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Konstantinou K, Apostolos A, Tsiachris D, Dimitriadis K, Papakonstantinou PE, Pappelis K, Panoulas V, Tsioufis K. Exploring the link between blood pressure variability and atrial fibrillation: current insights and future directions. J Hum Hypertens 2024:10.1038/s41371-024-00936-z. [PMID: 39026101 DOI: 10.1038/s41371-024-00936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/30/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder, especially in people over the age of 50, which affects more than 40 million people worldwide. Many studies have highlighted the association between hypertension with the development of AF. Blood pressure variability (BPV) is a dynamic size obtained by recording blood pressure oscillations using specific readings and at specific time intervals. A multitude of internal and external factors shape BPV while at the same time constituting a common pathogenetic pathway with the development of AF. Until recently, BPV has been applied exclusively in preclinical and clinical studies, without significant implications in clinical practice. Indeed, even from the research side, the determination of BPV is limited to patients without AF due to doubts about the accuracy of its measurement methods in patients with AF. In this review, we present the current evidence on common pathogenic pathways between BPV and AF, the reliability of quantification of BPV in patients with AF, the prognostic role of BPV in these patients, and discuss the future clinical implications of BPV in patients with AF.
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Affiliation(s)
- Konstantinos Konstantinou
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK.
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Anastasios Apostolos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panteleimon E Papakonstantinou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Pappelis
- Second Department of Ophthalmology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Anyfanti P, Triantafyllou A, Lazaridis A, Malliora A, Margouta A, Chionidou A, Nikolaidou B, Kotsis V, Gkaliagkousi E. Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-mediated Chronic Inflammation. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00651-3. [PMID: 38819777 DOI: 10.1007/s40292-024-00651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Blood pressure (BP) variability (BPV) has emerged as an indicator of subclinical organ damage and an independent predictor of cardiovascular disease (CVD) morbidity and mortality in high-risk populations. AIM We aimed to assess short-term variability of both brachial and aortic BP in psoriasis, a common immune-mediated inflammatory disorder characterized by increased CVD risk. METHODS Psoriasis patients and non-psoriasis individuals had their BP assessed throughout a 24 h period (Mobil-O-Graph device). Brachial and aortic BPV during the 24 h and the respective daytime and nighttime periods was calculated from relevant ambulatory BP profiles. In-house software was applied to automatically calculate average real variability (ARV) of brachial and aortic systolic (bSBP, aSBP) and diastolic BP (bDPB, aDBP), and the weighted standard deviation (wSD) of 24 h bSBP/aSBP. 24 h pulse wave velocity (PWV) and augmentation index (AIx) were used as widely applied markers of arterial stiffness. RESULTS Psoriasis patients (n = 74) presented increased ARV of 24 h and daytime bSBP/aSBP, and increased ARV of 24 h and daytime bDBP/aDBP, compared to controls (n = 40). PWV and AIx correlated with ARV of 24 h bSBP/aSBP, daytime bSBP/aSBP, while PWV further correlated with ARV of nighttime aSBP. The observed associations with PWV, yet not AIx, with indices of BPV remained significant after adjusting for CVD risk factors. CONCLUSIONS This is the first study reporting increased 24 h variability of both brachial and aortic BP in psoriasis. The association of short-term BPV with arterial stiffness implies a potential role of BPV in terms of CVD risk stratification in patients with chronic immune-mediated inflammation.
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Affiliation(s)
- Panagiota Anyfanti
- Second Medical Department, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Antonios Lazaridis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Anastasia Malliora
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Anastasia Margouta
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Agapi Chionidou
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Barbara Nikolaidou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece.
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Parati G, Bilo G, Kollias A, Pengo M, Ochoa JE, Castiglioni P, Stergiou GS, Mancia G, Asayama K, Asmar R, Avolio A, Caiani EG, De La Sierra A, Dolan E, Grillo A, Guzik P, Hoshide S, Head GA, Imai Y, Juhanoja E, Kahan T, Kario K, Kotsis V, Kreutz R, Kyriakoulis KG, Li Y, Manios E, Mihailidou AS, Modesti PA, Omboni S, Palatini P, Persu A, Protogerou AD, Saladini F, Salvi P, Sarafidis P, Torlasco C, Veglio F, Vlachopoulos C, Zhang Y. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗. J Hypertens 2023; 41:527-544. [PMID: 36723481 DOI: 10.1097/hjh.0000000000003363] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment. The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Paolo Castiglioni
- IRCCS Fondazione Don Carlo Gnocchi, Milan
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Sciences, University of Leuven, and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Enrico G Caiani
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Italy
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Przemysław Guzik
- Department of Cardiology -Intensive Therapy, University School of Medicine in Poznan, Poznan, Poland
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Geoffrey A Head
- Baker Heart and Diabetes Institute, Melbourne Victoria Australia
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Eeva Juhanoja
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Turku
- Department of Oncology; Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Thomas Kahan
- Karolinska Institute, Department of Clinical Sciences, Division of Cardiovascular Medicine, Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | | | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension and Medical Genomics, National Research Centre for Translational Medicine
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital Athens, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paolo Palatini
- Department of Medicine. University of Padova, Padua, Italy
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Athanasios D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesca Saladini
- Department of Medicine. University of Padova, Padua, Italy
- Cardiology Unit, Cittadella Town Hospital, Padova, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Franco Veglio
