scholarly journals Short-Term but not Long-Term Blood Pressure Variability Is a Predictor of Adverse Cardiovascular Outcomes in Young Untreated Hypertensives

2020 ◽  
Vol 33 (11) ◽  
pp. 1030-1037
Author(s):  
Francesca Saladini ◽  
Claudio Fania ◽  
Lucio Mos ◽  
Olga Vriz ◽  
Andrea Mazzer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Ambulatory Monitoring ◽  
Female Gender ◽  
Future Research ◽  
Office Visits ◽  
Short Term ◽  
Prognostic Information ◽  
Predictive Capacity

Abstract Background Whether blood pressure variability (BPV) measured with ambulatory monitoring (short-term BPV) or computed from office visits (long-term BPV) are related to each other and carry similar prognostic information is not well known. We investigated the independent determinants of short-term and long-term BPVs and their predictive capacity for the development of major adverse cardiovascular and renal events (MACEs) in a cohort of young hypertensive participants. Methods Long-term BPV was calculated as visit-to-visit SD and average real variability from office blood pressure (BP) measured during 7 visits, within 1 year. Short-term BPV was calculated as weighted 24-hour SD and coefficient of variation. Hazard ratios (HRs) for risk of MACE were computed from multivariable Cox regressions. Results 1,167 participants were examined; mean age was 33.1 ± 8.5 years. Variables independently associated with 24-hour systolic SD were 24-hour systolic BP, low physical activity, smoking, baseline office pulse pressure, systolic BP dipping, and diastolic white coat effect, while those associated with long-term BPV were mean systolic BP, age, female gender, and baseline office heart rate. During a median follow-up of 17.4 years 75 MACEs occurred. In Cox analysis only short-term BPV resulted a significant predictor of MACE (HR, 1.31 (1.07–1.59); P = 0.0086), while no index of long-term BPV was independently associated with outcome. Conclusions In young hypertensive subjects only short-term BPV resulted a significant predictor of MACE on top of traditional ambulatory BP monitoring parameters. Whether reduction of short-term BPV with therapy may reduce the cardiovascular risk independently from the effects on 24-hour BP is a matter for future research.

Long-Term and Short-Term Blood Pressure Variability in Transplanted Patients

1996 ◽  
Vol 783 (1 Neuroprotecti) ◽  
pp. 222-226 ◽  
Author(s):  
P. VAN DE BORNE ◽  
M. LEEMAN ◽  
J. P. DEGAUTE
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Short Term

P807Short-term versus visit-to-visit blood pressure variability as predictor of early adverse cardiovascular outcome in hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Mos ◽  
L Mos ◽  
F Saladini ◽  
A Mazzer ◽  
O Vriz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Standard Deviation ◽  
Blood Pressure Variability ◽  
Prediction Models ◽  
Prognostic Significance ◽  
Ambulatory Monitoring ◽  
Hazard Ratio ◽  
Short Term ◽  
Nocturnal Dipping

Abstract Background Blood pressure variability (BPV) has emerged as an important predictor of future cardiovascular events among hypertensive patients. However, it is not known whether BPV measured with ambulatory monitoring (short-term BPV) or computed from office visits (visit-to-visit BPV) are related to each other and carry similar prognostic significance. Purpose To investigate the association of short-term BPV and visit-to-visit BPVs with cardiovascular and renal events in a young hypertensive cohort untreated at baseline. Methods Short-term BPV was measured from 24-hour blood pressure (BP) monitoring at baseline in 1167 participants with stage 1 hypertension from the HARVEST study, aged 33.1±8.5 years. Visit-to-visit BPV was calculated from office BP measured in triplicate at each visit. Visits were made two weeks apart at baseline, and then after 1 month, 2 months, 3 months, 6 months, and 1 year. Only untreated subjects were taken into account for the analysis. Hazard ratios for short-term (weighted 24-hour BP Standard Deviation) and visit-to-visit Standard Deviation were computed, adjusting for the corresponding average BP, age, sex, body mass index, 24h heart rate, smoking, alcohol and coffee consumption, physical activity, parental cardiovascular disease, glucose, total cholesterol, HDL-cholesterol, and nocturnal BP dipping. Results Short-term systolic BPV showed a weak correlation with visit-to-visit BPV (p=0.018). No correlation was found for diastolic BPVs. Independent predictors of short-term BPV were average 24h BP, smoking, and nocturnal dipping. Predictors of visit-to-visit BPV were average office BP, parental cardiovascular disease, female gender, and nocturnal dipping. During a 15.4-year follow-up, 95 end-points were observed. In a parsimonious multivariable Cox model, short-term systolic BPV (p=0.03) was an independent predictor of the endpoints with a 7% increase in risk for each 1 mmHg increment in systolic BPV. The hazard ratio for a short-term systolic BPV ≥12.8 mmHg was 2.03 (95% CI, 1.34–3.05, p=0.0007). This threshold value was identified by ROC curve analysis. The association was particularly strong for coronary events (N=41) with a hazard ratio of 3.45 (95% CI, 1.73–6.89, p=0.0004). No independent association with outcome was found for visit-to-visit systolic or diastolic BPV (p>0.66). Similar results were obtained when average real variability was used instead of standard deviation as a metric of visit-to-visit BPV (p>0.15). Conclusions These data show that in untreated young hypertensive people short-term BPV and visit-to-visit BPV have a weak relationship and a different clinical significance. Only short-term BPV measured with ambulatory monitoring improved traditional risk prediction models in this setting. Acknowledgement/Funding Associazione 18 maggio 1370

