without myocardial infarction or stroke and with symptomatic hypotensive episodes, the high variability of daily systolic BP was observed in 36% of the subjects and averaged 14.3 mm Hg, in the absence of symptomatic hypotensive episodes, the variability of daily systolic BP was 16.3 mm Hg, with a variety of blood pressure exceeding the norm, 80% of the participants (p&amp;lt;0.05). In case of stroke or myocardial infarction in anamnesis and the presence of symptomatic hypotensive episodes, the systolic BP variability of daytime (18.0 mm Hg) and nighttime (14.8 mm Hg) was the highest. The proportion of participants with daily systolic BP variability exceeding the norm was 78%. In the absence of symptomatic hypotensive episodes, the blood pressure variability indicators did not deviate from the norm (p&amp;lt;0.05). Conclusion Heart attack and/or stroke in anamnesis with symptomatic hypotensive episodes are associated with lower daily systolic BP variability (14.3 mm Hg) in comparison with patients without symptomatic hypotensive episodes (16.3 mm Hg). If there were stroke or myocardial infarction in anamnesis, patients with symptomatic hypotensive episodes have higher daily systolic BP variability (18.0 mm Hg) than without hypotensive episodes (14.5 mm Hg). Symptomatic hypotensive episodes are not unidirectionally associated with the variability of blood pressure, the character of the relationship is associated with the presence of heart attack and/or stroke diseases in anamnesis. Funding Acknowledgement Type of funding sources: None.

The correlation of blood pressure variability and cognitive function in hypertension patients: A meta-analysis.

Cognitive impairment (CI) is very common in patients with hypertension. It is necessary to conduct a meta-analysis to evaluate the association between cognitive function and blood pressure variability in patients with hypertension, to provide insights into the clinical management of hypertension and cognitive impairment. We searched PubMed and other databases for case-control studies on the association between blood pressure variability and cognitive function up to 15 July 2021. Two researchers independently screened the literature and retrieved the data. RevMan 5.3 was used for meta-analysis. A total of 13 studies involving 2754 patients were included. Meta-analysis indicated that 24-hours systolic (MD=3.54, 95% CI [2.48, 4.60]) and diastolic (MD=2.43, 95% CI [1.55, 3.31]) blood pressure variation coefficients in the CI group were significantly higher than that of non-CI group (all P<.05). Standard deviations of systolic (MD=2.20, 95% CI [0.27, 4.13]) and diastolic (MD=1.79, 95% CI [0.80, 2.79]) blood pressure variation in the CI group were significantly higher than that of the non-CI group (all P<.05). Mean systolic (MD=3.73, 95% CI [0.92, 6.53]) and diastolic (MD=5.41, 95% CI [0.42, 10.40]) blood pressure variation in the CI group were significantly higher than that of non-CI group (all P<.05). There were no statistically significant differences in the morning peak systolic (MD=7.85, 95% CI [-1.30, 17.01]) and diastolic (MD=4.44, 95% CI [-6.00, 14.89]) blood pressure drop between the CI group and non-CI group (all P>.05). CI in hypertensive patients is closely associated with increased blood pressure variability. Clinical healthcare providers should pay attention to the management of blood pressure variability in hypertensive patients to reduce the occurrence of CI.

Актуальні аспекти варіабельності артеріального тиску при артеріальній гіпертензії

Ця стаття є оглядом даних літератури про клінічне значення варіабельності артеріального тиску в пацієнтів з артеріальною гіпертензією. Наведено найбільш часто аналізовані показники варіабельності артеріального тиску, особливості класифікації. Подані результати досліджень, присвячених взаємозв’язку показників варіабельності артеріального тиску та стратифікації серцево-судинних ризиків. Наводиться огляд даних про особливості лікування пацієнтів з артеріальною гіпертензією з урахуванням варіабельності артеріального тиску.

