Systolic Blood Pressure Variability Research Articles

SEX DIFFERENCES IN SHORT-TERM BP VARIABILITY AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS

Objective: The present study aimed to explore potential differences in short-term blood pressure (BP) variability between men and women with end-stage kidney disease undergoing peritoneal dialysis (PD). Design and method: In this comparative study, 48 male PD patients from Northern Greece were matched for age and history of heart failure with 48 female patients in a 1:1 ratio. All patients underwent 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). Short-term BP variability was assessed with the calculation of standard deviation (SD), coefficient of variation (CV) and average real variability (ARV) of systolic and diastolic BP during the 24-hour, daytime and nighttime periods. Results: Age, the duration of PD therapy and the prevalence of cardiovascular comorbidities were similar in men and women. During the 24-hour period, SD (13.4±3.8 vs. 14.6±3.1 mmHg, P = 0.091), CV (0.10±0.03% vs. 0.12±0.2%, P<0.05) and ARV (10.7±3.1 vs. 11.9±2.6 mmHg, P<0.05) of systolic BP were significantly lower in men than in women. Similarly, the variability of diastolic BP over the 24-hour period was numerically lower in men as compared with women (SD: 10.3±2.4 vs. 10.9±2.2 mmHg, P = 0.218; CV: 0.12±0.03% vs. 0.14±0.03%, P<0.05; ARV: 8.4±2.0 vs. 9.0±1.9 mmHg, P = 0.136). These sex differences in indices of short-term BP variability were consistent during both daytime and nighttime periods. Conclusions: The present study shows that among patients undergoing PD, SD, CV and ARV of systolic and diastolic BP are lower in men than in women. Longitudinal studies are needed to explore whether these sex-related differences in short-term BP variability are prognostically informative in the PD population.

A STUDY OF BRACHIAL AND CENTRAL 24HOUR BLOOD PRESSURE VARIABILITY ACROSS DIFFERENT HYPERTENSION PHENOTYPES

Objective: Masked hypertensives (MHs) are considered a group of increased cardiovascular risk similar to sustained hypertensives. Brachial short term blood pressure (BP) variability (BPV) has been increasingly related to a higher risk of hypertension-mediated damage. Accordingly, central BP (cBP) has been considered to be more closely associated with target-organ damage. Limited data exists regarding BPV in MHs whereas no study has ever investigated BPV of 24hour cBP in MHs. Therefore, this study aimed to investigate and compare brachial and central BPV measures across different hypertension phenotypes. Design and method: Untreated essential hypertensive patients (UHTs) including MHs and normotensive individuals (NTs) were included in the study. Ambulatory BP was measured with the Mobil-O-Graph device, according to standard guidelines. The BPV parameters including the weighted standard deviation (wSD) and average real variability (ARV) of 24hour brachial and central systolic BP (SBP) and diastolic BP (DBP) were calculated according to a standardized formula based on the ambulatory BP monitoring (ABPM) measurements. Results: A total of 141 participants were studied (49.4±8.6 years; 62.4% males) including 79 UHTs, 22 MHs and 40 NTs. Baseline characteristics were similar between groups. As expected, groups differed significantly in terms of office and ABPM-derived BPs. Remarkably, all markers of 24h brachial BPV and 24h central BPV were comparable between MHs and UHTs and significantly higher compared to NTs (Table 1). Conclusions: Brachial and central BPV parameters in MHs don’t differ compared to UHTs, but are significantly higher compared to NTs. Whether this observation is clinically meaningful in terms of cardiovascular risk and target organ damage prediction, merits further investigation.

