Mechanisms and Clinical Implications of Blood Pressure Variability

Mancia, Giuseppe; Grassı, Guıdo

doi:10.1097/00005344-200000004-00003

Cited by 96 publications

(68 citation statements)

References 32 publications

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“…There is a growing body of evidence to suggest that BPV is influenced by a number of neural, humoral, behavioural and structural factors [24]. In particular, an age-related degeneration of the arterial baroreflex has been correlated with increasing systolic BPV [25].…”

Section: Discussionmentioning

confidence: 99%

Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population

Pringle

Phillips

Thijs

et al. 2003

Journal of Hypertension

322

233

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, on behalf of the Syst-Eur investigatorsObjective To investigate whether baseline systolic blood pressure variability was a risk factor for stroke, cardiovascular mortality or cardiac events during the SystEur trial.Design The Syst-Eur study was a randomized, doubleblind, placebo-controlled trial, powered to detect differences in stroke rate between participants on active antihypertensive treatment and placebo. Systolic blood pressure variability measurements were made on 744 participants at the start of the trial. Systolic blood pressure variability was calculated over three time frames: 24 h, daytime and night-time. The placebo and active treatment subgroups were analysed separately using an intention-totreat principle, adjusting for confounding factors using a multiple Cox regression model. Participants An elderly hypertensive European population.Main outcome measures Stroke, cardiac events (fatal and non-fatal heart failure, fatal and non-fatal myocardial infarction and sudden death) and cardiovascular mortality (death attributed to stroke, heart failure, myocardial infarction, sudden death, pulmonary embolus, peripheral vascular disease and aortic dissection).Results The risk of stroke increased by 80% (95% confidence interval: 17-176%) for every 5 mmHg increase in night-time systolic blood pressure variability in the placebo group. Risk of cardiovascular mortality and cardiac events was not significantly altered. Daytime variability readings did not predict outcome. Antihypertensive treatment did not affect systolic blood pressure variability over the median 4.4-year follow-up. ConclusionIn the placebo group, but not the active treatment group, increased night-time systolic blood pressure variability on admission to the Syst-Eur trial was an independent risk factor for stroke during the trial.

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Section: Discussionmentioning

confidence: 99%

Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population

Pringle

Phillips

Thijs

et al. 2003

Journal of Hypertension

322

233

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“…Systematic error may be caused by (i) observer bias, (ii) last digit preference, (iii) problems with equipment, or (iv) variation in used technique [12,13]. Random variation reflects fluctuations in biological, mechanical and environmental circumstances, such as seasonal variation, body mass index, use of antihypertensive drug therapy, plasma cholesterol, smoking status, and diabetes [14][15][16]. In our study, AAI measurements were performed by a well-trained and experienced observer.…”

Section: Discussionmentioning

confidence: 99%

Best reproducibility of the ankle–arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure

Atsma¹,

Bartelink²,

Grobbee³

et al. 2005

Journal of Clinical Epidemiology

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Background and Objective: To investigate which method of ankle-arm index (AAI) measurement in terms of selected arteries and blood pressure devices yields the highest reproducibility.Study Design and Setting: In this cross-sectional study, duplicate AAI measurements were obtained at the right and left side in 320 postmenopausal women. Analyses were done as proposed by Bland and Altman and intraclass correlation coefficients were calculated.Results: The mean and standard deviation (SD) of the first and second systolic blood pressure (SBP) measurement separately did not differ from the mean and SD of the duplicate SBP measurements averaged. Coefficients of repeatability and intraclass correlation coefficients were comparable when the ankle SBP was measured in the posterior tibial artery or dorsalis pedis artery. Coefficients of repeatability as well as the intraclass correlation were better when the SBP in the brachial artery was measured with Doppler than with Dinamap.Conclusions: To achieve the best reproducibility and smallest systematic difference in the AAI, single SBP measurements should be obtained by Doppler in the brachial artery, posterior tibial artery and dorsalis pedis artery. The AAI should be calculated for each foot separately by dividing the highest ankle SBP by the highest arm SBP. Ó

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“…However, several factors such as humoral and neural factors (central or reflex) and behavioral mechanisms have been implicated. 9 Various humoral factors participate in the mechanisms of BP variability; these include nitric oxide, angiotensin and insulin. Studies have revealed a relationship between BP variability and resting sympathetic activity, 10 which progressively increases from a normotensive to a hypertensive state.…”

mentioning

confidence: 99%

Blood pressure variability and its implications in people of African descent

2011

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T echniques that assess systolic and diastolic blood pressure (BP) values in ambulant subjects have revealed that BP fluctuates spontaneously throughout the day. 1 Blood pressure variability has pathophysiological implications. The values may vary by more than 50 mm Hg in a day. These fluctuations are due to pressor and depressor episodes, and exhibit diurnal variation with high daytime and low nighttime values.Elevated BP is the most common and modifiable risk factor for cardiovascular disease. 2 Clinicians must recognize that measured BP is an intrinsically variable hemodynamic phenomenon. Measured BP remains variable even after correcting for faulty equipment or poor technique. 3 Recent studies have revealed distinct pathophysiological patterns of BP variability and reactivity that are clinically significant. These patterns are related to the modulation of sympathoadrenal output, to vascular reactivity and to behavioral aspects. 4 Sympathoadrenal output is modified by a variety of environmental stressors, baroreceptor reactivity and hypothalamic factors. These modifiers are affected by age, hypertension, genetic factors, angiotensin II levels and disease state. For example, normotensive individuals with a family history of hypertension have decreased baroreceptor activity, which contributes to BP variability. The study by Schutte et al. 5 did not indicate any family history of hypertension in their subjects.They studied BP variability in hypertensive and normotensive Caucasians and people of African descent in South Africa. The prevalence of hypertension is higher in people of African descent than in Caucasians. In addition, normotensive people of African descent are more likely to have a family history of hypertension compared with Caucasians.

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Mechanisms and Clinical Implications of Blood Pressure Variability

Cited by 96 publications

References 32 publications

Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population

Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population

Best reproducibility of the ankle–arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure

Blood pressure variability and its implications in people of African descent

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