Correlation Between Serum Total Bilirubin Levels and Blood Pressure Variability in Patients With Hypertension

Abstract Background To investigate the effect of serum total bilirubin levels on blood pressure and its variability in patients with hypertension. Methods This study was a retrospective observational study. A total of 189 subjects were recruited from September 2019 to March 2020. All hypertensive patients were scheduled for ambulatory blood pressure and a 24-hour dynamic electrocardiography. Standard deviations of 24-hour systolic and diastolic blood pressure were used as blood pressure variability indicators. A multiple linear regression was used to analyze the relationship between total bilirubin serum levels and blood pressure variability in hypertensive patients. Results All patients were divided into 3 groups according to tertile values of total bilirubin: low (≤12.2 µmol/l, n = 64), moderate (12.3–16.7 µmol/l, n = 64), and high (&amp;gt;16.8 µmol/l, n = 62) total bilirubin groups. Compared with low total bilirubin group, 24-hour mean systolic and diastolic blood pressure, 24-hour systolic blood pressure standard deviation, systolic blood pressure coefficient of variability, and 24-hour systolic blood pressure load were reduced in the moderate and high total bilirubin groups (all P &amp;lt; 0.05). Multiple linear regression analysis showed that female (B = −1.408, P = 0.013), age (B = 0.043, P = 0.035), diabetes (B = 2.624, P &amp;lt; 0.001), and moderate and high bilirubin grouping (B = −1.582, −3.079; both P &amp;lt; 0.05) were influencing factors of 24-hour systolic pressure standard deviation. Serum total bilirubin levels had no effect on the standard deviation of 24-hour diastolic blood pressure(P &amp;gt; 0.05). Conclusions In hypertensive patients, the total bilirubin serum level is an influencing factor for 24-hour systolic blood pressure variability.

Visit-to-visit blood pressure variability and mortality and cardiovascular outcomes after acute myocardial infarction.

The relationship between visit-to-visit blood pressure variability (BPV) and cardiovascular outcomes remains unclear. Our study assessed the prognostic implications of visit-to-visit BPV in patients after acute myocardial infarction (AMI). The present study enrolled 7,375 patients who underwent percutaneous coronary intervention for AMI and at least five measurements of blood pressure after hospital discharge. Visit-to-visit BPV was estimated as variability independent of mean. The primary endpoint was all-cause mortality. The secondary endpoints were major cardiovascular events (the composite of cardiovascular death, myocardial infarction, and ischemic stroke) and hospitalization for heart failure. During a median follow-up of 5.8 years, adjusted risks of all-cause mortality, major cardiovascular events, and hospitalization for heart failure continuously increased as systolic BPV and diastolic BPV increased. Patients in the highest quartile of systolic BPV (versus lowest) had increased risk of all-cause mortality (adjusted hazard ratio (aHR) 1.51 [95% confidence interval (CI) 1.23-1.85]), major cardiovascular events (aHR 1.31 [95% CI 1.1-1.55]), and hospitalization for heart failure (aHR 2.15 [95% CI 1.49-3.1]). Patients in the highest quartile of diastolic BPV was also associated with all-cause mortality (aHR 1.39 [95% CI 1.14-1.7]), major cardiovascular events (aHR 1.29 [95% CI 1.08-1.53]), and hospitalization for heart failure (aHR 2.01[95% CI 1.4-2.87]). Both systolic and diastolic BPV improved the predictive ability of the GRACE (Global Registry of Acute Coronary Events) risk score for both all-cause mortality and major cardiovascular events. Higher visit-to-visit BPV was associated with increased risks of mortality and cardiovascular events in patients after AMI.

Значення впливу контролю глікемії на варіабельність ритму серця та артеріального тиску в пацієнтів із цукровим діабетом 1-го типу

Актуальність. Ураження серцево-судинної системи при цукровому діабеті (ЦД) залишається провідною причиною смертності пацієнтів із даним захворюванням. Мета дослідження: визначити зміни варіабельності ритму серця (ВРС) й артеріального тиску (АТ) у пацієнтів із ЦД 1-го типу залежно від тривалості захворювання і контролю глікемії. Матеріали та методи. Обстежено 46 пацієнтів. Середній вік хворих становив 29,40 ± 3,18 року, тривалість захворювання — 12,50 ± 1,84 року, індекс маси тіла — 23,10 ± 0,73 кг/м2. Усі пацієнти перебували на інсулінотерапії за базисно-болюсною схемою, добова доза інсуліну становила 45,00 ± 3,76 Од. Пацієнти були розподілені на дві групи за рівнем НbА1с: група 1 (n = 2) із НbА1с ≤ 7,5 % і група 2 (n = 26) із НbА1с &gt; 7,5 %. Групи були розподілені на підгрупи за відсутністю (А) або наявністю (В) гіпоглікемії. Всім пацієнтам проводилися добовий моніторинг електрокардіограми за Холтером і моніторинг АТ протягом 24 годин паралельно з тривалим моніторингом глюкози крові. Результати. У пацієнтів із ЦД 1-го типу збільшення тривалості захворювання характеризується вірогідним зниженням ВРС як за часовими, так і за частотними показниками, а саме спостерігаються зниження RMSSD, pNN50% і підвищення LF/HF. Варіабельність добового АТ реалізується переважно за рахунок підвищення добових показників діастолічного артеріального тиску. Наявність епізодів гіпоглікемії помітно впливає як на часові, так і на спектральні показники ВРС незалежно від рівня HbA1c. Висновки. Епізоди гіпоглікемії супроводжуються підвищенням систолічного і діастолічного артеріального тиску і збільшенням частоти серцевих скорочень. Частота виникнення гіпоглікемічних епізодів зростає зі збільшенням тривалості ЦД 1-го типу незалежно від показника HbA1c.

