Non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity

Jp, Siché; Herpin, D.; Asmar, R; Poncelet, Pascal; Chamontin, B.; Comparat, V.; Gressin, Virginie; Boutelant, S; Mallion, Jean

doi:10.1097/00004872-199512010-00026

Cited by 17 publications

(18 citation statements)

References 7 publications

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“…[38] using similar methodology. The findings of increased systolic BP vari ability with increasing BP levels and reduced pulse inter val variability with increasing age reported in this study have also been shown in others using both short-term Finapres [38,39] and 24-hour intra-arterial BP recordings [40,41], Prattichizzo and Galetta [24] have previously reported an increase in BP variability in thromboembolic com pared to haemorrhagic stroke patients. However, their study was uncontrolled and assessed BP variability by the variability coefficient (SD/24-hour mean) taken from 10-to 15-min BP recordings made by non-invasive 24-hour BP monitoring devices.…”

Section: Discussionsupporting

confidence: 88%

A Comparison of Beat-to-Beat Blood Pressure Variability in Acute and Subacute Stroke Patients with Cerebral Infarction

Robinson¹,

Ward-Close²,

Potter³

1997

Cerebrovasc Dis

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Cerebrovascular dysautoregulation is well recognised following acute stroke, and thus blood pressure (BP) changes may have important effects on cerebral blood flow. Whilst absolute BP levels have been shown to influence outcome in some studies, the importance of short-term BP variability has not been addressed. We assessed beat-to-beat BP and pulse interval variability non-invasively using the Finapres device in 32 patients with CT-diagnosed acute cerebral infarction compared to a control group matched with respect to age and sex. Systolic BP variability was assessed as the standard deviation (SD) of all measurements and as the root mean squared of successive differences (RMS; which removes the portion of variability related to the underlying BP level). Systolic BP variability (taken as either the SD or the RMS) was significantly greater in acute stroke patients than controls. This difference is unlikely to reflect impaired cardiac baroreceptor sensitivity in acute stroke patients as no differences were observed in pulse interval variability compared to controls, but may be related to alterations in peripheral vascular resistance mediated by centrally induced changes in sympathetic nervous system activity. The prognostic significance of increased BP variability and the implications for BP management in acute stroke require further evaluation.

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Section: Discussionsupporting

confidence: 88%

A Comparison of Beat-to-Beat Blood Pressure Variability in Acute and Subacute Stroke Patients with Cerebral Infarction

Robinson¹,

Ward-Close²,

Potter³

1997

Cerebrovasc Dis

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“…Absolute (SD, in mm Hg) or relative (SD divided by the average) measures may be used for the assessment of BP variability. In the present study, as well as in previous ones, 11,15,24 the SD of ambulatory BP was directly associated with its average value. Therefore, to correct for the effect of average BP, we compared two groups of hypertensive patients with similar BP averages over 24 h, but different BP variability.…”

Section: Discussionsupporting

confidence: 87%

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

Schillaci¹,

Verdecchia²,

Borgioni³

et al. 1998

American Journal of Hypertension

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Blood pressure (BP) variability could induce detrimental effects on left ventricular (LV) structure in hypertension. We investigated the association between short-term BP variability, assessed with 24-h noninvasive ambulatory BP monitoring, and LV mass at echocardiography in 1822 untreated subjects (953 men, 869 women) with essential hypertension (EH). The standard deviation (SD) of daytime and night-time systolic BP (SBP, r ‫؍‬ 0.13/0.10; both P < .001), but not of diastolic BP, showed a weak correlation with LV mass. Because the SD of daytime SBP showed a direct association with average 24-h SBP (r ‫؍‬ 0.27), subjects were ranked into quartiles of the distribution of 24-h SBP. For each quartile, the subjects with SD of daytime (and night-time) SBP below or above the median were classified at low or high BP variability. In both genders, subjects with high daytime SBP variability were older than those at low variability (both P < .01). Within each quartile, LV mass did not differ between the groups at low v those at high SBP variability. Overall, age-adjusted LV mass index was 115 and 115 g/m 2 in men at low and high daytime SBP variability (P ‫؍‬ .84), and 116 and 114 g/m 2 in men at low and high nighttime SBP variability (P ‫؍‬ .31). The corresponding values in women were 98 and 99 g/m 2 (P ‫؍‬ .53) and 98 and 99 g/m 2 (P ‫؍‬ .64). In conclusion, when the effects of age, gender, and average 24-h BP are taken into account, short-term BP variability assessed with noninvasive monitoring is unrelated to LV mass in subjects with EH. Am J Hypertens 1998;11:515-522

