C urrent guidelines recommend the assessment of vascular risk factors, target organ damage, and blood pressure (BP) levels to guide the treatment on primary hypertension.1 Besides BP levels, other BP-related features, such as the nocturnal dipping 2 or more recently, visit-to-visit or long-term BP variability (BPV), have been independently associated with clinical cardiovascular outcomes in a recent systematic review and meta-analysis. 3 Also, the prognostic value of BPV measured with ambulatory BP monitoring (ABPM) for 24 hours (also value-to-value or short-term BPV) has been evaluated. Data on short-term BPV from 11 populations 4 suggest a positive association between measures of short-term BPV and cardiovascular death or any (fatal and nonfatal) event. Although the contribution of short-term BPV to the prediction of cardiovascular events was shown to be small (<1%), this is still a matter of debate because results from individual studies support significant contributions. 5,6 It has been also suggested that the prognostic significance of BPV on stroke risk is weaker for short-term than for longterm BPV in treated hypertension. 7 However, these data need further investigation taking into account not only between subject BPV but also within subject BPV.Moreover, several indices of short-term BPV have been related to the presence of subclinical damage in one or multiple organs, including the heart, kidney, and vessels, independently of BP levels. [8][9][10] About the brain, hypertension is a major risk factor for cerebral small vessel disease (CSVD), which is an Abstract-Blood pressure (BP) variability is associated with stroke risk, but less is known about subclinical cerebral small vessel disease (CSVD). We aimed to determine whether CSVD relates to short-term BP variability independently of BP levels and also, whether they improve CSVD discrimination beyond clinical variables and office BP levels. This was a cohort study on asymptomatic hypertensives who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. Office and average 24-hour, daytime and nighttime BP levels, and several metrics of BP variability (SD, weighted SD, coefficient of variation, and average real variability [ARV]) were calculated. Definition of CSVD was based on the presence of lacunar infarcts and white matter hyperintensity grades. Multivariate analysis and integrated discrimination improvement were performed to assess whether BP variability and levels were independently associated with CSVD and improved its discrimination. Four hundred eighty-seven individuals participated (median age, 64; 47% women). CSVD was identified in 18.9%, related to age, male sex, diabetes mellitus, use of treatment, ambulatory BP monitoring-defined BP levels, and ARV of systolic BP at any period. The highest prevalence (33.7%) was found in subjects with both 24-hour BP levels and ARV elevated. BP levels at any period and ARV (24 hours and nocturnal) emerged as independent predictors of CSVD, and discrimination was incrementally improv...

BackgroundTo investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria.MethodsA cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes).ResultsDefining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score.ConclusionsA shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy.