Abstract-Growing evidence associates blood pressure (BP) variability with cardiovascular events in hypertensive patients. Here we tested the existence of a relationship between awake BP variability and target-organ damage in subjects referred for suspected hypertension. Systolic and diastolic BP variability were assessed as the standard deviation of the mean out of 24-hour, awake and asleep BP recordings in 180 untreated subjects, referred for suspected hypertension. Measurements were done at 15-minute intervals during daytime and 30-minute intervals during nighttime. Left ventricular mass index (by echo), intima-media thickness (by carotid ultrasonography), and microalbuminuria were assessed as indices of cardiac, vascular and renal damage, respectively. Intima-media thickness and left ventricular mass index progressively increased across tertiles of awake systolic BP variability (P for trendϭ0.001 and 0.003, respectively). Conversely, microalbuminuria was similar in the 3 tertiles (PϭNS). Multivariable analysis identified age (Pϭ0.0001), awake systolic BP (Pϭ0.001), awake systolic BP variability (Pϭ0.015) and diastolic BP load (Pϭ0.01) as independent predictors of intima-media thickness; age (Pϭ0.0001), male sex (Pϭ0.012), awake systolic (Pϭ0.0001) and diastolic BP (Pϭ0.035), and awake systolic BP variability (Pϭ0.028) as independent predictors of left ventricular mass index; awake systolic BP variability (Pϭ0.01) and diastolic BP load (Pϭ0.01) as independent predictors of microalbuminuria. Therefore, awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels. Such relationship, found in subjects referred for recently suspected hypertension, likely appears early in the natural history of hypertension. Key Words: hypertension Ⅲ blood pressure variability Ⅲ target-organ damage Ⅲ intima-media thickness Ⅲ left ventricular mass index H ypertension involves an increased risk of cardiovascular events, 1 which may be predicted by the occurrence of target-organ damage, such as subclinical renal dysfunction (microalbuminuria), 2 left ventricular hypertrophy, 3 or increased intima-media thickness, this last as a surrogate marker for atherosclerosis. 4 The availability of 24-hour ambulatory blood pressure monitoring (ABPM), in addition to providing information on mean BP levels, also allows an estimate of BP variability, the clinical significance of which is currently debated. [5][6][7] It has been shown that BP variability, assessed with invasive 24-hour ABPM, which provides beatto-beat estimates of BP and therefore a large number of estimates over 24 hours, carries prognostic information, with a higher number of cardiovascular events occurring in patients with wider BP excursions. 8 Information of this kind is beginning to accumulate also with noninvasive 24-hour ABPM, which is now much of current clinical use. Here the day/night variability, as assessed by the occurrence of the dipper/nondipper pattern, has been associated with ...

Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke.

Variability in the acute BP response to coffee may be partly explained by genetic polymorphisms of the adenosine A2A receptors and α(2)-adrenergic receptors. This trial is registered at clinicaltrials.gov as NCT01330680.

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