A STUDY OF 24HOUR CENTRAL BLOOD PRESSURE VARIABILITY WITH MEASURES OF MACRO- AND MICROVASCULAR FUNCTION IN A POPULATION OF UNTREATED HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS

Objective: Central blood pressure (cBP) has been more closely associated with target-organ damage compared with brachial BP, although a bidirectional interplay between central and peripheral arteries exists. Brachial short term BP variability (BPV) has been increasingly related to impaired macro- and microvascular function. However, scarce data exists regarding 24hour central BPV (cBPV) and its impact on organ damage. This study aimed to measure 24h cBPV in a population of untreated essential hypertensive (UHTs) and normotensive (NTs) individuals and evaluate its association with measures of macro- and microvascular function. Design and method: Newly-diagnosed UHTs and NTs were enrolled. 24hour cBP and 24h pulse wave velocity (PWV) were measured with the Mobil-O-Graph device. BPV including average real variability (ARV) of 24h central systolic BP (cSBP) and diastolic BP (cDBP) was calculated according to a standardized formula based on the ambulatory BP monitoring (ABPM) measurements. Urine albumin excretion (UAE) was measured in 24h samples. Results: We recruited 119 individuals including 79 UHTs and 40 NTs that didn’t differ in baseline characteristics. As expected, PWV was increased in UHTs compared to NTs [7.7 (1.5) vs 6.7 (1.2) m/s, p<0.001]. Similarly, in a subset of 60 individuals, UAE was increased [12.1 (9.7) vs 6.4 (4.5) mg/24h, p = 0.008]. UHTs presented higher ARV of 24h, daytime and nighttime cSBP/cDBP compared to NTs (p<0.05 for all comparisons). In total population, 24h PWV positively correlated with ARV of 24h cSBP (r = 0.353, p<0.001) and cDBP (r = 0.235, p = 0.010), ARV of daytime cSBP (r = 0.342, p<0.001) and cDBP (r = 0.235, p = 0.010), and nighttime cSBP (r = 0.297, p = 0.007). Furthermore, UAE correlated with ARV of nighttime cDBP (r = 0.372, p = 0.017). In multivariate analysis after adjusting for age, sex, and hypertension, ARV of 24h cSBP remained an independent predictor of PWV (beta = 0.109, p<0.001). Likewise, ARV of nighttime cDBP independently predicted UAE (beta = 0.480, p = 0.002). Conclusions: In a population of untreated hypertensives and normotensives, cARV indices are significantly and independently associated with measures of macro- and microvascular function including PWV and UAE, respectively. Further studies are warranted to ascertain the clinical value of cARV in terms of risk stratification and management.

EFFECT OF COVID-19 ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS

Objective: To investigate the influence of COVID-19 on blood pressure variability in hypertensive patients with known subclinical organ damage (SCOD) previously assessed by evaluation of brachial artery Flow Mediated Dilatation (FMD), carotid artery Intima Media Thickness (IMT), left ventricular mass indexed to BSA (LVMI), E/e` ratio, left atrial volume indexed to BSA (LAVI). Design and method: We assessed 108 hypertensive patients who had SARS-CoV-2 infection in the previously 3 months before evaluation. All subjects included where evaluated for the presence of SCOD in the last 12 months before COVID-19 and underwent a 24-hour noninvasive ABPM on a working day, performing usual daily activities and avoiding heavy physical exercise. BP and heart rate readings were obtained every 15 minutes during daytime and every 30 minutes during nighttime. Subjects recorded a journal of the activities performed and the time of retiring to bed, ABPM recordings being divided into ‘awake’ or ‘asleep’ periods based on diary entries and not on predefined time intervals. BP variability was calculated as the standard deviation (SD) of mean blood pressure. Results: The hypertensive patients with previously known subclinical disease (SCOD+) compared with those without it (SCOD–) had significantly higher systolic and diastolic BP after SARS-CoV-2 infection, and significantly increased variability of both systolic and diastolic BP. Also, they had a significantly reduced decrease of nocturnal systolic BP (table 1). The analysis for each marker of subclinical organ damage indicated that increased systolic BP variability in hypertensive COVID-19 patients was significantly correlated with carotid IMT (r = 0.517, p = 0.001), brachial artery FMD (r = 0.426, p = 0.008), LVMI (r = 0.397, p = 0.009), E/e` ratio (r = 0.543, p = 0.001), left atrial volume indexed to BSA (LAVI) (r = 0.478, p = 0.003) and that diastolic BP variability is significantly correlated with carotid IMT (r = 0.362, p = 0.09), brachial artery FMD (r = 0.491, p = 0.006), LVMI (r = 0.369, p = 0.008), E/e` ratio (r = 0.422, p = 0.005), left atrial volume indexed to BSA (LAVI) (r = 0.407, p = 0.002). Conclusions: Our study indicates that SARS-CoV-2 infection in hypertensive patients induces an increased blood pressure variability which is significantly correlated with the presence of previously diagnosed subclinical disease.