EVALUATION OF CARDIOVASCULAR DYSREGULATION IN PATIENTS AFTER HEMORRHAGIC STROKE AS A COMPLICATION OF ESSENTIAL HYPERTENSION

The aim of the study was to compare blood pressure and electrocardiogram indices, assessed by their daily monitoring, and anamnestic data on mild traumatic brain injury between a group of patients with essential hypertension ≥6 months after a hemorrhagic stroke and a group of patients with essential hypertension without complications. Materials and methods. The total number of examined patients was 198 people, who were divided into 2 groups: the main (n = 94; age – 54,4±8,8 years, M±σyears) and the control (n = 104; age – 53,7±8,9 years) one. Patients in the main group suffered a hemorrhagic stroke as a complication of essential hypertension ≥6 months ago. The control group included patients with essential hypertension, stage II. In both groups of patients, the parameters of 24-hour ambulatory blood pressure monitoring and electrocardiogram were determined. Results. The indices of 24-hour ambulatory blood pressure monitoring in the main group and the control group were the following ones, respectively:the mean daytime systolic blood pressure was 109,6±1,6 and 121,1±1,1 mm Hg, the minimal one was 74,4±2,0 mm Hg and 82,3±12,5 mm Hg, and the maximal one was 168,2±1,9 and 161,9±1,7 mm Hg, p&lt;0,05. The daytime sigma systolic blood pressure (17,9±0,6) and its average real variability of (11,31±2,52 mm Hg) were bigger in the main group (p&lt;0,05). The daytime index of the hyperbaric load of systolic blood pressure was bigger in the main group: it was 403,6±25,9 against 231,7±12,1 mm Hg×h in the comparison group (p&lt;0,05). The mean, minimum and maximum heart rate at night were significantly lower in the main group (p&lt;0,05). The QTcmin index was significantly lower in the main group in contrast to the control one – 286,28±43,34 and 336,69±22,55, and the QTvariance was greater – 232,56±44,55 – in comparison to the control group(188,31±33,67) (p&lt;0,05). From the anamnestic data of patients, a significantly higher prevalence of mild traumatic brain injurywas found in 37,4% (35 patients out of 94) in the main group relative to the control one – 13,5% (14 out of 104), p&lt;0,05. Conclusions: The results of the study indicate the larger ranges of blood pressure variability in patients with essential hypertension complicated with hemorrhagic stroke, which can be caused by impaired autoregulation according to the QTc interval data. In combination with the disturbances of cerebral circulation, caused by the injury of the brain due to the hemorrhagic stroke alone or in combination with mild traumatic brain injury episode, such a situation may lead to the development of recurrent stroke.

The “Inverse” Seasonal Blood Pressure Variability Phenotype

The seasonal blood pressure variability (BPV) is known to demonstrate a typical winter peak. Recently, more attention is paid to the opposite situation: the summer BP levels being higher than those in winter. This phenomenon is called inverse BPV. The present article summarizes recent data on this topic. The data of the HOMED-BP project, as well as the results of the original prospective study in 770 hypertensive patients from two Russian Federation regions (mean follow-up duration 6.4 years), were used. According to the preliminary knowledge, the prevalence of inverse BPV in hypertensive patients is relatively high (15-25%). This phenomenon is more typical for treated patients, particularly for those on combination therapy, and is associated with beta-blocker intake. Higher duration of hypertension and higher levels of some risk factors (smoking) characterize the patients with inverse BPV. According to the HOMED-BP data, patients with inverse BPV had the highest overall cardiovascular risk (hazard ratio in comparison with the reference group of “minimal” “normal” BPV was 3.07; p=0.004). In summary, inverse BPV is a potentially unfavorable BP phenotype. However, its reproducibility and prospective value deserve further investigation. The absolute magnitude of seasonal BPV in these patients, calculated using different BP measurement methods, warrants special attention.

