The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m 2 and 60 mL/min/ 1.73 m 2 and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities. J Clin Hypertens (Greenwich). 2015;17:473-480. ª 2015 Wiley Periodicals, Inc.Since the pioneering observations of Stephen Hales during the 18th century it has been recognized that blood pressure (BP) is not a constant parameter; rather, it shows marked spontaneous oscillations over shortterm (minutes to hours) and long-term (days to months) periods. Far from being a "background noise" that hindered assessment of "true BP," short-term BP variability (BPV) seems to be relevant to the pathophysiology of target organ damage and to the incidence of clinical events, as suggested by studies performed in humans by invasive continuous 24-hour BP measurements 1,2 and as clearly shown by investigations conducted in sinoaortic-denervated rats.3-6 Although the precise quantification of short-term BPV requires beatto-beat BP recording, 7 its assessment is also possible, even if less accurately, through the use of intermittent noninvasive 24-hour ambulatory BP monitoring (ABPM). However, studies in which short-term BPV was estimated by ABPM yielded conflicting results. 8-32Short-term BP variability has been usually estimated by 24-hour, daytime, or nighttime standard deviation (SD) of average BP. However, the limitations of the SD as a measure of short-term BPV have stimulated the search of more refined BPV estimates. 6,7,10,13,20,21 One of these is the average real variability (ARV) of 24-hour BP, ie, the average of the absolute differences of consecutive measurements. 20 This statistical parameter is sensitive to the individual BP measurement order and less sensitive to low sampling frequency of ABPM. 21Some studies suggest that ARV better predicts cardiovascular (CV) risk in comparison to the traditional SD. 20,22,23 Another new index of short-term BPV is the "weighted" SD of the 24-hour mean value, ie, the average SD of daytime and nighttime BP, each weighted for the duration of the day and night periods, respectively. This in order ...

Background and aim: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results.The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. Methods and results: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained.In the overall population we observed no significant correlation of SUA with LV mass indexed for height 2.7 (LVMH 2.7 ) (r Z 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r Z 0.27; p < 0.001), but not in males (r Z À0.042; p Z NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH 2.7 was observed in the highest tertiles in women (44.5 AE 15.6 vs 47.5 AE 16 vs 55.9 AE 22.2 g/m 2.7 ; p < 0.001), but not in men.The association between SUA and LVMH 2.7 in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. Conclusions: Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension. ª

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An extensive and highly consistent body of evidence indicates that the average level of 24-h ambulatory blood pressure (BP) correlates more closely than casual BP with the cardiovascular (CV) and renal complications of arterial hypertension. 1,2 However, average pressures neglect the temporal variation in BP, which may be also prognostically relevant. 1,[3][4][5][6][7] Since the pioneering observations ofStephen Hales, during the 18th century, BP has been recognized as a fluctuating parameter 2 ; indeed, it has been shown to be characterized by marked spontaneous oscillations over short-term (minutes to hours) and long-term (days to months) periods. Important BP variations from summer to winter have also been consistently reported (seasonal BP variability). Although in physiological conditions these variations may represent an adaptive humoral and neural response to environmental, behavioral, and emotional stimuli occurring in daily life, they may also reflect alterations in CV regulatory mechanisms. 1 Historically, variability in BP has been viewed as a factor inhibiting accurate measurement of mean BP and as a phenomenon to be overcome by improved monitoring. 1,2 Far from being a "background noise" that hinders the assessment of "true BP," 2 short-term BP variability (BPV) seems to be relevant to the pathophysiology of target organ damage and to the incidence of clinical events. 1,3-10 | IND I CE S OF S HORT-TERM B LOOD PRE SSURE VARIAB ILIT YAlthough the precise quantification of short-term BPV requires beat-to-beat BP recording, its assessment is also possible, even if less accurately, through the use of intermittent noninvasive 24hour ambulatory BP monitoring (ABPM), at intervals from 15 to 20 minutes. 1 This allows the straightforward estimation of shortterm BPV by calculating the 24-h BP standard deviation (SD) and the coefficient of variation (SD X 100/BP mean), which accounts for the dependence of the SD on mean BP levels. 1 Despite the

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