Prognosis in Relation to Blood Pressure Variability

Asayama, Kei; Fang, Wei; Hara, Azusa; Hansen, Tine W.; Li, Yan; Staessen, Jan A.

doi:10.1161/hypertensionaha.115.04808

Cited by 86 publications

(26 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, the number of required readings in our current analyses should not be extrapolated to studies with a focus on blood pressure variability or on the diurnal rhythmicity of blood pressure. However, compared with blood pressure level, blood pressure variability is a substantially weaker predictor of cardiovascular risk [37][38][39]. Third, for sake of generalizability, we reported the minimum number of daytime and night-time readings for investigators applying short fixed time intervals excluding the transition periods in the morning and evening when blood pressure usually changes rapidly [22].…”

Section: Discussionmentioning

confidence: 99%

Evidence-based proposal for the number of ambulatory readings required for assessing blood pressure level in research settings: an analysis of the IDACO database

et al. 2018

Self Cite

View full text Add to dashboard Cite

, we randomly selected a certain number of readings (from 30 to 1 awake and 10 to 1 asleep readings) at a time over 1000 bootstraps at each step. We evaluated: (i) concordance of the ABP level; (ii) consistency of the cross-classification based on office blood pressure and ABP; and (iii) accuracy in predicting cardiovascular complications. For each criterion, we fitted a regression line joining data points relating outcome to the number of readings covering the ranges of 30-20/10-7 for awake/ asleep readings. Results: Reducing readings widened the SD of the systolic/diastolic differences between full (reference) and selected recordings from 1.7/1.2 (30 readings) to 14.3/10.3 mm Hg (single reading) during wakefulness, and from 1.9/1.4 to 10.3/7.7 mm Hg during sleep; lowered the j statistic from 0.94 to 0.63, and decreased the hazard ratio associated with 10/5 mm Hg increments in systolic/diastolic ABP from 1.21/1.14 to 1.06/1.04 during wakefulness and from 1.26/1.17 to 1.14/1.08 during sleep. The first data points falling off these regression lines during wakefulness/sleep corresponded to 8/3 and 8/4 readings for criteria (i) and (iii) and to 5 awake readings for criterion (ii). Conclusions: 24-h ambulatory recordings with !8/!4 awake/asleep readings yielded ABP levels similar to recordings including the guideline-recommended !20/!7 readings. These criteria save valuable data in a research setting, but are not applicable to clinical practice.

show abstract

Section: Discussionmentioning

confidence: 99%

Evidence-based proposal for the number of ambulatory readings required for assessing blood pressure level in research settings: an analysis of the IDACO database

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…VIM was calculated as the SD divided by the within-individual mean to the power p and multiplied by the average value of systolic BP in the cohort to the power p . 11, 25 The power p is obtained by fitting a curve of SD against within-individual mean systolic BP using the model SD=a times mean p , where p was derived by nonlinear regression analysis as implemented in the SAS PROC NLIN procedure. 11, 25 VIM was shown to correlate highly with other indices of BP variability 26 while its correlation with mean BP level is almost zero.…”

Section: Methodsmentioning

confidence: 99%

“…11, 25 The power p is obtained by fitting a curve of SD against within-individual mean systolic BP using the model SD=a times mean p , where p was derived by nonlinear regression analysis as implemented in the SAS PROC NLIN procedure. 11, 25 VIM was shown to correlate highly with other indices of BP variability 26 while its correlation with mean BP level is almost zero. 11, 27 VIM allows assessing the association of BP variability with outcomes while removing the confounding effect of BP level.…”

Section: Methodsmentioning

confidence: 99%

Association Between Long-Term Blood Pressure Variability and 10-Year Progression in Arterial Stiffness

et al. 2017

View full text Add to dashboard Cite

Experimental studies conducted on animal and human endothelium suggested that higher systolic blood pressure (SBP) variability reduces bioavailability of nitric oxide and increases vascular smooth muscle cell proliferation. These vascular wall changes could stiffen the arterial wall. Using data from the Multi-Ethnic Study of Atherosclerosis, we investigated the association between long-term SBP variability and ten-year percent change in arterial stiffness among 1122 individuals (mean age 57 years, 46% Males at baseline) who were not taking anti-hypertensive medications. Within-individual standard deviation (SD), variability independent of the mean (VIM), and coefficient of variation (CV) of SBP across 5 visits were used to capture long-term SBP variability. Carotid arterial stiffness was measured using distensibility coefficient (DC) and Young’s elastic modulus (YEM) at baseline and after a mean of 9.5 years of follow-up (visit 5). In a multivariate linear regression model, individuals in the 5th quintile as compared to those in the 1st quintile of SD, VIM, and CV of SBP had a 9.8% (95% CI: −17.0%, −2.7%), 6.4% (95% CI: −13.2%, 0.4%), and 8.7% (95% CI: −15.4%, −1.9%) higher decline in DC and a 27.5% (95% CI: 15.8%, 39.3%), 25.8% (95% CI: 14.7%, 36.9%), and 27.9% (95% CI: 16.8%, 39.1%) higher progression in YEM, respectively, after ten years of follow-up. Linear trends in the decline of DC and progression of YEM were observed across the quintiles of SBP variability indices. These findings suggest that higher long-term SBP variability may be a risk factor for arterial stiffness progression independent of mean BP.

show abstract

“…[7][8][9][10][11][12][13][14][15][16][17] However, the degree to which variability improves the prediction of cardiovascular risk is controversial. [18][19][20] Previous studies have shown that nighttime BP is generally a better predictor of cardiovascular outcomes than daytime BP in patients with hypertension, and diminished nocturnal decline in BP is associated with or predictive of organ damage and cardiovascular events. [21][22][23][24][25][26] Only a few studies have analyzed whether different phenotypes on the hypertension spectrum such as normotension, white-coat hypertension, masked hypertension, and sustained hypertension are associated with BP variability independent of mean BP.…”

Section: Introductionmentioning

confidence: 99%

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain

et al. 2017

View full text Add to dashboard Cite

El acceso a la versión del editor puede requerir la suscripción del recurso Access to the published version may require subscription Three observer-measured home BPs and 24-hour ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP standard deviation and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime, and nighttime systolic BP standard deviations and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (p<0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-hour but not daytime or nighttime BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (p<0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (p<0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (p<0.001). In conclusion, 24-hour BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.

show abstract

Prognosis in Relation to Blood Pressure Variability

Cited by 86 publications

References 69 publications

Evidence-based proposal for the number of ambulatory readings required for assessing blood pressure level in research settings: an analysis of the IDACO database

Evidence-based proposal for the number of ambulatory readings required for assessing blood pressure level in research settings: an analysis of the IDACO database

Association Between Long-Term Blood Pressure Variability and 10-Year Progression in Arterial Stiffness

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain

Contact Info

Product

Resources

About