Reduced beat‐to‐beat blood pressure variability is associated with cognitive decline over six years in the Malaysian Elders Longitudinal Research (MELoR) study

AbstractBackgroundBlood pressure variability (BPV) is defined as fluctuations in blood pressure (BP) from visit‐to‐visit, day‐to‐day, hour‐to‐hour and beat‐to‐beat. While published evidence on visit‐to‐visit BPV have suggested an association between BPV and cognitive decline, but published research on beat‐to‐beat BPV and cognitive decline remains limited. This prospective study, therefore, aimed to determine the relationship between beat‐to‐beat BPV and changes in cognitive performance over a six‐year period.MethodThe first and fourth wave data from Malaysian Elders Longitudinal Research (MELoR) study, which included community dwellers aged 55 years and over at recruitment, were utilized. Non‐invasive continuous beat‐to‐beat BP was recorded at baseline using the vascular unloading method (TaskforceTM,CNSystems). Systolic (SBPV) and diastolic (DBPV) BPV were calculated using standard deviation (SD), coefficient of variation (CV) and average real variability (ARV), which were then dichotomized using median cut‐offs. The Montreal Cognitive Assessment (MoCA) Blind instrument was utilized to allow for telephone‐based assessments at Wave 4 which occurred during the COVID‐19 pandemic. Cognitive decline was defined as 2 points reduction in MoCA.ResultData were available from492 participants, mean (SD) age = 67.8 (6.8) years. Mean MoCA‐blinds scores had increased from 17.1 (3.0) to 18.6 (2.7) from baseline to follow‐up. Cognitive decline was observed in 65 (13%). Individuals with cognitive decline had lower depression scores at baseline . Lower SD‐DBPV (mean difference, MD (95%CI) = 0.56 (0.31,0.98) and CV‐DBPV (MD (95%CI) = 0.51 (0.28,0.91) were significantly increased cognitive change after adjustment for potential co‐founders.ConclusionLower BPV was associated with increased risk of cognitive decline in our population‐based study, which conflicted with available studies using primarily visit‐to‐visit and ambulatory BP measurements and involving mainly hospital‐based populations. Beat‐to‐beat BPV may be a measure of arterial stiffness which may is associated with increased risk of vasculopathy and development cognitive impairment. Future studies should determine whether interventions which lead to increased beat‐to‐beat BPV could reduce cognitive decline.

PROGNOSTIC SIGNIFICANCE OF BLOOD PRESSURE FLUCTUATIONS IN THE MORNING AND EVENING FOR CARDIOVASCULAR OUTCOMES

Objective: Independent of office blood pressure (BP) levels, home BP is associated with the occurrence of cardiovascular events. Abnormal diurnal variations in BP have been linked to cardiovascular disease (CVD). However, data on diurnal patterns of home BP, the morning and evening BP difference (MEdiff), are scarce. This study looked into the relationship between all MEdiff indices and cardiovascular outcomes. Design and method: The association was assessed using data from the International Database of Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO), which comprised 6753 patients from five cohorts. We found 1254 patients who had taken home BP readings every morning and every evening for more than 14 days. The MEdiff over a 13-day period, omitting the first day, for each patient were used to calculate the average (MEdiff_sbp_avg), minimum (MEdiff sbp_min), and maximum (MEdiff_sbp_max) values. MEdiff is defined as morning (6AM-8AM) minus evening BP (8PM-10PM) measures. The prognostic values of these parameters were assessed using Cox proportional hazards models. Factors adjusted in the base model included age, sex, body mass index, total cholesterol, high-density lipoprotein cholesterol, smoking status, prevalence of diabetes, history of cardiovascular disease, and antihypertensive drug treatment. Results: Only MEdiff_min_sbp strongly predicted CVD (183 events; mean follow-up time of 13.4 years), but MEdiff_avg_sbp (hazard ratio: 0.906, 95% CI: 0.087-1.018 per SD), MEdiff_max_sbp (0.949, 0.846-1.064 per SD) did not. Spline regression analysis with thresholds of -17 mmHg and -4 mmHg revealed a U-curve association between MEdiff_min_sbp and the risk of CVD outcomes. Three groups were identified by MEdiff_min_sbp: lower than -17 mmHg (Low, n = 574), between -17 and -4 mmHg (medium, n = 568) and higher than -4 mmHg (high, n = 112). Compared to the low group, the high group had a significantly higher risk of CVD (1.353, 1.052-1.739), in the models with adjustment for the mean of the morning and evening SBP values, and MEdiff_avg_sbp or various BP variability indices. Conclusions: MEdiff_min_sbp was strongly associated with an increased risk of cardiovascular outcomes, suggesting that it could be a useful BP index for describing abnormal BP diurnal variations for CVD risk prediction.

