Lack of Association Between Blood Pressure Variability and Left Ventricular Mass in Essential Hypertension

Schillaci, Giuseppe; Verdecchia, Paolo; Borgioni, Claudia; Ciucci, Antonella; Porcellati, Carlo

doi:10.1016/s0895-7061(97)00413-5

Cited by 45 publications

(31 citation statements)

References 42 publications

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“…Conversely, in hypertensive Africans, left ventricular mass was significantly associated with office, 1-minute, 24-h, daytime and night time BP, as well as BP reactivity measurements, but there was a complete absence regarding the relationship with 24-h SBP variability. Schillaci et al 38 and Roman et al 43 also observed this lack of association in Caucasians with essential hypertension. Contradictory results have been provided over the years regarding the predictive value of BP variability, 4,8,10,14 which might be due to differences in methods, too few events or different indexes of BP variability.…”

Section: Discussionmentioning

confidence: 91%

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Schutte

Huisman

et al. 2011

Hypertens Res

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The prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention. The need for early markers of cardiovascular dysfunction is imperative in black South Africans who have a significant risk for cardiovascular disease. We therefore compared 24-h BP variability with various traditional and advanced BP measurements, regarding their association with sub-clinical organ damage in black and white South Africans. The study included 409 African and Caucasian teachers aged 25-60 yrs. We measured office BP, 1-min continuous (finger) BP, ambulatory BP, BP reactivity and determined weighted 24-h BP variability. Albumin-to-creatinine ratio, Cornell product and carotid cross-sectional wall area (CSWA) were measures of organ damage. Africans had higher 24-h BP, BP variability, BP reactivity and sub-clinical organ damage (Po0.001). Correlations of BP variability with organ damage were overall weak when compared with other BP measurements. In normotensive groups, we found an independent association of 24-h systolic BP (SBP) variability with Cornell product only in Africans (r¼0.37; P¼0.01), confirmed in multiple regression models, with 24-h SBP included in the model. Only in hypertensive Caucasians, a significant correlation between CSWA and 24-h SBP variability was evident (r¼0.30; P¼0.01), although CSWA indicated stronger correlations with office or 24-h SBP than 24-h SBP variability. To conclude, 24-h SBP variability could potentially be an effective measure for the early detection of normotensive Africans at increased risk for the development of cardiovascular complications. Its usefulness based on associations with target organ damage in hypertensive groups seems to be less than traditional office or 24-h BP measurements. Hypertension Research (2011Research ( ) 34, 1127Research ( -1134 doi:10.1038/hr.2011; published online 28 July 2011Keywords: albumin-to-creatinine ratio; ethnicity; intima-media thickness; left ventricular hypertrophy INTRODUCTIONThe prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention in the literature. [1][2][3][4][5][6][7][8][9][10] Where some papers emphasize the importance of BP variability in prediction of risk of vascular events, 1,2,6,9 others question its prediction of cardiovascular outcome. 4,5,10 Despite this upsurge of recent papers, consistent evidence over the past three decades lends support that both target organ damage and the rate of cardiovascular events of hypertensive patients are significantly and independently related to the degree of BP variability. [11][12][13][14][15] A limitation of many of these papers is that either BP variability alone was investigated, or various measures of BP variability (such as s.d. of 24-h BP, average real variability index 16 and weighted 24-h BP s.d. 17 ) were being compared, regarding the strength of their association with target organ damage.The question therefore arises how BP variability would benchmark against a comprehensive range of both traditional and advanced

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Section: Discussionmentioning

confidence: 91%

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Schutte

Huisman

et al. 2011

Hypertens Res

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“…In the PIUMA study, for any level of 24-h systolic BP, hypertensive subjects were classified at low or high BP variability according to their SD of daytime and nighttime systolic BP below or above the median. LV mass at echocardiography did not differ between the groups at low versus high systolic BP variability (39). Then we showed that the variability score for daytime and nighttime systolic pressure failed to enter in a model that included age, diabetes, previous CV events, and average nighttime systolic BP (5).…”

Section: Bp Variabilitymentioning

confidence: 95%

Clinical Usefulness of Ambulatory Blood Pressure Monitoring

Verdecchia

Angeli

Gattobigio

2004

Journal of the American Society of Nephrology

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Abstract. During the past decade, several prospective studies showed that ambulatory BP (ABP) measurements provide a better prediction of major cardiovascular events when compared with clinic BP measurements. This review summarizes the available evidence supporting the use of ABP monitoring to refine prognostic stratification in hypertension. On the basis of available evidence, an operational flowchart is suggested to interpret results of ABP for better treatment of patients with elevated BP.The first device for noninvasive ambulatory BP (ABP) monitoring (ABPM) was developed in 1962 and subsequently modified by Sokolow et al. in 1966 (1). It used a microphone taped over the brachial artery, a cuff inflated by the patient, and a magnetic tape recorder for storing cuff pressure (1). During the past 20 yr, new devices have been were developed and ABPM is now widely used for research and clinical purposes. Evidence is accumulating that ABP measurements provide a better prediction of clinical outcome as compared with conventional clinic BP measurements (2-19). This review examines the evidence supporting the use of ABPM, discusses the advantages of ABPM over clinic BP to predict clinical outcome, and provides information on how to interpret ABPM profile and on when it should be used in clinical practice. Which Is the Rationale for Use of ABPM in Clinical Practice? Association between ABPM and Target Organ DamageMost studies have shown that end-organ damages associated with hypertension, including left ventricular (LV) hypertrophy, proteinuria, serum creatinine, atherosclerotic plaque, narrowing of the retinal arteries, and impaired arterial distensibility and compliance, are more strongly correlated with ABPM than with clinic BP measurements (2-16). The association between clinic BP and hypertension-related organ damage is relatively poor because the main limitations of clinic BP are those referred to the marked variability of BP measurements and the white-coat effect. ABPM and Prediction of Clinical OutcomeIn treated or untreated patients with hypertension, ABP is a significantly better predictor of cardiovascular (CV) and cerebrovascular events than clinic BP measurements (2-19). Table 1 provides an overview of event-based prognostic studies on ABP published in full-length papers by several independent groups. Each group is represented in Table 1 with its largest contribution (2-19). Even if most of the available evidence on the prognostic value of ambulatory BP relies on subjects who were untreated at the time of ABPM, a recent study from our group provided substantial evidence that achieved ambulatory BP during treatment is a potent determinant of the subsequent events and that its potency is superior to both pretreatment ABP and pretreatment and in-treatment clinic BP (17). How to Interpret ABP ProfileAn average daytime ABP Ͻ135 mmHg systolic and 85 mmHg diastolic is generally considered normal for adults; levels Ͻ130/80 mmHg may be considered optimal (20 -23). White-Coat HypertensionWhite-coat hypertension (W...

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“…At any given level of 24-hour BP, left ventricular mass at echocardiography did not differ between the groups. 55 In a recent study, after adjustment for several confounders, a high variability (SD above mean) in systolic BP during the night, but not during the day, was associated with a 51% higher risk of cardiac events (Pϭ0.024) but not of cerebrovascular events. The relations of daytime BP variability with cardiac events and that of daytime and nighttime BP variability with cerebrovascular events were not significant in a multivariate analysis.…”

Section: Bp Variabilitymentioning

confidence: 95%

Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring

Verdecchia¹,

Mazzotta

Gentile³

et al. 2009

Hypertension

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Lack of Association Between Blood Pressure Variability and Left Ventricular Mass in Essential Hypertension

Cited by 45 publications

References 42 publications

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Clinical Usefulness of Ambulatory Blood Pressure Monitoring

Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring

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