- Internal Medicine Division and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1 Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Ambulatory Blood Pressure Variability after Adenotonsillectomy in Childhood Sleep Apnea. Laryngoscope 2022; 132:2491-2497. [PMID: 35156724 DOI: 10.1002/lary.30058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the influence of adenotonsillectomy (T&A) on ambulatory blood pressure (BP) variability in children with obstructive sleep apnea (OSA). STUDY DESIGN Prospective, interventional study. METHODS Children with OSA symptoms were recruited from a tertiary center. After OSA diagnosis was confirmed (ie, apnea-hypopnea index [AHI] > 1), these children underwent T&A for treatment. We performed polysomnography and 24-hour recordings of ambulatory BP before and 3 to 6 months postoperatively. Ambulatory BP variability was presented as the standard deviation of mean blood pressure in the 24-hour monitoring of ambulatory BP. Differences in BP variability among different subgroups were tested using a multivariable linear mixed model. RESULTS A total of 190 children were enrolled (mean age: 7.8 ± 3.3 years; 73% were boys; 34% were obese). The AHI significantly decreased from 12.3 ± 17.0 to 2.7 ± 5.5 events/hr after T&A. Overall, daytime, and nighttime ambulatory BP did not significantly change postoperatively, and overall, daytime, and nighttime ambulatory BP variability did not differ significantly preoperatively and postoperatively. In the subgroup analysis, children aged <6 years demonstrated a significantly greater decrease in ambulatory BP variability postoperatively than those aged >6 years (nighttime diastolic BP variability: 9.9 to 7.7 vs. 8.9 to 9.4). Children with hypertension also showed a significantly greater decrease in ambulatory BP variability than those without hypertension. CONCLUSIONS We concluded that overall ambulatory BP variability does not significantly change after T&A in children with OSA. Moreover, young-aged and hypertensive children demonstrate a significant decrease in BP variability after T&A. LEVEL OF EVIDENCE 4 Laryngoscope, 132:2491-2497, 2022.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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5
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Ojji DB, Cornelius V, Partington G, Francis V, Pandie S, Smythe W, Hickman N, Barasa F, Damasceno A, Dzudie A, Jones E, Ingabire PM, Mondo C, Ogah O, Ogola E, Sani MU, Shedul GL, Shedul G, Rayner B, Sliwa K, Poulter N. Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial. Hypertension 2022; 79:2593-2600. [DOI: 10.1161/hypertensionaha.121.18333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The effect of 3 commonly recommended combinations of anti-hypertensive agents—amlodipine plus hydrochlorothiazide (calcium channel blocker [CCB]+thiazide), amlodipine plus perindopril (CCB+ACE [angiotensin-converting enzyme]-inhibitor), and perindopril plus hydrochlorothiazide (ACE-inhibitor+thiazide) on blood pressure variability (V) are unknown.
Methods:
We calculated the blood pressure variability (BPV) in 405 patients (130, 146, and 129 randomized to ACE-inhibitor+thiazide, CCB+thiazide, and CCB+ACE-inhibitor, respectively) who underwent ambulatory blood pressure monitoring after 6 months of treatment in the Comparisons of Three Combinations Therapies in Lowering Blood Pressure in Black Africans trial (CREOLE) of Black African patients. BPV was calculated using the SD of 30-minute interval values for 24-hour ambulatory BPs and for confirmation using the coefficient of variation. Linear mixed model regression was used to calculate mean differences in BPV between treatment arms. Within-clinic BPV was also calculated from the mean SD and coefficient of variation of 3 readings at clinic visits.
Results:
Baseline distributions of age, sex, and blood pressure parameters were similar across treatment groups. Participants were predominately male (62.2%) with mean age 50.4 years. Those taking CCB+thiazide had significantly reduced ambulatory systolic and diastolic BPV compared with those taking ACE-inhibitor+thiazide. The CCB+thiazide and CCB+ACE-inhibitor groups showed similar BPV. Similar patterns of BPV were apparent among groups using within-clinic blood pressures and when assessed by coefficient of variation.
Conclusions:
Compared with CCB-containing combinations, ACE-inhibitor plus thiazide was associated with higher levels, generally significant, of ambulatory and within-clinic systolic and diastolic BPV. These results supplement the differential ambulatory blood pressure–lowering effects of these therapies in the CREOLE trial.
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Affiliation(s)
- Dike B. Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Nigeria (D.B.O.)
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.)
| | - Giles Partington
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.)
| | - Veronica Francis
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | - Shahiemah Pandie
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | - Wynand Smythe
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | - Nicky Hickman
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | | | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A. Damasceno)
| | | | - Erika Jones
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (E.J., B.R.)
| | | | - Charles Mondo
- St Francis Hospital, Nsambya, Kampala, Uganda (P.M.I., C.M.)
| | - Okechukwu Ogah
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria (O.O.)
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya (E.O.)
| | - Mahmoud U. Sani
- Department of Medicine, Bayero University, Kano and Aminu Kano Teaching Hospital, Nigeria (M.U.S.)
| | - Gabriel Lamkur Shedul
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada (G.L.S.)
| | - Grace Shedul
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Nigeria (G.S.)
| | - Brian Rayner
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (E.J., B.R.)
| | - Karen Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Cape Town, South Africa (K.S.)
| | - Neil Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.)
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Kinoshita H, Saku K, Mano J, Mannoji H, Kanaya S, Sunagawa K. Very short-term beat-by-beat blood pressure variability in the supine position at rest correlates well with the nocturnal blood pressure variability assessed by ambulatory blood pressure monitoring. Hypertens Res 2022; 45:1008-1017. [PMID: 35418609 DOI: 10.1038/s41440-022-00911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/07/2022] [Accepted: 03/04/2022] [Indexed: 11/09/2022]
Abstract
Blood pressure variability (BPV) is an important indicator in risk stratification for hypertension. Among the daily BPVs assessed using a 24-h ambulatory blood pressure (BP) monitor nocturnal systolic BPV has been suggested to predict cardiovascular risks. We hypothesized that very short-term BPV at rest would correlate with nocturnal BPV because of the shared autonomic BP regulatory system under no daily exertion. Thirty untreated normotensive and hypertensive adults underwent 30-min continuous beat-by-beat BP recordings in the supine position, followed by 24-h ambulatory blood pressure monitoring (ABPM). The relationship between very short-term BPV (standard deviation (SD), coefficient of variation (CV)) and daytime and nocturnal BPV (SD, CV, average real variability (ARV), and standardized ARV (CV-ARV)) was assessed with Pearson's correlation coefficients. Very short-term BPV correlated significantly with nocturnal BPV (ARV, r = 0.604, p < 0.001) but not with daytime BPV. These trends were more pronounced with the increasing data length of continuous beat-by-beat BP recording. Using a data segment from the last 10 min of a 30-min continuous beat-by-beat BP recording resulted in a stronger correlation between very short-term BPV and nocturnal BPV than using earlier segments. The findings of this study suggest that very short-term BPV in the supine position at rest may predict nocturnal BPV. Since the burden of ABPM for patients has hindered clinical dissemination, very short-term BPV has the potential to develop a novel index of BPV.