DETERMINANTS OF WITHIN-VISIT OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY: EUROPEAN DATA FROM 1.053 INDIVIDUALS

Objective: Blood pressure (BP) variability is the physiological sequelae of the complex interaction of multiple neural, humoral, reflex, and behavioral factors. This analysis aimed to evaluate the determinants of BP variability and instability within a single office visit, which is routinely used for hypertension evaluation in clinical practice. Design and method: A retrospective analysis of cross-sectional data was performed, comprising adults with triplicate office BP measurements in a single office visit and 24h ambulatory BP monitoring collected within the context of prospective clinical studies in Finland, Greece, and United Kingdom. Indices of BP variability and instability included: (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office BP (Max) (v) maximum-minimum difference (MMD) of office BP (vi) ratio of the difference between 1st-3rd measurement to the mean office BP (Relative change). White-coat effect was defined as the difference between office and daytime ambulatory BP. Results: Data from 1.053 individuals were analyzed (mean age 57.7 ± 11.3 years, males 50%, treated hypertensives 50.3%, average office BP 133.5 ± 18.7/83.5 ± 10.9 mmHg, daytime ambulatory BP 132.5 ± 14.1/80.7 ± 9.9 mmHg). All the indices of BP variability and instability were positively associated with average office BP, age, BMI, and white-coat effect, but with an inverse association between age and maximum diastolic BP (all p < 0.05). In multivariable linear regression analysis systolic BP variability was mainly determined by average office systolic BP, and treatment for hypertension, while diastolic BP variability was determined by office diastolic BP and female sex (Table). Conclusions: These results suggest that the variability and instability of BP within a single office visit is mainly influenced by the BP level, female sex and the administration of antihypertensive treatment.

ELEVATED GROWTH AND DIFFERENTIATION FACTOR 15 (GDF-15) LEVELS AMPLIFIES THE ASSOCIATION BETWEEN HOME BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOME

Objective: Growth and differentiation factor 15 (GDF-15) is a marker of cell senescence. Although age is strongly determinant of GDF-15 level, several studies suggest that GDF-15 reflects biological age rather than chronological age. Since age is also associated with increased blood pressure variability, we hypothesized that the association between day-by-day home blood pressure variability (HBPV) and cardiovascular outcome may be steeper in patients with elevated GDF-15. Design and method: We analyzed 4030 patients from a practitioner-based population (mean±SD age 64.9±10.9 years: 79.0% taking antihypertensive medication) with at least one cardiovascular risk factor who underwent home blood pressure monitoring in the Japan Morning Surge-Home Blood Pressure Study. The standard deviation was assessed as indexes of day-by-day home systolic blood pressure variability. We divided patients into elevated (1200 ng/L or more) and non-elevated GDF-15 (less than 1200 ng/L) groups. Results: During a mean follow-up of 6.2 years, 247 cardiovascular events occurred. Participants with the highest HBPV tertile without elevated GDF-15 (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.03-2.23) or those with elevated GDF-15 without the highest BPV tertile (HR, 1.52; 95%CI, 1.03-2.16) had approximately 1.5-fold higher risk of cardiovascular events compared with those with low HBPV without elevated GDF-15. Adjusted risk of cardiovascular events was approximately 2.3-fold higher among participants with elevated GDF-15 and the highest HBPV tertile, compared with those with low HBPV without elevated GDF-15 (HR, 2.34; 95%CI, 1.58-3.45). Conclusions: We conclude that elevated GDF-15 contributes to the association between home BP variability and cardiovascular events.