Visit-to-visit blood pressure variability in patients after acute coronary syndrome

Objective. The aim of the study was to assess the possible association of visit-to-visit blood pressure (BP) variability and the risk of adverse outcomes in hypertensive (HTN) patients after acute coronary syndrome.Design and methods. We analyzed data of 1,456 patients (mean age 65,6 ± 12,2 years, 875 (60,1 %) men) discharged from the hospital after acute coronary syndrome and followed up for 1 year in 4 vascular centers in Moscow, Astrakhan, Kazan and Krasnodar in 2014–2017. BP, heart rate, and adverse events were recorded on the day of discharge and on days 25, 90, 180 and 360 after discharge. The visit-to-visit BP variability was assessed by the VIM coefficient (variation independent of mean).Results. The systolic BP variability was 7,81 ± 0,226 mm Hg, diastolic BP variability was 9,89 ± 0,577 mm Hg during follow-up. In total, 110 deaths from any cause, 63 coronary deaths, 130 repeated non-fatal coronary events, 33 ischemic strokes were recorded. A decrease in BP variability was associated with the dihydropyridine calcium antagonists (10,21 ± 6,45 and 7,99 ± 4,70 mm Hg, p = 0,024) and thiazide diuretics (10,34 ± 6,59 and 7,63 ± 9,63 mm Hg, p = 0,049). Multivariate analysis showed that high long-term variability of BP is a more significant factor associated with the overall mortality rate than the initial severity of HTN and even the fact of achieving target BP. The risk of ischemic stroke in patients with HTN was associated with factors such as atrial fibrillation, heart failure, a history of stroke, and high visit-to-visit BP variability.Conclusions. Visit-to-visit BP variability is an important characteristic of BP control and is associated with the risk of death from any causes and stroke in patients with coronary heart disease.

MO642DAPAGLIFLOZIN HAS NO IMPACT ON SHORT-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH TYPE-2 DIABETES MELLITUS

Abstract Background and Aims Increased blood-pressure-variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM. Method This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM (NCT02887677). Subjects were randomized to oral dapagliflozin 10mg once daily or placebo for 12 weeks. All participants underwent 24-h ambulatory blood pressure (BP) monitoring with the Mobil-O-Graph NG device at baseline and study-end. Standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), average real variability (ARV) and variation independent of mean (VIM) were calculated with validated formulae for the 24-h and the daytime and nighttime periods. Results Dapagliflozin reduced 24-h brachial BP compared to placebo. From baseline to study-end 24-h brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51±3.45 vs 11.05±3.35; p=0.326, SBP-wSD: 13.59±3.60 vs 13.48±3.33; p=0.811) or placebo (SBP-ARV: 11.47±3.63 vs 11.05±3.00; p=0.388, SBP-wSD: 13.85±4.38 vs 13.97±3.87; p=0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no differences between the groups were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between-groups (SBP-wSD: dapagliflozin: -0.11±3.05 vs placebo: 0.12±4.20; p=0.227). Conclusion This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in patients with T2DM, showing no effect on dapagliflozin on all BPV indexes studied.

Clinical impact of blood pressure variability in patients with COVID-19 and hypertension.

