Abstract P170: Visit-to-visit Blood Pressure Variability Is Associated With Functional Decline In Older Adults: The S.ages Cohort

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Laure Rouch ◽  
Jean-Sébastien Vidal ◽  
Olivier Hanon
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Standard Deviation ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Pressure ◽  
Daily Living ◽  
Blood Pressure Variability ◽  
Functional Decline ◽  
Over Time

Objective: To investigate the impact of visit-to-visit systolic, diastolic, mean arterial pressure and pulse pressure variability on functional decline in non-institutionalized patients aged ≥ 65 years. Methods: 3042 subjects from the S.AGES (elderly subjects) cohort underwent clinical examinations every 6 months during 3 years. Systolic, diastolic, mean arterial pressure and pulse pressure variability were evaluated using standard deviation, coefficient of variation, average real variability, successive variation, variation independent of mean and residual standard deviation. Functional decline was assessed using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales and defined over time as any help required to perform at least one task. Cox proportional hazards models were used for the analyses. Results: Among the 3042 subjects, 527 (17.3%) had functional decline (ADL) over time. After adjustment for demographics, systolic blood pressure, antihypertensive drugs, coronary artery disease, diabetes mellitus, chronic heart failure, atrial fibrillation, transient ischemic attack or stroke, smoking, dyslipidemia and Mini Mental State Examination at baseline, higher systolic blood pressure variability was associated with greater risk of functional decline (ADL) (adjusted HR per 1-SD increase of coefficient of variation = 1.12, 95% CI [1.03-1.22], p<0.01). Similar results were observed for diastolic blood pressure variability (adjusted HR = 1.11, 95% CI [1.01-1.22], p=0.03) and mean arterial pressure variability (adjusted HR = 1.15, 95% CI 1.05-1.25, p<0.01). Higher pulse pressure variability was no longer significantly associated with functional decline after adjustment for age (p=0.6). Similar patterns were found with all indicators of variability and loss of autonomy defined using IADL. Conclusion: Higher blood pressure variability could be a novel risk factor for functional decline and controlling blood pressure instability a promising interventional target in preserving autonomy in older adults.

scholarly journals Visit-to-Visit Blood Pressure Variability Is Associated With Cognitive Decline and Incident Dementia

Hypertension ◽  
2020 ◽  
Vol 76 (4) ◽  
pp. 1280-1288 ◽  
Author(s):  
Laure Rouch ◽  
Philippe Cestac ◽  
Brigitte Sallerin ◽  
Matthieu Piccoli ◽  
Linda Benattar-Zibi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Cognitive Decline ◽  
Pulse Pressure ◽  
Coefficient Of Variation ◽  
Blood Pressure Variability ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Arterial Pressure Variability

To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS—Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=−0.12 (0.06), P =0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=−0.20 (0.06), P <0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD ( P =0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01–1.50], P =0.04). Similar results were found for diastolic BPV and mean arterial pressure variability ( P <0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.

Blood Pressure Variability in Man: Its Relation to High Blood Pressure, Age and Baroreflex Sensitivity

1980 ◽  
Vol 59 (s6) ◽  
pp. 401s-404s ◽  
Author(s):  
G. Mancia ◽  
A. Ferrari ◽  
L. Gregorini ◽  
G. Parati ◽  
G. Pomidossi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Standard Deviation ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Blood Pressure Variability ◽  
Baroreflex Sensitivity ◽  
Variation Coefficient ◽  
Arterial Blood ◽  
Normotensive Subjects

1. Intra-arterial blood pressure and heart rate were recorded for 24 h in ambulant hospitalized patients of variable age who had normal blood pressure or essential hypertension. Mean 24 h values, standard deviations and variation coefficient were obtained as the averages of values separately analysed for 48 consecutive half-hour periods. 2. In older subjects standard deviation and variation coefficient for mean arterial pressure were greater than in younger subjects with similar pressure values, whereas standard deviation and variation coefficient for heart rate were smaller. 3. In hypertensive subjects standard deviation for mean arterial pressure was greater than in normotensive subjects of similar ages, but this was not the case for variation coefficient, which was slightly smaller in the former than in the latter group. Normotensive and hypertensive subjects showed no difference in standard deviation and variation coefficient for heart rate. 4. In both normotensive and hypertensive subjects standard deviation and even more so variation coefficient were slightly or not related to arterial baroreflex sensitivity as measured by various methods (phenylephrine, neck suction etc.). 5. It is concluded that blood pressure variability increases and heart rate variability decreases with age, but that changes in variability are not so obvious in hypertension. Also, differences in variability among subjects are only marginally explained by differences in baroreflex function.