Combined Exercise Training Promotes More Benefits on Cardiovascular Autonomic Modulation in Ovariectomized Rats Than Isolated Aerobic or Resistance Training.

Cardiovascular risk increase after ovarian deprivation has been extensively demonstrated by our research group through cardiovascular autonomic analysis. Interventions involving different types of exercises, such as resistance exercises or combined exercises (aerobic and resistance) have been widely recommended to prevent or minimize neuromuscular decline in postmenopausal women, which is aggravated by a sedentary lifestyle. Experimentally, the cardiovascular effects of resistance or combined training, as well as comparison between aerobic, resistance, and combined training, in ovariectomized animals are scarce. In this study, we hypothesized that the combination of aerobic and resistance training may be more effective in preventing muscle mass loss, as well as improving cardiovascular autonomic modulation and baroreflex sensitivity, than aerobic or resistance training individually in ovariectomized rats. Female rats were divided into 5 groups: sedentary (C); ovariectomized (Ovx); trained ovariectomized submitted to aerobic training (OvxAT); resistance training (OvxRT); combined training (OvxCT). Exercise training lasted 8 weeks, with the combined group alternating between aerobic training and resistance training every other day. At the end of the study, glycemia and insulin tolerance were evaluated. Arterial pressure (AP) was directly recorded. Baroreflex sensitivity was assessed by heart rate response to changes in arterial pressure. Cardiovascular autonomic modulation was evaluated by spectral analysis. Combined training was the only training regime that increased baroreflex sensitivity for tachycardic response and reduced all systolic blood pressure variability parameters. Furthermore, all animals submitted to exercise training on a treadmill (OvxAT and OvxCT) presented lower systolic, diastolic, and mean pressure, as well as improvements in the autonomic modulation for the heart. Combined training showed to be more effective than isolated aerobic and resistance training, mixing the isolated benefits of each modality. It was the only modality able to increase baroreflex sensitivity to tachycardic responses, reduce arterial pressure and all parameters of vascular sympathetic modulation.

FAT-FREE MASS DOMINATES THE RELATIONSHIP BETWEEN BODY COMPOSITION AND SYSTOLIC BLOOD PRESSURE IN CHILDREN AND ADOLESCENTS

Objective: Systolic blood pressure (SBP) significantly associates with body composition. However, which one of the components of body composition is the dominant contributor to SBP in children and adolescents remains unclear. We aimed to determine the dominant contributor to SBP among components of body composition in a large cohort of American children and adolescents derived from the National Health and Nutrition Examination Survey. Design and method: 13618 children and adolescents (median age 13 years; 6107 girls) with available data on whole-body dual-emission X-ray absorptiometry measurements were included. Results: Multiple linear regression showed that SBP significantly associated with fat-free mass in boys (↓ = 0.49, P<0.001) and girls (↓ = 0.47, P<0.001) and with total fat mass only in boys (↓ = 0.12, P<0.001), after adjustment for covariates. When taking fat distribution into consideration, SBP positively associated with trunk fat mass (Boys: ↓ = 0.28, P<0.001; Girls: ↓ = 0.15, P<0.001), but negatively associated with leg fat mass (Boys: ↓ = -0.14, P<0.001; Girls: ↓ = -0.11, P<0.001), in both boys and girls. Dominance analysis showed that fat-free mass was the dominant contributor to SBP (boys: 49%; girls: 55.3%), followed by trunk fat mass (boys: 32.1%; girls: 26.9%); leg fat mass contributed the least to SBP in boys (18.9%) and girls (17.8%). Conclusions: Fat-free mass was not only significantly associated with SBP, but also the most dominant contributor to SBP variation in American children and adolescents.