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“…The exact mechanisms underlying the beat-to-beat BPV after stroke are unknown, but a reduction in cardiac BRS after acute cerebral infarction is well established, 19,33 and decreased BRS is well known to result in a rise in BPV. 34,39 In keeping with these findings, Tokgozoelu et al 40 have shown that heart rate variability is reduced after acute stroke, particularly where the lesion lies in the region of the insular cortex. The relation between shortterm measurements of beat-to-beat BPV and target organ damage has not been studied in great detail, and we believe this is the first report that has looked at beat-to-beat BPV after acute stroke and outcome.…”

Section: Discussionmentioning

confidence: 78%

Which Parameters of Beat-to-Beat Blood Pressure and Variability Best Predict Early Outcome After Acute Ischemic Stroke?

Dawson

Manktelow

Robinson

et al. 2000

Stroke

166

112

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Background and Purpose-In hypertensive populations, increasing blood pressure (BP) levels and BP variability (BPV) are associated with a greater incidence of target organ damage. After stroke, elevated 24-hour BP levels predict a poor outcome, although it is uncertain whether shorter-length BP recordings assessing mean BP levels and BPV have a similar predictive role. The objectives of this study were to compare the different measures of beat-to-beat BP and BPV on outcome after acute ischemic stroke and assess whether these parameters were affected by stroke subtype. Methods-Ninety-two consecutive admissions with a CT-confirmed diagnosis of acute ischemic stroke were recruited, of whom 54 had cortical infarction, 29 subcortical, and 9 posterior circulation infarction. Casual and two 5-minute recordings of beat-to-beat BP (Finapres, Ohmeda) were made under standardized conditions within 72 hours of ictus, with mean BP levels taken as the average of this 10-minute recording and BPV as the standard deviation. Outcome was assessed at 30 days as dead/dependent or independent (Rankin Յ2). The effects of BP, BPV, and stroke subtype on outcome were studied with the use of logistic regression. Stroke subjects were subsequently divided by BP quartiles and within each quartile into low-and high-variability groups; the influence of high BPV on outcome was also assessed. Results-The odds ratio for death/dependency was significantly higher in cortical strokes compared with subcortical and posterior circulation strokes even after controlling for differences in BP and BPV (OR 4.19, Pϭ0.002). Beat-to-beat systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP Ϯ SD) levels were higher in the dead/dependent group compared with the independent group (MAP 106Ϯ20.4 mm Hg vs 97Ϯ19.1 mm Hg, PϽ0.02), as was MAP variability: 6.1 (interquartile range 4.5 to 7.4 mm Hg) versus 4.9 (3.8 to 6.4 mm Hg, Pϭ0.02). The odds ratio for a poor outcome was 1.38 (Pϭ0.014) for every 10 -mm Hg increase in MAP and 1.32 (Pϭ0.02) for every 1-mm Hg increase in MAP variability. Casual BP measurements had no prognostic significance. For the group as a whole when separated into BP quartiles, those with a high MAP and DBP but not SBP variability within each quartile had a worse prognosis compared with those with a low BPV. Conclusions-A poor outcome at 30 days after ischemic stroke was dependent on stroke subtype, beat-to-beat DBP, and MAP levels and variability. Important prognostic information can be readily obtained from a short period of noninvasive BP monitoring in the acute stroke patient. These findings have important implications, particularly regarding the use of hypotensive agents in the acute stroke period. (Stroke. 2000;31:463-468.)

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Non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity

Cited by 17 publications

References 7 publications

A Comparison of Beat-to-Beat Blood Pressure Variability in Acute and Subacute Stroke Patients with Cerebral Infarction

A Comparison of Beat-to-Beat Blood Pressure Variability in Acute and Subacute Stroke Patients with Cerebral Infarction

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

Which Parameters of Beat-to-Beat Blood Pressure and Variability Best Predict Early Outcome After Acute Ischemic Stroke?

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