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Affiliation(s)
- Hiroyuki Kinoshita
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Japan.,Technology Development HQ, Omron Healthcare Co., Ltd., Muko, Japan
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
| | - Jumpei Mano
- Technology Development HQ, Omron Healthcare Co., Ltd., Muko, Japan
| | - Hiroshi Mannoji
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigehiko Kanaya
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Japan
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Triantafyllidi H, Benas D, Schoinas A, Birmpa D, Trivilou P, Varytimiadi E, Voutsinos D, Ikonomidis I. Hypertension-mediated organ damage regression associates with blood pressure variability improvement three years after successful treatment initiation in essential hypertension. J Clin Hypertens (Greenwich) 2021; 23:1150-1158. [PMID: 33554428 PMCID: PMC8678708 DOI: 10.1111/jch.14209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
Blood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short‐term BPV reduction and hypertension‐mediated organ damage (HMOD) regression in hypertensive patients 3‐year post‐treatment initiation regarding BP control. 24‐h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never‐treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima‐media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP < 130/80 mm Hg based on 2nd ABPM and subsequently, patients were characterized as controlled (n = 119, age = 53 ± 11 years) or non‐controlled (n = 61, age = 47 ± 11 years) regarding their BP levels. In the whole population and the controlled group, 24 h SBP/DBP, sBPV/dBPV, LVMI, and IMT were decreased. Additionally, LVMI improvement was related with both sBPV (p < .001) and dBPV reduction (r = .18, p = .02 and r = .20, p = .03, respectively). In non‐controlled hypertensives, PWV was increased. In multiple linear regression analysis, sBPV and dBPV reduction predicted LVMI improvement in total population and controlled group independently of initial office SBP, mean BP, and 24 h‐SBP levels. In middle‐aged hypertensive patients, a 3‐year antihypertensive treatment within normal BP limits, confirmed by 24‐h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement.
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Affiliation(s)
- Helen Triantafyllidi
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitrios Benas
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Antonios Schoinas
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dionyssia Birmpa
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Paraskevi Trivilou
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Efthimia Varytimiadi
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitrios Voutsinos
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
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Mulè' G, Sorce A, Vario MG, Giambrone M, Cottone S. Should reduction of increased short-term blood pressure variability be a target of antihypertensive therapy? J Clin Hypertens (Greenwich) 2021; 23:1162-1164. [PMID: 33538054 PMCID: PMC8678723 DOI: 10.1111/jch.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
It has long been known that blood pressure (BP) is characterized by marked short-term fluctuations occurring within a 24-h period and also by long-term oscillations occurring over more prolonged periods of time. An increased short-term blood pressure variability (BPV) appears to importantly contribute to target organ damage and to the enhanced cardiovascular risk of hypertensive patients, over and above the effect of an increase in mean BP levels. Reducing 24-h mean BP is the main aim of antihypertensive therapy, but initial data are available that additional cardiovascular protection can be achieved by reducing BPV. However, to definitively prove the prognostic role of short-term BPV and the need for its control by treatment, evidence is still needed from intervention trials aimed at demonstrating that by reducing BPV through administration of antihypertensive drugs, a reduction in organ damage and in the rate of cardiovascular events can be obtained.
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Affiliation(s)
- Giuseppe Mulè'
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Alessandra Sorce
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Maria Giovanna Vario
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Marta Giambrone
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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9
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Argan O, Avci E, Bozyel S, Yildirim T, Safak O, Yildirim SE, Dolapoglu A, Kisacik HL. Elevated levels of short-term blood pressure variability: A marker for ascending aortic dilatation in hypertensive patients. Clin Exp Hypertens 2021; 43:311-319. [PMID: 33423545 DOI: 10.1080/10641963.2021.1871915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD).Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV.Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT patients with normal AA, daytime SBP, daytime SD of SBP, 24-h SD of SBP, daytime CV of SBP, and 24-h CV of SBP were significantly higher in HT patients with AAD. Compared with the HT patients with normal AA, the frequency of nondipper pattern was higher and dipper pattern was lower in HT patients with AAD. In multivariate logistic regression analysis, the daytime CV of SBP, daytime SD of SBP, 24-h SD of SBP, daytime SBP, and left ventricular mass index were independently associated with AAD. In receiver operating characteristic curve analysis, the daytime CV of SBP levels of >12.95 had a sensitivity of 61% and a specificity of 59% (area under the curve, 0.659; 95% CI, 0.562-0.756; P= .01); moreover, daytime SD of SBP > 16.4 had sensitivity of 62% and specificity of 61% (AUC, 0.687; 95% CI, 0.591-0.782; P< .001).:Conclusion Increased short-term BPV is independently associated with AAD and may be recommended as a remarkable factor risk for AAD in HT patients.
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Affiliation(s)
- Onur Argan
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Eyup Avci
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tarik Yildirim
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ozgen Safak
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Seda Elcim Yildirim
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ahmet Dolapoglu
- Department of Cardiovascular Surgery, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Halil Lutfi Kisacik
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
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10
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Kochetkov AI. Thiazide and Thiazide-like Diuretics in the Treatment of Arterial Hypertension: are there Any Differences? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-16-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the current clinical guidelines for arterial hypertension, diuretics are considered one of the first line antihypertensive drugs, which are equivalent in their effectiveness to other main pharmacological classes used in the treatment of this disease. To date, much attention is paid to both the antihypertensive potential of diuretics and their safety profile and ability to influence prognosis. In this regard, a rational approach to the consideration of the clinical and pharmacological properties of these drugs is the isolation of thiazide and thiazide-like drugs among them, which is reflected in international clinical guidelines. Among thiazide-like diuretics, indapamide occupies a special place, favorably distinguished by its antihypertensive properties, metabolic neutrality, as well as the ability to improve the prognosis and favorably influence hard endpoints in the form of mortality rates in patients with hypertension. A unique feature of indapamide is also the presence, in addition to the direct diuretic effect, pleiotropic properties, including, in particular, some antagonism towards calcium and beneficial effects on arteries. This drug has been studied in a large number of studies, including such "difficult" categories of patients as the elderly and patients with diabetes mellitus, where indapamide has proven its powerful target-organ protective potential and metabolic neutrality, distinguishing it among both thiazide-like and thiazide diuretics. Indapamide provides a comprehensive target-organ protection at the level of the heart, blood vessels, kidneys and brain. Based on this, it can be expected that the widespread use of this drug as part of a first-line combination antihypertensive therapy will not only achieve target blood pressure levet in most patients with hypertension, but also provide an improved prognosis and improve the quality and duration of their life.
