Awake Systolic Blood Pressure Variability Correlates With Target-Organ Damage in Hypertensive Subjects

Abstract

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 ...

Assessment of Short‐term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

“…17 However, Tatasciore et al reported that nighttime systolic BPV was not correlated with target-organ damage in patients with untreated and recently diagnosed hypertension. 18 Similarly, in our study, nighttime BPV was not correlated with aortic size index, but 24-hour and daytime systolic BPV were found to be positively correlated with aortic size index in recently diagnosed hypertensive patients.…”

Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients

“…Based on 24h ambulatory BP measurements, several studies have reported that both visit-to-visit BPV and short-term BPV were correlated with AS [10][11][13][14][15]. BPV has been reported to be closely associated with CAS [13][14][15]20].…”

“…BPV has been reported to be closely associated with CAS [13][14][15]20]. However, due to the existence of various BPV indices and poor reproducibility of these indices, it is difficult to draw solid conclusions about the relationship between BPV and CAS.…”

“…Many studies have reported that BPV is a risk predictor for organ damage, and considered that BPV is more valuable than increased blood pressure (BP), leading to the suggestion that reducing BPV is more important than lowering BP [9][10][11][13][14][15]. Recent research has also suggested that BPV is higher in hypertensive patients than in the healthy subjects [9][10][11].…”

“…Although many studies have provided evidence that CAS is closely associated with BPV [13][14][15]18], the relationship between CAS and BPV has not been quantified. In addition, different studies have used different BPV indices.…”