OFFICE BLOOD PRESSURE VARIABILITY: WITHIN SESSION STABILITY ACROSS CONSECUTIVE MEASUREMENTS USING OSCILLOMETRIC DEVICES

Objective: Blood pressure (BP) is routinely monitored by healthcare providers and during drug development. For improvement in accuracy, several oscillometric devices perform multiple sequential inflations, rather than relying on a single inflation, to determine a mean systolic and diastolic blood pressure (SBP, DBP). Blood pressure is known to vary physiologically throughout a day, and over the course of days and weeks, due to intrinsic and extrinsic factors. Little data has been published describing the variability of SBP and DBP recorded minutes apart using oscillometric methods (i.e. within session variability). Design and method: We investigated the stability of within session SBP and DBP across 4 datasets by evaluating differences between 3 consecutive inflations recorded 1-2 minutes apart using a clinically validated oscillometric BP monitor that passed the ANSI/AAMI/ISO 2013, ESH-IP 2002 and BHS 1993 protocols (Table 1). These datasets included patients with controlled or uncontrolled hypertension. Results: Data were available from over 10.000 measurement pairs. The differences between inflation 1 and 2 were within ±10, 20 and 30 mmHg for 78.1, 94.4 and 97.9% of the SBP measurements, respectively. For the DBP, 90.7, 95.5 and 97.3 % of the differences between inflation 1 and 2 were within ±10, 15 and 20 mmHg, respectively. A similar trend was seen between inflation 2 and 3. Table 1: Categorical Analysis of BP changes between consecutive inflations. Conclusions: Our data demonstrate substantial variability between consecutive oscillometric BP measurements performed a few minutes apart. Over 20% of the time, consecutive inflations show an absolute change in SBP of at least 10 mmHg. It is unclear whether this represents true physiologic changes in BP or is partly artefactual due to failure of a device's algorithm to determine BP accurately from the oscillometric waveform. These data suggest that criteria for within session variability for automated oscillometric blood pressure devices should be established, including a threshold for repeating the session after 10 minutes of rest.

DO COGNITIVE FUNCTION IN HYPERTENSION WORSE OR BETTER IN WOMEN OR MEN: ARE COMPARISONS REALISTIC?

Objective: More evidence confirms that cognitive disorders (CD) in hypertension (H) are early signs of cerebral blood flow deregulation and often occur before other target organs are affected. Therefore, assessment and monitoring of cognitive functions in H should be a criterion for the effectiveness of treatment and prognosis of the course of the disease. Design and method: The study results are based on the data of a comprehensive examination of 185 working patients with controlled H stage II with SCORE risk of CVD <5 %. According to the neuropsychological testing on MMSE and MoCA scales, 157 people with various severity CD were found. There were 87 (55.4 %) women and 70 (44.6 %) men among them, and the average age was 52.3 (8.2) years; the average duration of H was 10 (8 - 12 years). The comparison and control groups were adequate for the purpose. The standard methods of parametric and non-parametric statistics processed the obtained data. Results: Significant differences were noted in the parameters of the daily profile of blood pressure (VAR SBP, VAR DBP), both during day and night, in patients with H and CD of both genders due to ambulatory monitoring of BP. According to the data of the correlation analysis, a significant direct correlation of average strength was established between the day and night variability of SBP and DBP and the development of CD in patients with H, regardless of the gender of the patients: with VAR SBP during the day - r = 0.573, with VAR SBP at night - r = 0.614, with VAR DBP during the day - r = 0.426, with VAR DBP at night - r = 0.453. Conclusions: Hypertension is a significant risk factor for the development and progression of CD in both genders. No objective reason to discuss whose gender cognitive functions are worse or better. It is also essential to pay attention to the high autonomic index and variability of blood pressure ambulatory monitored day and night due to the increased risk of development and progression of CD.