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Affiliation(s)
- A. I. Kochetkov
- Russian Medical Academy of Continuing Professional Education
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11
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Manousopoulos K, Koroboki E, Barlas G, Lykka A, Tsoutsoura N, Flessa K, Kanakakis I, Paraskevaidis I, Zakopoulos N, Manios E. Association of home and ambulatory blood pressure variability with left ventricular mass index in chronic kidney disease patients. Hypertens Res 2020; 44:55-62. [DOI: 10.1038/s41440-020-0512-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 01/10/2023]
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12
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Omboni S, Posokhov I, Parati G, Arystan A, Tan I, Barkan V, Bulanova N, Derevyanchenko M, Grigoricheva E, Minyukhina I, Mulè G, Orlova I, Paini A, Peixoto Maldonado JM, Pereira T, Ramos-Becerra CG, Tilea I, Waisman G. Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry. J Hypertens 2020; 38:701-715. [DOI: 10.1097/hjh.0000000000002312] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens Res 2020; 43:609-620. [DOI: 10.1038/s41440-020-0421-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 01/21/2023]
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14
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Effects of third-generation β-blockers, atenolol or amlodipine on blood pressure variability and target organ damage in spontaneously hypertensive rats. J Hypertens 2020; 38:536-545. [DOI: 10.1097/hjh.0000000000002284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Tully PJ, Yano Y, Launer LJ, Kario K, Nagai M, Mooijaart SP, Claassen JAHR, Lattanzi S, Vincent AD, Tzourio C. Association Between Blood Pressure Variability and Cerebral Small-Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 9:e013841. [PMID: 31870233 PMCID: PMC6988154 DOI: 10.1161/jaha.119.013841] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Research links blood pressure variability (BPV) with stroke; however, the association with cerebral small‐vessel disease (CSVD) remains unclear. As BPV and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding cerebrovascular morphological characteristics. Methods and Results A systematic review was performed from inception until March 3, 2019. Eligibility criteria included population, adults without stroke (<4 weeks); exposure, BPV quantified by any metric over any duration; comparison, (1) low versus high or mean BPV and (2) people with versus without CSVD; and outcomes, (1) CSVD as subcortical infarct, lacunae, white matter hyperintensities, cerebral microbleeds, or enlarged perivascular spaces; and (2) standardized mean difference in BPV. A total of 27 articles were meta‐analyzed, comprising 12 309 unique brain scans. A total of 31 odds ratios (ORs) were pooled, indicating that higher systolic BPV was associated with higher odds for CSVD (OR, 1.27; 95% CI, 1.14–1.42; I2=85%) independent of mean systolic pressure. Likewise, higher diastolic BPV was associated with higher odds for CSVD (OR, 1.30; 95% CI, 1.14–1.48; I2=53%) independent of mean diastolic pressure. There was no evidence of a pairwise interaction between systolic/diastolic and BPV/mean ORs (P=0.47), nor a difference between BPV versus mean pressure ORs (P=0.58). Fifty‐four standardized mean differences were pooled and provided similar results for pairwise interaction (P=0.38) and difference between standardized mean differences (P=0.70). Conclusions On the basis of the available studies, BPV was associated with CSVD independent of mean blood pressure. However, more high‐quality longitudinal data are required to elucidate whether BPV contributes unique variance to CSVD morphological characteristics.
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Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health School of Medicine The University of Adelaide Australia
| | - Yuichiro Yano
- Community and Family Medicine Duke University Durham NC
| | - Lenore J Launer
- Intramural Research Program National Institute on Aging National Institutes of Health Bethesda MD
| | - Kazuomi Kario
- Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Michiaki Nagai
- Department of Cardiology Hiroshima City Asa Hospital Hiroshima Japan
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics Leiden University Medical Center Institute for Evidence-Based Medicine in Old AgeLeiden the Netherlands
| | - Jurgen A H R Claassen
- Radboud Alzheimer Center and Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen the Netherlands
| | - Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Andrew D Vincent
- Freemasons Foundation Centre for Men's Health School of Medicine The University of Adelaide Australia
| | - Christophe Tzourio
- Bordeaux Population Health University of Bordeaux Inserm Team HEALTHY UMR 1219 CHU Bordeaux Bordeaux France
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Kochetkov AI, Ostroumova OD, Borisova EV, Piksina GF. [Mechanisms for the Development of Blood Pressure Variability and the Potential of Antihypertensive Drugs in Their Correction]. ACTA ACUST UNITED AC 2019; 59:56-65. [PMID: 31849300 DOI: 10.18087/cardio.2019.11.n803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022]
Abstract
Blood pressure variability (BPV) is the fluctuations of blood pressure over a certain period of time under the influence of various factors. The issue of increased BPV is of particular clinical importance due to high predictive value of this parameter as a risk factor for fatal and non-fatal cardiovascular, cerebrovascular and renal events. It is proved that in the BPV increasing, the key role is played by impairments in arterial baroreflexes, which, in turn, are mediated by increased vascular stiffness, impact of angiotensin II and the sympathetic nervous system, endothelial dysfunction, nitric oxide deficiency and aging, including the vascular aging. Antihypertensive drugs that targeting largest amount of pathophysiological mechanisms in BPV increasing have a most advantages in correcting excessive pressure fluctuations. In this regard such drugs are perindopril and amlodipine, which can eliminate almost the entire spectrum of increased BPV causes and, therefore, optimally reduce the cardiovascular risk.
