Modern Views on the Variability of Blood Pressure

Горбунов, В. М.

doi:10.20996/1819-6446-2012-8-6-810-818

Cited by 13 publications

(5 citation statements)

References 25 publications

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“…В отечественной научной литературе конца ХХ века 24-часовая ВАД характеризовалась как отклонение от кривой суточного ритма [11]. Более универсальное определение было предложено сотрудниками НМИЦ ПМ: вариабель-ность -это отклонения АД от систематического тренда, как правило, выражаемые с помощью SD или родственных SD индексов [18]. В соответствии с рекомендациями РМОАГ, ВАД являются колебания АД, превышающие физиологическую норму [19], однако это определение представляется менее точным [20].…”

Section: Discussionunclassified

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

Смирнова

Горбунов

Kurekhyan³

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p<0.0001-0.026). Conclusion. The main BPV indices are higher in patients with asthma and COPD, in comparison with CLAD-free hypertensive patients. ABPM is the most reliable method of BPV assessment in hypertensive patients with CLAD, according to our data. The increase in BPV is associated with irreversible airway obstruction and renal function. Adverse outcomes were associated with both nighttime BPV and nocturnal BP fall, as well as with rhythm disorders and leukocyte count as a marker of systemic inflammation. BPV in patients with CLAD warrants further investigation.

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Section: Discussionunclassified

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

Смирнова

Горбунов

Kurekhyan³

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

Self Cite

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“…ВАД определялась как отклонения АД от среднего уровня в дневное и ночное время суток [17,18]. Индекс времени гипотензии (ИВГ) рассчитывался как процент измерений АД, выходящих за пределы пороговых значений.…”

Section:  цель исследованияunclassified

Daily Variability of Blood Pressure and Morphofunctional State of the Central Nervous System in Patients with Chronic Ischemic Heart Failure of Ischemic Origin

Бугаева¹,

Михель²,

Соколов³

et al. 2022

Кардиология В Беларуси

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Цель. Изучить взаимосвязи параметров суточной вариабельности артериального давления с количественными характеристиками гиппокампа и показателями когнитивных тестов у пациентов с хронической сердечной недостаточностью ишемического генеза в сочетании с гипертонической болезнью.Материалы и методы. Обследовано 90 пациентов с гипертонической болезнью и хронической сердечной недостаточностью ишемического генеза. Группу сравнения составили 50 пациентов с гипертонической болезнью без хронической сердечной недостаточности, сопоставимых по полу и возрасту. Всем участникам исследования выполнены стандартная электрокардиография, триплексное сканирование брахиоцефальных артерий, суточное мониторирование артериального давления, трансторакальная допплер-эхокардиография, ядерная магнитно-резонансная томография головного мозга, а также проведена оценка когнитивных способностей. Изучаемые взаимосвязи определялись посредством канонического и парного корреляционного анализов.Результаты. У пациентов с гипертонической болезнью без хронической сердечной недостаточности более высокая вариабельность артериального давления в течение суток достоверно связана с меньшими размерами гиппокампа и не ассоциирована с нарушением когнитивных способностей. У пациентов с хронической сердечной недостаточностью принципиально изменялся характер вышеуказанных взаимосвязей, а именно более высокая вариабельность артериального давления в течение суток ассоциирована с большими размерами гиппокампа, а также с более высокими показателями когнитивных функций.Заключение. Наличие хронической сердечной недостаточности оказывает влияние на характер взаимосвязей между суточной вариабельностью артериального давления и морфофункциональным состоянием центральной нервной системы у пациентов с гипертонической болезнью. Вероятно, снижение вариабельности артериального давления у пациентов с хронической сердечной недостаточностью может косвенно отражать снижение адаптационных способностей организма. Purpose. To study the relationship between the parameters of diurnal variability of blood pressure and the quantitative characteristics of the hippocampus and indicators of cognitive tests in patients with chronic heart failure of ischemic origin in combination with hypertension.Materials and methods. 90 patients with hypertension and chronic heart failure of ischemic origin were examined. The comparison group consisted of 50 patients with hypertension without chronic heart failure, comparable in sex and age. All study participants underwent standard electrocardiography, triplex scanning of the brachiocephalic arteries, 24-hour blood pressure monitoring, transthoracic doppler echocardiography, nuclear magnetic resonance imaging of the brain, and an assessment of cognitive abilities. The studied relationships were determined by canonical and pairwise correlation analyses.Results. In patients with hypertension without chronic heart failure a higher variability in blood pressure during the day was significantly associated with a smaller hippocampus and was not associated with cognitive impairment. In patients with chronic heart failure, the nature of the above relationships fundamentally changed, namely, a higher variability in blood pressure during the day is associated with a larger hippocampus, as well as with higher cognitive functions.Conclusion. The presence of chronic heart failure affects the nature of the relationship between the daily variability of blood pressure and the morphofunctional state of the central nervous system in patients with hypertension. Probably, a decrease in blood pressure variability in patients with chronic heart failure may indirectly reflect a decrease in the body’s adaptive abilities.

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“…Кроме абсолютных значений уровня АД, в клинической практике важную роль играют его отклонения от среднего уровня за тот или иной промежуток времени, или вариабельность АД (ВАД) [23]. В настоящее время повышенная ВАД признана новым фактором риска развития сердечно-сосудистых и цереброваскулярных осложнений [24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: вариабельность ад как фактор риска развития осложненийunclassified

What do we Mean by “Ideal” Blood Pressure Control?

et al. 2021

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Arterial hypertension (AH) is one of the most important risk factors for development of myocardial infarction, chronic heart failure, stroke, cognitive disorders and dementia, and chronic kidney disease. Currently, special attention is paid to increased blood pressure variability (BPV) as a new risk factor for development of cardiovascular and cerebrovascular complications. The available evidence-based body of clinical studies demonstrates the importance of reducing not only the blood pressure itself but also the increased BPV to provide significant improvement of the prognosis and limits the risk of complications. This notion has been validated in consensus documents on the management of patients with AH. Among antihypertensive drugs, the fixed-dose combination (FC) amlodipine/perindopril has demonstrated a unique capability for reducing all types of BPV (visit-to-visit, day-to-day, during 24 h). According to current clinical guidelines, this combination belongs to first-line FCs indicated for most patients with AH. A distinctive feature of the FC amlodipine/perindopril is numerous data from real-life clinical practice, which support both its high antihypertensive efficacy and the ability to decrease high BPV. Therefore, the FC amlodipine/perindopril can be recommended for a broad range of AH patients to achieve BP control and to improve the prognosis.

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Modern Views on the Variability of Blood Pressure

Cited by 13 publications

References 25 publications

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

Daily Variability of Blood Pressure and Morphofunctional State of the Central Nervous System in Patients with Chronic Ischemic Heart Failure of Ischemic Origin

What do we Mean by “Ideal” Blood Pressure Control?

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