scholarly journals Blood pressure variability in pregnant women with risk factors of preeclempsia

2019 ◽  
Vol 100 (3) ◽  
pp. 426-433 ◽  
Author(s):  
S D Mayanskaya ◽  
A V Ganeeva ◽  
R I Gabidullina
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Blood Pressure Variability ◽  
Placental Insufficiency ◽  
Fetal Growth Retardation ◽  
Second Trimester ◽  
Short Term

Aim. To assess the short-term and long-term variability of blood pressure in women, starting from early pregnancy, to predict the development of complications of gestation, including preeclempsia. Methods. In 131 pregnant women, systolic blood pressure, diastolic blood pressure, as well as short-term (intra-visit) and long-term (inter-visit) blood pressure variability were assessed during the gestation period and 6 weeks after delivery. At the end of gestation period, depending on the identified complications, all study participants were divided into four groups: group 1 - control (healthy); group 2 - pregnant with preeclempsia; group 3 - with placental insufficiency; group 4 - with chronic arterial hypertension. In patients with placental insufficiency the indices of fetal growth retardation were also analyzed. Results. In group 4, starting from the second trimester, higher values of short-term blood pressure variability were demonstrated, which increased as pregnancy progressed. Long-term blood pressure variability increased in groups 2 and 4, starting from the second trimester. In pregnant women with fetal growth retardation in the first trimester, blood pressure variability was higher than in pregnant controls and in the second trimester it was higher than in the group with the subsequent development of preeclempsia. Thus, during pregnancy complicated by preeclempsia or placental insufficiency with fetal growth retardation, high long-term blood pressure variability was observed. At the same time, the highest values were observed in the third trimester. Conclusion. The assessment of long-term blood pressure variability from the early gestation seems to be an effective tool for detecting preclinical changes in the body of a pregnant woman, preceding the development of preeclempsia and fetal growth retardation, and in the presence of risk factors of preeclampsia allows narrowing the group of patients for target follow-up and prevention.

scholarly journals How important is blood pressure variability?

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E1-E6 ◽  
Author(s):  
Enrico Agabiti Rosei ◽  
Giulia Chiarini ◽  
Damiano Rizzoni
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Pressure Variability ◽  
Prognostic Significance ◽  
Early Morning ◽  
Continuous Variable ◽  
Short Term ◽  
Arterial Blood ◽  
Relevant Risk Factor

Abstract Arterial blood pressure (BP) is a continuous variable, with a physiology characterized by significant variability stemming from the complex interaction among haemodynamic factors, neuronal reflexes, as well as hormonal, behavioural, and environmental stimuli. The homoeostatic response accounts for the physiologic variability in BP in normotensive individuals, which is more evident in hypertensive patients. Blood pressure variability is a complex phenomenon, which could be classified in various types: very short term (beat to beat), short term (during 24 h), mid-term (day by day), long term (<5 years), and very long term (>5 years). Accurate measurement of BP variability represents a complex and often controversial endeavour, despite several methodological approaches are available. Albeit a prognostic significance has been demonstrated for some indicators of BP variability, the clinical significance of this measurement is still uncertain. In fact, none of the indicators presently available for BP variability, including early morning BP rise, substantially affects, and redefines, the cardiovascular risk of the hypertensive patient, over and beyond the mere BP values. Accordingly, in defining the cardiovascular risk, the focus should be on the absolute BP values, which remain the most relevant risk factor, and the one more susceptible to modification with both non-pharmacologic and pharmacologic treatment.

scholarly journals Blood Pressure Variability: Prognostic Value and Therapeutic Implications

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Christian Höcht
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Renal Lesion ◽  
Short Term

Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs.

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