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Affiliation(s)
- A I Kochetkov
- Pirogov Russian National Research Medical University, Russian Gerontology Clinical Research Center
| | - O D Ostroumova
- Pirogov Russian National Research Medical University, Russian Gerontology Clinical Research Center
| | | | - G F Piksina
- City Clinical Hospital named after E. O. Mukhin
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17
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Effect of antihypertensive treatment on 24-h blood pressure variability: pooled individual data analysis of ambulatory blood pressure monitoring studies based on olmesartan mono or combination treatment. J Hypertens 2019; 36:720-733. [PMID: 29045341 PMCID: PMC5862001 DOI: 10.1097/hjh.0000000000001608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: To evaluate the impact of olmesartan alone or combined with one to three antihypertensive drugs on 24-h blood pressure variability (BPV) and on distribution of BP reduction in a pooled individual data analysis of 10 double-blind, randomized, ambulatory BP monitoring (ABPM) studies. Methods: ABPMs were performed before and after 6–12 weeks of treatment with placebo (n = 119), active control monotherapy [n = 1195, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), dihydropyridine calcium channel blockers (DCCBs)] olmesartan monotherapy (n = 1410), active control dual combination [n = 79, DCCB + thiazide diuretic (TD)], olmesartan dual combination (n = 637, DCCB or TD), and triple combination therapy (n = 102, DCCB+TD). 24-h BPV was calculated as unweighted or weighted SD of the mean BP, and average real variability. BP control was assessed by smoothness index and treatment-on-variability index. Results: The greatest effect on 24-h systolic BPV/diastolic BPV was observed under olmesartan triple [−2.6/−1.9; −1.9/−1.3; −1.4/−1.3 mmHg] and active control dual combination [−1.8/−1.4; −1.9/−1.5; −1.2/−1.1 mmHg]. Smoothness indexes and treatment-on-variability indexes were significantly (P = 0.0001) higher under olmesartan dual (1.53/1.22, 1.67/1.29, 2.05/1.59), olmesartan triple (2.47/1.85, 2.80/2.06, 3.64/2.67), or active control dual combination (1.70/1.26, 1.85/1.33, 2.29/1.65) than under monotherapies (control: 0.86/0.73, 0.80/0.65, 1.01/0.82; olmesartan: 1.02/0.86, 0.95/0.78, 1.23/1.00). They were also greater in patients receiving high-dose olmesartan monotherapy or high-dose olmesartan dual combination than in the corresponding low-dose group. Conclusion: Olmesartan plus a DCCB and/or a TD produces a larger, more sustained, and smoother BP reduction than placebo and monotherapies, a desirable feature for a more effective prevention of the cardiovascular consequences of uncontrolled hypertension.
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18
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Shin DH, Song S, Lee YB. Comparison of the Effect of Fimasartan versus Valsartan on Blood Pressure Variability in Acute Ischemic Stroke: A Double-Blind Randomized Trial. Cardiovasc Ther 2019; 2019:7836527. [PMID: 31772615 PMCID: PMC6739756 DOI: 10.1155/2019/7836527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/04/2022] Open
Abstract
Higher blood pressure variability (BPV) is associated with poor functional outcome and mortality in acute stroke. This randomized controlled trial was conducted to compare the effect on BPV between fimasartan and valsartan (Boryung Pharmaceutical Co., Ltd., Seoul, Republic of Korea) in patients with acute ischemic stroke. Eighty patients were randomly assigned to receive either valsartan or fimasartan after 7 days of acute ischemic stroke onset, for duration of 8 weeks. Of them, 62 patients completed the study [valsartan (n=31), fimasartan (n=31)]. We measured BP for 24 hours using ambulatory BP monitoring device before and after 8 weeks of starting BP medication. We calculated several indexes such as standard deviation (SD), weighted 24-hour BP with SD (wSD), coefficient of variation (CV), and average real variability (ARV) to assess BPV and to compare indexes of BPV between 2 drugs. SD values of systolic BP in daytime, nighttime, and 24 h period (15.55±4.02 versus 20.55±8.77, P=0.006; 11.98±5.52 versus 16.47±6.94, P=0.007; 17.22±5.30 versus 21.45±8.51, P=0.024), wSD of systolic BP (8.27±3.01 versus 10.77±4.18, P=0.010), and ARV of systolic BP (15.85±6.17 versus 19.68±7.83, P=0.040) of patients receiving fimasartan after 8 weeks were significantly lower than patients receiving valsartan. In paired t-test, SD values of daytime, nighttime, and 24 h period of systolic BP of patients receiving fimasartan were significantly decreased after 8 weeks (15.55±4.02 versus 18.70±7.04, P=0.038; 11.98±5.52 versus 17.19±7.35, P=0.006; 17.22±5.30 versus 20.59±5.91, P=0.015). Our study showed that fimasartan had greater effect on reducing BPV after acute ischemic stroke than valsartan. Trials registry number is KCT0003254.
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Affiliation(s)
- Dong Hoon Shin
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Soohwa Song
- Department of Biomedical Engineering, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Yeong Bae Lee
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Borisova EV, Kochetkov AI, Ostroumova OD. [Single Pill Indapamide and Perindopril Arginine Combination: Optimal Coupling of Vascular Protection and Hemodynamic Risk Factors Reduction in Patients with Essential Arterial Hypertension]. ACTA ACUST UNITED AC 2019; 59:18-26. [PMID: 30990137 DOI: 10.18087/cardio.2019.3.10236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to investigate the impact of indapamide / perindopril single-pill combination (I / P SPC) on arterial stiffness parameters, blood pressure (BP) level and BP variability (BPV) in middle-aged patients with stage II grade 1-2 essential arterial hypertension (EAH). Materials and methods. We retrospectively formed a group of patients with stage II grade 1-2 EAH who had not previously received regular antihypertensive therapy (AHT) (n=52, mean age 52.9±6.0 years). All patients were treated with I / P SPC and all of them achieved target office BP level (less than 140 / 90 mm Hg). After 12 weeks of follow-up (from the time of reaching the target BP) assessment of AHT effectiveness (general clinical data, ambulatory blood pressure monitoring [ABPM], volume sphygmography, echocardiography), and vascular stiffness evaluation were performed. RESULTS At the end of follow-up office systolic BP (SBP), diastolic BP (DBP), pulse BP, day-time, night-time and 24‑hour SBP and DBP significantly (p<0.001 for all) decreased. According to the ABPM data day-time, nighttime, and 24‑hour systolic BPV significantly decreased (p=0.029, p=0.006 and p<0.001, respectively); day-time and 24‑hour diastolic BPV also significantly decreased (p=0.001 and p<0.001, respectively). Day-night standard deviation (SDdn) significantly decreased too (p=0.002 and p<0.001, respectively). Volumetric sphygmography showed significant decrease of right cardio-ankle vascular index (CAVI) (from 8.20±1.29 to 7.58±1.44, p=0.001) and of left CAVI (from 8.13±1.40 to 7.46±1.43, p<0.001), as well as reduction of the number o f patients with a right- and / or left-CAVI >9.0 (from 32.7 to 11.5 %, p=0.018). According to assessment of arterial stiffness using the Vasotens24 software package, the arterial stiffness index (ASI) significantly (p<0.001) decreased from 153.5±29.9 to 138.3±20.0 (by -9.2±13.1 %). Transthoracic echocardiography data demonstrated significant decrease (p<0.001) in effective arterial elastance (from 1.82±0.43 to 1.58±0.36 mm Hg; by -11.85±16.29 %) and significant (p<0.001) increase in the arterial compliance - from 1.27±0.34 to 1.54±0.38 mm Hg / ml (+26.95±38.06 %). CONCLUSION In AHT naive patients 40-65 years old with stage II grade 1-2 EAH therapy with I / P SPC provided effective 24‑hour BP control, reduced BPV and improved arterial stiffness parameters.
