Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index

Abstract

BackgroundBlood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI).Methods and ResultsIn a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses.ConclusionTime rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

A Randomized Controlled Trial Comparing the Effects of Yoga With an Active Control on Ambulatory Blood Pressure in Individuals With Prehypertension and Stage 1 Hypertension

“…Standard deviations are displayed in Table 2 and range from approximately 9–16 mmHg. These values are similar to some previous studies using ambulatory blood pressure monitoring 28,29 but are greater than in others 30 . Future research will require larger sample sizes to achieve sufficient power for comparisons with control groups.…”

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“…ABPM showed short‐term BP variability within a day during the subacute phase of ischemic stroke. In a previous report, the time rate of BP variation measured using ABPM was associated with ABI in patients with hypertension . However, in the previous study, BP variability evaluated using SD or CV was not significantly associated with low ABI values.…”

Ambulatory Arterial Stiffness Index and circadian blood pressure variability

“…8,15,16 The inclusion of all 24 hours of BP data into the AASI may hide the relationship between a degree of variability that a pressure metric like PP, or systolic BP, has with it because of the differences in BP during the day (when it is usually higher) and the night (when it is typically lower). The recent focus on BP variability as a predictor of stroke and other cardiovascular outcomes 17 has raised issues on the best period over which to evaluate variability 9 with options including the visit-to-visit values, 2 values more than 24 hours using ABPM, 18 or at home or in office with repeated measurements. 1,2,19 Among these options, it seems to us that ABPM blends the best balance of a relatively large number of readings and includes values obtained during sleep.…”