Blood pressure variability and short-term outcomes after mechanical thrombectomy in patients with acute ischemic stroke

ObjectivesThere is limited data evaluating effects of post-mechanical thrombectomy (MT) blood pressure (BP) control on short-term clinical outcomes in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). We aim to investigate the association of BP variations, after MT, with stroke early outcomes. Materials and methodsA retrospective study was conducted on AIS patients with LVO undergoing MT at a tertiary center over 3.5 years. Hourly BP data was recorded within the first 24- and 48-hours post-MT. BP variability was expressed as the interquartile range (IQR) of BP distribution. Short-term favorable outcome was defined as modified Rankin scale (mRS) 0-3, discharge to home or inpatient rehabilitation facility (IRF). ResultsOf the 95 enrolled subjects, 37(38.9%) had favorable outcomes at discharge and 8 (8.4%) died. After adjustment for confounders, an increase in IQR of systolic blood pressure (SBP) within the first 24 hours after MT revealed a significant inverse association with favorable outcomes (OR 0.43, 95% CI [0.19, 0.96], p = 0.039). Increased median MAP within the first 24 hours after MT correlated with favorable outcomes (OR 1.75, 95% CI [1.09, 2.83], p = 0.021). Subgroup analysis redemonstrated significant inverse association between increased SBP IQR and favorable outcomes (OR 0.48, 95% CI [0.21, 0.97], p = 0.042) among patients with successful revascularization. ConclusionsPost-MT high SBP variability was associated with worse short-term outcomes in AIS patients with LVO regardless of recanalization status. MAP values may be used as indicators for functional prognosis.

Modeling biomarker variability in joint analysis of longitudinal and time-to-event data.

The role of visit-to-visit variability of a biomarker in predicting related disease has been recognized in medical science. Existing measures of biological variability are criticized for being entangled with random variability resulted from measurement error or being unreliable due to limited measurements per individual. In this article, we propose a new measure to quantify the biological variability of a biomarker by evaluating the fluctuation of each individual-specific trajectory behind longitudinal measurements. Given a mixed-effects model for longitudinal data with the mean function over time specified by cubic splines, our proposed variability measure can be mathematically expressed as a quadratic form of random effects. A Cox model is assumed for time-to-event data by incorporating the defined variability as well as the current level of the underlying longitudinal trajectory as covariates, which, together with the longitudinal model, constitutes the joint modeling framework in this article. Asymptotic properties of maximum likelihood estimators are established for the present joint model. Estimation is implemented via an Expectation-Maximization (EM) algorithm with fully exponential Laplace approximation used in E-step to reduce the computation burden due to the increase of the random effects dimension. Simulation studies are conducted to reveal the advantage of the proposed method over the two-stage method, as well as a simpler joint modeling approach which does not take into account biomarker variability. Finally, we apply our model to investigate the effect of systolic blood pressure variability on cardiovascular events in the Medical Research Council elderly trial, which is also the motivating example for this article.

Effects of concurrent exercise training on blood pressure variability and values are blunted in subjects with non-dipping blood pressure nocturnal pattern

Abstract Funding Acknowledgements Type of funding sources: None. The purpose of this study was to investigate the effects of 12-weeks concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks patients underwent six minute walk test, ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). After CT exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the nondipping group (between groups changes: -1.0 mmHg and -1.3 mmHg; p 0.02 and p 0.006 respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while were unchanged in the non-dipping group (between groups changes: -7.1 mmHg and -7.8 mmHg; p 0.004 and p 0.0002 respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small not significant changes in both groups. In conclusion: the effects of CT on BPV and BP were blunted in hypertensive subjects with non.dipping BP pattern

Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023.
 Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP.
 Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ​​and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.

Accuracy of cuff blood pressure and systolic blood pressure amplification

Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference –7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.

Visit-to-Visit Blood Pressure Variability and Cognitive Decline in Apolipoprotein ɛ4 Carriers versus Apolipoprotein ɛ3 Homozygotes.