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Affiliation(s)
- E V Borisova
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry City Clinical Hospital named after E. O. Mukhin
| | - A I Kochetkov
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - O D Ostroumova
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry Sechenov First Moscow State Medical University (Sechenov University)
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20
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Wang Z, Zhang C, Bao H, Huang X, Fan F, Zhao Y, Li J, Chen J, Hong K, Li P, Wu Y, Wu Q, Wang B, Xu X, Li Y, Huo Y, Cheng X. Value of electrocardiographic left ventricular hypertrophy as a predictor of poor blood pressure control: Evidence from the China stroke primary prevention trial. Medicine (Baltimore) 2018; 97:e12966. [PMID: 30383646 PMCID: PMC6221643 DOI: 10.1097/md.0000000000012966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recent studies have shown that hypertension is poorly controlled in many populations worldwide. Electrocardiographic left ventricular hypertrophy is a common manifestation of preclinical cardiovascular disease that strongly predicts cardiovascular disease morbidity and mortality. However, little information is available regarding the role of left ventricular hypertrophy in blood pressure (BP) control. We aimed to assess the relationship between electrocardiographic left ventricular hypertrophy and BP control in the China Stroke Primary Prevention Trial. The study population included 17,312 hypertensive patients who were selected from a group of 20,702 adults who had participated in the China Stroke Primary Prevention Trial and had undergone electrocardiography at baseline visit. Multivariate analysis identified left ventricular hypertrophy as a predictor of unsatisfactory BP control. The results revealed that 8.1% of hypertensive adults exhibit left ventricular hypertrophy and that the disease is more prevalent in males (12.8%) than in females. Multivariate regression analysis showed that the electrocardiographic left ventricular hypertrophy group had a significantly higher rate of unsatisfactory BP control [odds ratio (OR) 1.42, 95% confidence interval (95% CI) 1.26-1.61, P < .001) than the nonleft ventricular hypertrophy group.Notable differences in BP control were also observed among males (OR 1.37, 95% CI 1.17-1.60, P < .001) and females (OR 1.45, 95% CI 1.18-1.77, P < .001) and especially among patients with comorbid diabetes (OR 2.32, 95% CI 1.31-4.12, P = .004). In conclusion, the results of this study indicate that electrocardiographic left ventricular hypertrophy appears to be an independent predictive factor for poor BP control, especially in females and patients with comorbid diabetes.
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Affiliation(s)
- Zhenzhen Wang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Chunyan Zhang
- Department of Neurology, the Second Hospital, Shanxi Medical University, Shanxi
| | - Huihui Bao
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Xiao Huang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Yan Zhao
- Department of Cardiovascular Medicine, XinHua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Juxiang Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Jing Chen
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Yanqing Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Qinghua Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Binyan Wang
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiping Xu
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yigang Li
- Department of Cardiovascular Medicine, XinHua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
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Differences in visit-to-visit blood pressure variability between normotensive and hypertensive pregnant women. Hypertens Res 2018; 42:67-74. [PMID: 30315199 DOI: 10.1038/s41440-018-0112-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/06/2018] [Accepted: 05/01/2018] [Indexed: 11/08/2022]
Abstract
We evaluated the relationship between blood pressure variability (BPV) and the development of hypertension during pregnancy. A total of 4163 pregnant women with normal blood pressure (BP) before 20 weeks of gestation were included in this study. The visit-to-visit blood pressure variability (VVV) was evaluated using the standard deviation (SD) of the systolic BP taken three times during pregnancy at approximately 10, 20, and 30 weeks of gestation. The VVV gradually decreased during pregnancy in normotensive subjects (SD: 7.2 ± 4.2 mmHg, 6.8 ± 3.9 mmHg, and 6.3 ± 3.6 mmHg at 10, 20, and 30 weeks, respectively). However, the VVV of hypertensive subjects did not decrease (SD: 8.2 ± 5.7 mmHg, 7.6 ± 5.0 mmHg, and 8.3 ± 5.3 mmHg at 10, 20, and 30 weeks, respectively) and was significantly greater than the VVV of normotensive subjects (p < 0.001). The VVV was significantly higher in patients who developed hypertension, and there was no decrease in VVV during pregnancy. Pregnancy complications were significantly increased in women with higher VVV at 10 and 30 weeks. Therefore, increased VVV during pregnancy may be a predictor of poor pregnancy outcomes.
