Blood Pressure Variability in Clinical Practice: Past, Present and the Future

Abstract

Recent advances in wearable technology through convenient and cuffless systems will enable continuous, noninvasive monitoring of blood pressure (BP), heart rate, and heart rhythm on both longitudinal 24‐hour measurement scales and high‐frequency beat‐to‐beat BP variability and synchronous heart rate variability and changes in underlying heart rhythm. Clinically, BP variability is classified into 4 main types on the basis of the duration of monitoring time: very‐short‐term (beat to beat), short‐term (within 24 hours), medium‐term (within days), and long‐term (over months and years). BP variability is a strong risk factor for cardiovascular diseases, chronic kidney disease, cognitive decline, and mental illness. The diagnostic and therapeutic value of measuring and controlling BP variability may offer critical targets in addition to lowering mean BP in hypertensive populations.

Reliability of beat-to-beat blood pressure variability in older adults

“…Additionally, ARV considers the temporal order of BP measurements, adding a time series variability component to the measurement ( 63 ) since it reflects the variation in successive differences in beat-to-beat BP. These features of ARV potentially add prognostic value ( 64 ) and overcome some potential pitfalls of the SD-based measures which only measure dispersion around mean BP and may be more influenced by outliers ( 41 ), while also ignoring the temporal order of BP measurements ( 2 , 47 , 64 - 66 ). Additionally, two individuals with different BP profiles may have similar BPV dispersion measures but different ARVs, likely making ARV a more specific measure of BPV ( 67 ).…”

“…This may also explain the finding that ARV is a better predictor of 24-hour BPV and subclinical organ damage compared to dispersion metrics ( 64 ). Lastly, the measurement of consecutive beat-to-beat differences rather than dispersion from the mean may make ARV particularly well-suited for assessing beat-to-beat variation in BP ( 2 ). A parallel can be drawn here to a heart rate variability (HRV) metric, root mean square of successive differences (RMSSD) ( 68 ), which acts as a high pass filter thus reflecting the high frequency variability in heart rate and is calculated similarly to ARV ( 68 ).…”

“…Blood pressure variability (BPV) has emerged as a hemodynamic marker of interest with widespread clinical and research utility. BPV is associated with increased mortality ( 1 ), and is a risk factor for cardiovascular disease ( 2 - 9 ), stroke ( 10 - 12 ), cerebral small vessel disease (CSVD) ( 13 , 14 ), neurodegenerative disease ( 15 ) and dementia ( 16 , 17 ), independent of average blood pressure (BP). The regulatory mechanisms which underlie BPV modulation are complex and multifactorial, potentially involving arterial baroreflex sensitivity ( 18 ), arterial stiffness ( 19 ), endothelial dysfunction ( 20 ), and kidney function ( 20 ) among other factors ( 21 , 22 ).…”

“…Methodologies for BPV calculation fall into four main categories including very short-term (beat-to-beat) BPV, short-term BPV (<24 hours), medium-term BPV (day-to-day), and long-term BPV (visit-to-visit over months or years) ( 2 ). Each category offers unique advantages and disadvantages.…”

24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

“…Rather than waiting months to years to accumulate BP recordings to calculate BPV, ambulatory BP monitoring may enable scientists and clinicians to estimate BPV in a matter of 24 hours and accelerate individualized treatment planning goals. Although ambulatory BP monitoring is not currently ubiquitous in clinical settings, more care sites and clinical trials may utilize this approach in the future ( 54 ). Ambulatory BP monitoring has the advantages of measuring BP in one’s everyday environment, which may reduce the likelihood of a white-coat effect or masked hypertension, and assessing the influence of circadian rhythms on BP.…”