Background: Optimizing blood pressure variability seems to represent a new therapeutic target in the management of hypertension. It is emphasized that scheduling at least one antihypertensive agent at bedtime, has the ability to reduce blood pressure. Aim of the study : We have proposed to test whether the divided treatment regimen also lowers blood pressure variability. Material and methods: A number of 37 treated hypertensive patients were enrolled, who underwent 24-hour ambulatory blood pressure monitoring (ABPM) at inclusion and at 8 weeks after therapeutic intervention with divided treatment regimen. BPV was assessed using average real variability. Results: The 24-hour systolic blood presure decreased from 139.5 ± 8.8 mmHg to 127.4 ± 8.9 mmHg (p <0.0001), and we noted a 2.1 mmHg drop in blood pressure variability (p <0.0001), as well as a two-fold increase in the percentage of dippers. After baseline ABPM assessment, in 15 cases an angiotensin-converting-enzyme-inhibitor was scheduled at bedtime, and in 10 cases it was given twice a day. In 17 cases a thiazide diuretic was administered in the afternoon, and in 18 cases a calcium channel blocker was administered at bedtime. Conclusions: For a more accurate management of patients with hypertension, the assessment of circadian blood pressure profile and the implementation of an individualized treatment that uses divided antihypertensive agents at bedtime or midday administration have the ability to optimize blood pressure control, restore dipper-profile, and decrease blood pressure variability.

Background: A number of studies reveal that home blood pressure variability is associated with cardiovascular risk factors. However, we do not have a consensus regarding the variability index and the frequency of measurements. Objective: The aim of the study was to assess home blood pressure variability for a period of 7 consecutive days and 24-hour ambulatory blood pressure variability using the average real variability index and to test whether home blood pressure variability represents a suitable parameter for long-term monitoring of the hypertensive patients. Material and methods: A number of 31 hypertensive patients were included in the study, 8 male, 23 female, mean age 60.19±7.35 years. At the inclusion ambulatory blood pressure monitoring was performed, home blood pressure monitoring was carried out for 7 consecutive days with 2 measurements daily. We compared ambulatory blood pressure values, variability using paired t-test. We were looking for correlations between HBP values and cardiovascular risk factors. Results: Ambulatory versus home blood pressure derived mean blood pressure was 131.38±15.2 versus 131.93±8.25, p=0.81. Ambulatory derived variability was 10.65±2.05 versus home variability 10.56±4.83, p=0.91. Home versus ambulatory pulse pressure was 51.8± 9.06 mmHg vs. 54.9±11.9 mmHg, p=0.046. We found positive correlation between HBPV and home BP values, p=0.027, r2=0.1577, (CI: 0.04967 to 0.6588). Home, as well as ambulatory derived variability were positively correlated to age p=0.043, r2=0.1377 (CI: 0.01234 to 0.6451) versus p<0.0001, CI: 0.3870 to 0.8220, r2=0.4302. Conclusion: Assessment of home blood pressure monitoring and variability could represent a well-tolerated alternative for long-term follow-up of hypertension management.