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Baroreflex failure and beat-to-beat blood pressure variation. Hypertens Res 2018; 41:547-552. [DOI: 10.1038/s41440-018-0056-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 02/07/2023]
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Impact of age on the association between 24-h ambulatory blood pressure measurements and target organ damage. J Hypertens 2018; 36:1895-1901. [PMID: 29782391 DOI: 10.1097/hjh.0000000000001778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of age on the associations between hemodynamic components derived from 24-h ambulatory blood pressure (24-h ABPM) and target organ damage, in apparently healthy, nonmedicated individuals. METHODS Twenty-four-hour ABPM and target organ damage (left ventricular mass index, pulse wave velocity, urine albumin : creatinine ratio and carotid atherosclerotic plaques) were evaluated in 1408 individuals. Associations were examined in regression models, stratified for age [middle-aged (41 or 51 years) or elderly (61 or 71 years)], and adjusted for sex, smoking status, and total-cholesterol. RESULTS In middle-aged individuals, an increase of 10 mmHg in 24-h SBP was independently associated with an increase of 3.8 (2.7-4.8) g/m in LVMI. The effect was nearly doubled in the elderly subgroup, where the same increase resulted in an increase in LVMI of 6.3 (5.0-7.6) g/m (P for interaction <0.01). An increase of 10 mmHg of 24-h SBP was associated with a 6.7% increase in pulse wave velocity in middle-aged individuals and with an 9.1% increase in elderly individuals (P for interaction <0.01). An independent association between 24-h ABPM and urine albumin : creatinine ratio was only observed in the elderly subgroup. Associations between the presence of atherosclerotic plaques and components from 24-h ABPM except 24-h DBP were not modified by age (all P for interaction >0.26). CONCLUSION Age enhances the associations between hemodynamic components obtained from 24-h ABPM and measures of arterial stiffness, microvascular damage, and cardiac structure, but not atherosclerosis.
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de la Sierra A, Pareja J, Yun S, Acosta E, Aiello F, Oliveras A, Vázquez S, Armario P, Blanch P, Sierra C, Calero F, Fernández-Llama P. Central blood pressure variability is increased in hypertensive patients with target organ damage. J Clin Hypertens (Greenwich) 2018; 20:266-272. [DOI: 10.1111/jch.13172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/07/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alejandro de la Sierra
- Department of Internal Medicine; Hospital Mutua Terrassa; University of Barcelona; Terrassa Spain
| | - Julia Pareja
- Department of Internal Medicine; Hospital Mutua Terrassa; University of Barcelona; Terrassa Spain
| | - Sergi Yun
- Department of Internal Medicine; Hospital Mutua Terrassa; University of Barcelona; Terrassa Spain
| | - Eva Acosta
- Department of Internal Medicine; Hospital Mutua Terrassa; University of Barcelona; Terrassa Spain
| | - Francesco Aiello
- Department of Internal Medicine; Hospital Mutua Terrassa; University of Barcelona; Terrassa Spain
| | - Anna Oliveras
- Department of Nephrology; Hospital del Mar; Barcelona Spain
| | - Susana Vázquez
- Department of Nephrology; Hospital del Mar; Barcelona Spain
| | - Pedro Armario
- Cardiovascular Disease Unit; Hospital Moisés Broggi Sant Joan Despí; Spain
| | - Pedro Blanch
- Cardiovascular Disease Unit; Hospital Moisés Broggi Sant Joan Despí; Spain
| | - Cristina Sierra
- Department of Internal Medicine; Hospital Clínic; Barcelona Spain
| | - Francesca Calero
- Renal and Hypertension Units; Fundació Puigvert Universitat Autónoma de Barcelona; Barcelona Spain
| | - Patricia Fernández-Llama
- Renal and Hypertension Units; Fundació Puigvert Universitat Autónoma de Barcelona; Barcelona Spain
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Del Mauro JS, Prince PD, Donato M, Fernandez Machulsky N, Morettón MA, González GE, Bertera FM, Carranza A, Gorzalczany SB, Chiappetta DA, Berg G, Morales C, Gelpi RJ, Taira CA, Höcht C. Effects of carvedilol or amlodipine on target organ damage in L-NAME hypertensive rats: their relationship with blood pressure variability. ACTA ACUST UNITED AC 2017; 11:227-240. [PMID: 28595719 DOI: 10.1016/j.jash.2017.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/17/2017] [Accepted: 02/14/2017] [Indexed: 01/19/2023]
Abstract
The aim of the study was to compare the effects of chronic oral treatment with carvedilol or amlodipine on blood pressure, blood pressure variability and target organ damage in N-nitro-l-arginine methyl ester (L-NAME) hypertensive rats. Wistar rats were treated with L-NAME administered in the drinking water for 8 weeks together with oral administration of carvedilol 30 mg/kg (n = 6), amlodipine 10 mg/kg (n = 6), or vehicle (n = 6). At the end of the treatment, echocardiographic evaluation, blood pressure, and short-term variability measurements were performed. Left ventricular and thoracic aortas were removed to assess activity of metalloproteinase 2 and 9 and expression levels of transforming growth factor β, tumor necrosis factor α, and interleukin 6. Histological samples were prepared from both tissues. Carvedilol and amlodipine induced a comparable reduction of systolic and mean arterial pressure and its short-term variability in L-NAME rats. The expression of transforming growth factor β, tumor necrosis factor α, and interleukin 6 decreased in both organs after carvedilol or amlodipine treatment and the activity of metalloproteinase was reduced in aortic tissue. Treatment with carvedilol or amlodipine completely prevented left ventricular collagen deposition and morphometric alterations in aorta. Oral chronic treatment with carvedilol or amlodipine significantly attenuates blood pressure variability and reduces target organ damage and biomarkers of tissue fibrosis and inflammation in L-NAME hypertensive rats.
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Affiliation(s)
- Julieta S Del Mauro
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Farmacología, Buenos Aires, Argentina.