The influence of different surgical procedures on hypertension after repair of coarctation

2005 ◽  
Vol 15 (5) ◽  
pp. 477-480 ◽  
Author(s):  
Ugo Giordano ◽  
Salvatore Giannico ◽  
Attilio Turchetta ◽  
Fatma Hammad ◽  
Flaminia Calzolari ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Pulse Pressure ◽  
Ambulatory Monitoring ◽  
Peak Exercise ◽  
End To End

We measured resting and exercise haemodynamics, as well as 24-hour ambulatory blood pressure, so as to study the influence on development of hypertension in children after repair of coarctation by either construction of a subclavian flap or end-to-end anastamosis. The patients in both groups were studied a mean time of 13 years after surgery. Thus, we divided 43 children who had undergone surgical repair of coarctation, and who were not on antihypertensive therapy, into a group of 22 patients who had undergone subclavian flap repair, with a mean age of 14 plus or minus 2.6 years, and another group of 21 patients undergoing end-to-end anastomosis, with a mean age of 13.5 plus or minus 3.9 years. We examined blood pressure at rest and during exercise, along with the measurement of cardiac output using impedance cardiography, and during 24-hour ambulatory monitoring. We recorded systolic and diastolic blood pressures, pulse pressure, cardiac output and total peripheral vascular resistance at rest and at peak exercise. During ambulatory monitoring, we measured mean pressures over 24 hours, in daytime and nighttime, 24-hour pulse pressure, and 24-hour mean arterial pressure. Student's t test was used to judge significance, accepting this when p was less than 0.05. The group repaired using the subclavian flap showed significantly disadvantageous differences for diastolic blood pressure at rest, systolic blood pressure at peak exercise and for 24-hour systolic and diastolic blood pressure, 24-hour mean arterial pressure, and daytime and nighttime systolic blood pressure during ambulatory monitoring. Our findings suggest that, after repair using the subclavian flap in comparison to end-to-end anastomosis, patients show a higher incidence of late hypertension, both during exercise and ambulatory monitoring. The data indicate different residual aortic stiffnesses, these being lower after end-to-end anastomosis, which may be due to the greater resection of the abnormal aortic tissue when coarctation is repaired using the latter technique.

scholarly journals Ambulatory blood pressure variability measures in hypertensive patients according to non-alcoholic fatty liver disease state

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Kakouri ◽  
D Konstantinidis ◽  
E Siafi ◽  
F Tatakis ◽  
D Polyzos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Liver Disease ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Alcoholic Fatty Liver ◽  
Hypertensive Patients

Abstract Background Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events. Purpose To compare different BPV measures in hypertensive patients with and without NAFLD. Methods Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge. Results Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p&lt;0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment. Conclusions Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Association of High Levels of Spot Urine Protein with High Blood Pressure, Mean Arterial Pressure and Pulse Pressure with the Development of Diabetic Chronic Kidney Dysfunction or Failure among Diabetic Patients. Statistical Regression Modeling to Predict Diabetic Proteinuria

2019 ◽  
Vol 15 (6) ◽  
pp. 486-496 ◽  
Author(s):  
Kamran M. Ahmed Aziz
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Renal Disease ◽  
Pulse Pressure ◽  
Odds Ratio ◽  
Chronic Renal Disease ◽  
Diabetic Patients ◽  
Urine Protein ◽  
Spot Urine

Introduction:In research elevated Blood Pressure (BP) has been demonstrated to be a risk for the development of nephropathy and chronic renal disease (CKD) Or Diabetic Kidney Disease (DKD) among diabetics. However, no study has find correlation for the spot urine protein (UPr) excretion with elevated BP, Pulse Pressure (PP) and mean arterial pressure MAP). This technique was invented in the current study.Methods:10,270 were recruited for more than 12 years. Demographically, 43%, 38%, and 16% showed hypertension, nephropathy and chronic renal disease, respectively. UPr demonstrated significant correlations with systolic BP (SBP) and diastolic BP (DPB), MAP and PP (p < 0.0001 for all). SBP, DBP, PP and MAP, UPr were observed to be higher among the groups with nephroaphty and CKD/DKD with highly significant p-values (all p < 0.05). With logistic regression, odds ratio of hypertension (HTN) with nephropathy was observed to be 2.99 (95% CI 2.44 to 3.7; p < 0.0001); and odds ratio of HTN with CKD/DK was 7.1 (95% CI 4.3 to 11.84; p<0.0001), indicating that HTN significantly contributes to the development of nephropathy and CKD/DKD in diabetics.Results:Invented regression models for the excretion of UPr from the kidney with elevated SBP, DBP, MAP and PP were highly significant (p < 0.0001 for all); UPr = -138.6 + [1.347 × SBP] ; UPr = -93.4 + [1.62 × DBP] ; UPr = -149.5 + [1.922 × MAP] ; UPr = -41.23 +[1.541 × PP].Conclusion:Current study is the first one to introduce this technique. These invented new equations can be used by physicians to estimate protein excretion in urine at bedside and outpatients departments for monitoring proteinuria and CKD/DKD.