This study aimed to investigate the relationship between blood pressure variability (BPV) and clinical outcomes in patients with coronavirus disease 2019 (COVID-19) and hypertension. A total of 136 patients hospitalized with COVID-19 were enrolled in this study. Patients were grouped according to the presence of hypertension and BPV. Mean arterial pressure (MAP) measured at 8 a.m. and 8 p.m. was analyzed, and BPV was calculated as the coefficient of variation of MAP (MAPCV). High BPV was defined as MAPCV values above the median. We compared the age, level of C-reactive protein (CRP), creatine kinase-MB (CK-MB), N-terminal pro-B type natriuretic peptide (NT-proBNP), creatinine and in-hospital mortality and investigated the relationship among the groups. COVID-19 patients with hypertension were older (70 ± 12 vs. 53 ± 17 years; P < 0.001), had higher levels of CRP (9.4 ± 9.2 vs. 5.3 ± 8.2 mg/dL; P = 0.009), MAPCV (11.4 ± 4.8 vs. 8.9 ± 3.2; P = 0.002), and higher in-hospital mortality (19.6% vs. 5.9%; P = 0.013) than those without hypertension. There was a proportional relationship between BPV and age, levels of CRP, CK-MB, NT-proBNP, creatinine and in-hospital mortality (all, P < 0.05). In Cox regression analysis, advanced age [≥80 years, hazard ratio (HR) 10.4, 95% confidence interval (CI) 2.264-47.772, P = 0.003] and higher MAPCV (HR 1.617, 95% CI, 1.281-2.040, P < 0.001) were significantly associated with in-hospital mortality. High BPV in COVID-19 patients with hypertension is significantly associated with in-hospital mortality. Advanced age and systemic inflammation are proportional to high BPV. Additional attention is needed for COVID-19 patients with hypertension and high BPV.

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

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

THE INFLUENCE OF RENAL DENERVATION ON BLOOD PRESSURE VARIABILITY IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: Comparative evaluation of the impact of renal denervation versus pharmacological treatment with sympathetic nervous system (SNS) blockers on blood pressure variability in patients with resistant hypertension. Design and method: 75 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized into three groups, depending on medication supplimented to the previously administred: group I M - selective I1-imidazoline agonist Moxonidine, group II B – cardioselective beta-blocker Bisoprolol, group III D – renal artery denervation (RDN). Blood pressure variability assessed by ambulatory blood pressure monitoring (ABPM) were determined at baseline, 3 and 6 months follow-up. Results: The media/day and media/night systolic blood pressure (SBP) variability increased at the baseline in all three groups was reduced statistically significant from 3 months of monitoring, reaching the maximum effect towards the end of the study, when its normal values were recorded in all observational groups. Although treatment group supplimented with Moxonidine demonstrated an effect superior to that with Bisoprolol, and RDN - superiority to both, all three schemes had an authentic dynamics in improving SBP at 6 months of evaluation (p &lt; 0,001) (Fig.1). The evolution of diastolic blood pressure (DBP) media/day and media/night variability noted a beneficial effect, starting with 3 months, the improvement of this parameter being maintained until the end of the study. Although the reduction of DBP variability was statistically authentic in all three groups at all stages of evaluation, the Bisoprolol treatment group noted a smaller effect in improving this parameter, the higher net effect being manifested by the RDN patients group (p &lt; 0,001) (Fig.2). Conclusions: RDN in patients with resistant hypertension reduced statistically significant SBP and DBP variability starting with 3 months of follow-up and reaching maximum effect at the end of the study, simultaneously demonstrating superiority over treatment with SNS blockers.

Dapagliflozin Does Not Affect Short-Term Blood Pressure Variability in Patients With Type 2 Diabetes Mellitus.

Increased blood pressure variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type-2 diabetes mellitus (T2DM). Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM. This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM. Subjects were randomized to dapagliflozin 10 mg/day or placebo for 12 weeks. All participants underwent 24-hour ambulatory blood pressure (BP) monitoring with Mobil-O-Graph-NG device at baseline and study-end. SD, weighted SD (wSD), coefficient of variation, average real variability (ARV), and variation independent of mean were calculated for the 24-hour, daytime and nighttime periods. Dapagliflozin reduced 24-hour brachial BP compared with placebo. From baseline to study-end 24-hour brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51 ± 3.45 vs. 11.05 ± 3.35; P = 0.326, SBP-wSD: 13.59 ± 3.60 vs. 13.48 ± 3.33; P = 0.811) or placebo (SBP-ARV: 11.47 ± 3.63 vs. 11.05 ± 3.00; P = 0.388, SBP-wSD: 13.85 ± 4.38 vs. 13.97 ± 3.87; P = 0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no between-group differences were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between groups (SBP-wSD: dapagliflozin: -0.11 ± 3.05 vs. placebo: 0.12 ± 4.20; P = 0.227). This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in T2DM, showing no effect of dapagliflozin on all BPV indexes studied. Trial Number NCT02887677.