Blood Pressure Variability: Assessment, Predictive Value, and Potential as a Therapeutic Target

Abstract

A large body of evidence has consistently supported the relationship between blood pressure (BP) levels and the risk of cardiovascular complications. In recent years, several independent studies have also indicated that this risk may not only depend on the magnitude of the blood pressure elevation per se but also on the presence of other associated conditions such as increased blood pressure variability. This concept has been supported by a series of reports, most of which post hoc analyses of clinical trials in hypertension, showing that increasing values of BP variability (BPV) (either in the short term, in the midterm, or in the long term) may predict development, progression, and severity of cardiac, vascular, and renal organ damage, as well as cardiovascular events and mortality. Remarkably, studies conducted in populations at high cardiovascular risk have shown increasing values of BPV in the individual subjects (so-called intra- or within-individual BPV) to be strong predictors of cardiovascular morbidity and mortality, even to a larger extent than average BP values. However, in subjects at low to moderate cardiovascular risk, the contribution of BPV to cardiovascular risk prediction over and beyond average BP values has been shown to be only moderate. The aim of this paper is to critically review the evidence addressing the prognostic relevance of different components of BPV addressing a yet open question, i.e., whether routine assessment of BPV in clinical practice should be regarded as an additional target of antihypertensive treatment to improve cardiovascular protection.

Treating Visit-to-Visit Blood Pressure Variability to Improve Prognosis

“…3,13,20 Arterial stiffness and endothelial and smooth muscle dysfunction have been proposed as mechanisms underlying the association between VVV and outcome. 26,27 Furthermore, the underlying mechanisms accounting for the beneficial effect of CCBs-especially amlodipine-on VVV have not been clarified, but there are a few hypotheses.…”

“…BP fluctuates constantly and its variability not only may have diagnostic implications regarding the accurate assessment of hypertension but also seems to exert additional stress on the cardiovascular system over and above average BP levels. 3 Different components of BPV have been identified, characterized by BP fluctuations between hours, days, or months/years, respectively, termed as short-, mid-, and longterm components. 3 All these types of BPV have been shown to carry an independent prognostic value in terms of cardiovascular events and all-cause and cardiovascular mortality.…”

“…3 Different components of BPV have been identified, characterized by BP fluctuations between hours, days, or months/years, respectively, termed as short-, mid-, and longterm components. 3 All these types of BPV have been shown to carry an independent prognostic value in terms of cardiovascular events and all-cause and cardiovascular mortality. [4][5][6][7][8][9][10] Three interesting articles have been recently published in this journal regarding long-term visit-to-visit BPV (VVV).…”

Predictors of blood pressure control in patients with resistant hypertension

“…However, by defi nition, this index shows the dispersion of the BP around the mean and is therefore infl uenced by the mean BP levels. Although this can be addressed by calculating the coeffi cient of variation (22) it would still be dependent on underlying BP trends during the day, such as day-night changes. Short term measure to measure BP variations could be therefore undetected by SD.…”

Evaluation of ambulatory arterial stiffness index in hyperthyroidism

“…Short-term blood pressure variability is defined as the standard deviation or coefficient variation from the mean BP in 24-h ABPM recordings (9). Variability may reflect alterations in cardiovascular regulatory mechanisms, which in turn may also affect cardiovascular prognosis (10).…”