Sex Differences in Correlates of Steady State and Pulsatile Component of Blood Pressure

1996 ◽  
Vol 91 (4) ◽  
pp. 385-389 ◽  
Author(s):  
A. Scuteri ◽  
A. M. Cacciafesta ◽  
M. G. Di Bernardo ◽  
A. M. De Propris ◽  
D. Recchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Regression Analysis ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Body Mass ◽  
Pulse Pressure ◽  
Coronary Insufficiency

1. The aim of the present study was to evaluate whether metabolic factors are linked to the steady component and the pulsatile component of blood pressure, evaluated as mean arterial pressure and pulse pressure respectively, in a sex-specific manner. 2. A cohort of 299 subjects (152 males, 147 females; 25–80 years of age) was studied. Patients presenting congestive heart failure, coronary insufficiency, severe valvular heart disease, neurological accident in the last 6 months, renal or respiratory failure, cancer, diabetes mellitus or acute infectious disease were excluded. None of the women was taking oral contraceptives or oestrogen supplementation. All cardioactive drugs were withdrawn at least 2 weeks before the subjects entered the study. 3. Men presented higher mean arterial pressure (120 ± 15 compared with 115 ± 16 mmHg, P < 0.01) and lower pulse pressure values (63 ± 16 compared with 67 ± 18 mmHg, P < 0.05) than women. In men, no significant relation between mean arterial pressure and the tested variables was detected; multiple regression analysis demonstrated that age contributed independently to the model for pulse pressure with a multiple r2 of 0.10 (P < 0.01). In women, body mass index contributed independently to the model for mean arterial pressure, with a multiple of 0.12 (P < 0.005); age and, to a lesser extent, body mass index, glycaemia and triglyceridaemia persisted as independent determinants of pulse pressure at the multiple regression analysis, with a multiple r2 of 0.20 (P < 0.001). 4. Our findings suggest that metabolic risk factors are associated differently with pulse pressure and mean arterial pressure values in the two sexes.

scholarly journals Arterial Stiffness and Blood Pressure in Patients Newly Diagnosed with Graves’ Disease Compared with Euthyroid Controls

2020 ◽  
Vol 9 (3) ◽  
pp. 148-156
Author(s):  
Diana Grove-Laugesen ◽  
Sofie Malmstroem ◽  
Eva Ebbehoj ◽  
Anne Lene Riis ◽  
Torquil Watt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Stiffness ◽  
Arterial Pressure ◽  
Pulse Pressure ◽  
Graves Disease ◽  
Newly Diagnosed ◽  
Office Setting ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk

Introduction and Objective: The excess cardiovascular morbidity and mortality in hyperthyroidism and Graves’ disease (GD) is inadequately understood. We aimed to elucidate whether well-established cardiovascular risk factors such as arterial stiffness in terms of pulse wave velocity (PWV) and blood pressure differ in GD and controls. Methods: This was a cross-sectional study comparing 55 hyperthyroid patients with newly diagnosed GD and 55 euthyroid, population-based controls matched for age, sex and menopausal status. PWV and blood pressure were measured in office (SphygmoCor Xcel) and 24-h ambulatory settings (Arteriograph). Differences between groups were assessed using adjusted linear regression analysis. Results: Compared to controls, GD patients showed higher PWV in the 24-h but not in the office setting with an adjusted 24-h PWV difference of 1.0 (95% CI: 0.6–1.5) m/s. PWV was higher in GD at both day and night, and nightly PWV dipping was lower (–5.5, 95% CI: –10.4 to –0.6%). Furthermore, central and brachial pulse pressure was significantly higher in both the office and 24-h setting, whereas nightly central pulse pressure dipping was significantly lower in GD (–5.4, 95% CI: –10.5 to –0.2%). Mean arterial pressure did not differ between the groups. Conclusions: Despite comparable blood pressure, GD is associated with a higher 24-h PWV that was not detected in the office setting. Pulse pressure was higher in GD, whereas mean arterial pressure did not differ between the groups. Longitudinal studies should pursue whether higher PWV might be a piece to the puzzle of understanding the increased risk of cardiovascular disease in hyperthyroidism and GD.

scholarly journals Relationship of anthropometric indices with rate pressure product, pulse pressure and mean arterial pressure among secondary adolescents of 12–17 years

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Godfrey Katamba ◽  
Abdul Musasizi ◽  
Mivule Abdul Kinene ◽  
Agnes Namaganda ◽  
Francis Muzaale
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Pressure ◽  
Neck Circumference ◽  
Rate Pressure Product ◽  
Hemodynamic Parameters ◽  
Anthropometric Indices ◽  
Waist Hip Ratio ◽  
Significant Difference

Abstract Objectives To determine the correlation between anthropometric indices and the selected hemodynamic parameters among secondary adolescents aged 12–17 years. Results Our findings showed weak positive correlation between generally body surface area, neck circumference and conicity index with the hemodynamic parameters (systolic blood pressure, diastolic blood pressure, resting pulse rate, mean arterial pressure, rate pressure product and pulse pressure). However, the ponderosity index, body mass index and waist hip ratio showed negative weak correlations with the hemodynamic parameters. There was a significant difference in pulse pressure among the BMI categories. All parameters showed significant (p < 0.05) differences across the categories of neck circumference and waist hip ratio. Generally, in multivariate regression analysis, anthropometric indices showed significant prediction of the hemodynamic parameters.

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