Blood pressure variability (BPV) is associated with cognitive decline and Alzheimer's disease (AD), but relationships with AD risk gene apolipoprotein (APOE) ɛ4 remain understudied. Examined the longitudinal relationship between BPV and cognitive change in APOE ɛ4 carriers and APOE ɛ3 homozygotes. 1,194 Alzheimer's Disease Neuroimaging Initiative participants (554 APOE ɛ4 carriers) underwent 3-4 blood pressure measurements between study baseline and 12-month follow-up. Visit-to-visit BPV was calculated as variability independent of mean over these 12 months. Participants subsequently underwent ≥1 neuropsychological exam at 12-month follow-up or later (up to 156 months later). Composite scores for the domains of memory, language, executive function, and visuospatial abilities were determined. Linear mixed models examined the 3-way interaction of BPV×APOE ɛ4 carrier status x time predicting change in composite scores. Higher systolic BPV predicted greater decline in memory (+1 SD increase of BPV: β= -0.001, p < 0.001) and language (β= -0.002, p < 0.0001) among APOE ɛ4 carriers, but not APOE ɛ3 homozygotes (memory: +1 SD increase of BPV: β= 0.0001, p = 0.57; language: β= 0.0001, p = 0.72). Systolic BPV was not significantly associated with change in executive function or visuospatial abilities in APOE ɛ4 carriers (ps = 0.08-0.16) or APOE ɛ3 homozygotes (ps = 0.48-0.12). Cognitive decline associated with high BPV may be specifically accelerated among APOE ɛ4 carriers.

Visit-to-Visit Blood Pressure Variability and Cardiovascular Outcomes in Patients Receiving Intensive Versus Standard Blood Pressure Control: Insights From the STEP Trial.

The clinical prognostic value of visit-to-visit blood pressure (BP) variability (BPV) is debatable, and relative studies among patients receiving BP control to achieve lower BP targets are limited. We analyzed a dataset from the STEP trail (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) to investigate the relationship between visit-to-visit BPV and cardiovascular events in patients with hypertensive aged 60 to 80 years. Visit-to-visit BPV was defined as the coefficient of variation, SD, delta, average real variability, and variability independent of the mean of BP measured at 6-, 9-, 12-, 15-, and 18-month follow-up visits. We computed hazard ratios for the risks associated with a 1-SD increase in BPV indexes in multivariable cox regression models. Among 7678 patients from the STEP trial, after adjustment for multiple confounders, diastolic BPV indexes were significantly associated with the primary composite end point (hazard ratios ≥1.21; P≤0.029) in the standard group, while there was no association between the clinical outcomes and systolic BPV (P≥0.091). In the intensive treatment group, either systolic or diastolic BPV was no association with clinical outcomes(P≥0.30). Sensitivity analyses using an alternative method to calculate BPV based on 7 BP records generated confirmatory results. In older adults with hypertension, visit-to-visit diastolic BPV is an independent predictor of adverse health outcomes in the standard treatment group. However, BPV did not have prognostic value in the intensive treatment group. URL: https://www. gov; Unique identifier: NCT03015311.

Role of perfusion index in early detection of hypotension following spinal anesthesia for cesarean section

ABSTRACT Background The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame. Methods Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA. Results PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = −.432, p < .0001); by using univariate linear regression analysis, the PI explains 20.2% of variability in SBP as PI significantly predicts the change occurred in SBP (F = 24.8, p < .0001), as each one unit increase in PI, accompanied by a significant decrease in SBP by 2.089 (mm/hg), as (b, t, p) (−2.089, −4.987, .0001), respectively. There was a significant difference in SBP and PI before and after giving oxytocin bolus [(z = −1.9, P = .05) and (z = −4.3, P < .0001), respectively]. By comparing PI before vs. after taking ephedrine bolus, there was a significant decrease in median of PI [median of PI before 10 (5.5–15) vs. median of PI after 7.5 (6–15.5) (z = −6.6, P < .0001)]. Discussion After SA with sympathetic blockade, peripheral vascular tone declined and therefore PI increased. Conclusion PI could anticipate the incidence of hypotension during cesarean delivery with SA. Ephedrine effect could be evaluated rapidly by the alteration in the PI so that further need can be judged. Oxytocin has a significant impact on vascular tone with 5 international unit bolus, although it does not have a significant effect on blood pressure.