| | - Paula D Prince
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Físicoquímica, Instituto de Bioquímica y Medicina Molecular-Consejo Nacional de Investigaciones Científicas y Técnicas (IBIMOL-CONICET), Buenos Aires, Argentina
| | - Martín Donato
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Fisiopatología Cardiovascular (INFICA), Departamento de Patología, Buenos Aires, Argentina
| | - Nahuel Fernandez Machulsky
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Lípidos y Aterosclerosis, Departamiento de Bioquímica Clínica, INFIBIOC, Buenos Aires, Argentina
| | - Marcela A Morettón
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Tecnología Farmacéutica, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Germán E González
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Fisiopatología Cardiovascular (INFICA), Departamento de Patología, Buenos Aires, Argentina
| | - Facundo M Bertera
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Farmacología, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
| | - Andrea Carranza
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Farmacología, Buenos Aires, Argentina
| | - Susana B Gorzalczany
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Farmacología, Buenos Aires, Argentina
| | - Diego A Chiappetta
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Tecnología Farmacéutica, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Gabriela Berg
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Lípidos y Aterosclerosis, Departamiento de Bioquímica Clínica, INFIBIOC, Buenos Aires, Argentina
| | - Celina Morales
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Fisiopatología Cardiovascular (INFICA), Departamento de Patología, Buenos Aires, Argentina
| | - Ricardo J Gelpi
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Fisiopatología Cardiovascular (INFICA), Departamento de Patología, Buenos Aires, Argentina
| | - Carlos A Taira
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Farmacología, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
| | - Christian Höcht
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Farmacología, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
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Georgakis MK, Synetos A, Mihas C, Karalexi MA, Tousoulis D, Seshadri S, Petridou ET. Left ventricular hypertrophy in association with cognitive impairment: a systematic review and meta-analysis. Hypertens Res 2017; 40:696-709. [DOI: 10.1038/hr.2017.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
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Analysis of beat-to-beat blood pressure variability response to the cold pressor test in the offspring of hypertensive and normotensive parents. Hypertens Res 2017; 40:581-589. [DOI: 10.1038/hr.2017.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/05/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
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Omboni S, Posokhov IN, Rogoza AN. Relationships between 24-h blood pressure variability and 24-h central arterial pressure, pulse wave velocity and augmentation index in hypertensive patients. Hypertens Res 2016; 40:385-391. [PMID: 27881851 DOI: 10.1038/hr.2016.156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/14/2016] [Accepted: 10/06/2016] [Indexed: 11/09/2022]
Abstract
Twenty-four-h blood pressure variability (BPV) predicts cardiovascular complications in hypertension, but its association with pulse wave indices (central arterial pressure, pulse wave velocity (PWV) and augmentation index (AIx)) is poorly understood. In the present study, we assessed the degree of the effect of 24-h BPV on 24-h pulse wave indices. Brachial blood pressure was measured non-invasively over the 24 h with an electronic, oscillometric, automated device (BPLab) in 661 uncomplicated treated or untreated hypertensive patients. Digitalized oscillometric waveforms were analyzed with a validated algorithm to obtain pulse wave indices. Twenty-four-h BPV was calculated as the unweighted (SDu) or weighted s.d. (SDw) of the mean blood pressure or as the average real variability (ARV). Twenty-four-h systolic BPV showed a direct and significant relationship with the central arterial systolic pressure (r=0.28 SDu, r=0.40 SDw, r=0.34 ARV), PWV (r=0.10 SDu, r=0.21 SDw, r=0.19 ARV) and AIx (r=0.17 SDu, r=0.27 SDw, r=0.23 ARV). After adjustment for age, sex, body mass index, antihypertensive treatment and 24-h systolic blood pressure, the relationship lost some power but was still significant for all measures, except for the AIx. Pulse wave indices were higher in patients with high BPV than in those with low BPV: after adjustment, these differences were abolished for the AIx. The diastolic BPV showed a weak association with the pulse wave indices. In conclusion, in hypertensive patients, 24-h systolic BPV is moderately and independently associated with 24-h central arterial pressure and stiffness.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
| | | | - Anatoly N Rogoza
- Department of New Methods of Diagnostics, Russian Cardiology Research and Production Complex, Moscow, Russia
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Irigoyen MC, De Angelis K, Dos Santos F, Dartora DR, Rodrigues B, Consolim-Colombo FM. Hypertension, Blood Pressure Variability, and Target Organ Lesion. Curr Hypertens Rep 2016; 18:31. [PMID: 27002717 DOI: 10.1007/s11906-016-0642-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertensive patients have a higher risk of developing health complications, particularly cardiovascular (CV) events, than individuals with normal blood pressure (BP). Severity of complications depends on the magnitude of BP elevation and other CV risk factors associated with the target organ damage. Therefore, BP control and management of organ damage may contribute to reduce this risk. BP variability (BPV) has been considered a physiological marker of autonomic nervous system control and may be implicated in increased CV risk in hypertension. This review will present some evidence relating BPV and target organ damage in hypertension in clinical and experimental settings.
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Affiliation(s)
- Maria-Cláudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil.
| | - Kátia De Angelis
- Laboratory of Translational Physiology, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Fernando Dos Santos
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil
| | - Daniela R Dartora
- Instituto de Cardiologia do Rio Grande do Sul/ Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
| | - Bruno Rodrigues
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fernanda Marciano Consolim-Colombo
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil.,Laboratory of Translational Physiology, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Impact of awake blood pressure variability on cerebrovascular atherosclerosis in Chinese patients with acute ischemic stroke. Blood Press Monit 2016; 21:271-6. [PMID: 27214144 DOI: 10.1097/mbp.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blood pressure (BP) variability has been shown to be an independent risk factor of stroke and target organ damage because of hypertension, but so far, there have been very few studies investigating the impact of BP variability on cerebrovascular atherosclerosis. METHODS A total of 409 participants were enrolled and classified according to patterns of cerebrovascular atherosclerosis (i.e. large or small artery atherosclerosis; extracranial; or intracranial artery atherosclerosis). Coefficient of variation (CV) was used as a marker of BP variability. Multivariate binary logistical regression was used to analyze the associations between BP variability and the risk of different patterns of cerebrovascular atherosclerosis. RESULTS The risk of large artery atherosclerosis and extracranial arterial stenosis, respectively, had a dose-responsive positive relationship with the tertiles of awake systolic blood pressure (SBP) CVs [large artery atherosclerosis, the second tertile, adjusted odds ratio (OR)=2.839, 95% confidence interval (CI) 1.593-5.059, P<0.001; the third tertile, adjusted OR=4.010, 95% CI 1.859-8.651, P<0.001; extracranial arterial stenosis, the second tertile, adjusted OR=2.274, 95% CI 1.189-4.348, P=0.013; the third tertile, adjusted OR=2.568, 95% CI 1.230-5.360, P=0.012, when referenced to the first tertile], but not with those of mean awake SBP. The third tertile of awake SBP CVs indicated a significantly higher risk of intracranial arterial stenosis (adjusted OR=2.253, 95% CI 1.118-4.538, P=0.023) and advanced intracranial arterial stenosis (adjusted OR=5.073, 95% CI 2.064-12.466, P<0.001) when referenced to the first tertile. CONCLUSION In Chinese patients with acute atherosclerotic stroke, higher awake BP variability (measured in the subacute stage) might be associated with a higher risk of large artery atherosclerosis.
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