Progression of Beat-to-Beat Blood Pressure Variability Despite Best Medical Management

Abstract

Beat-to-beat variability in blood pressure (BP) is associated with recurrent stroke despite good control of hypertension. However, no study has identified rates of progression of beat-to-beat BP variability (BPV), its determinants, or which patient groups are particularly affected, limiting understanding of its potential as a treatment target. In consecutive patients one month after a transient ischaemic attack or nondisabling stroke (Oxford Vascular Study), continuous noninvasive BP was measured beat-to-beat over 5 minutes (Finometer). Arterial stiffness was measured by carotid-femoral pulse wave velocity (Sphygmocor). Repeat assessments were performed at the 5-year follow-up visit and agreement determined by intraclass correlation coefficient. Rates of progression of systolic BPV (SBPV) and diastolic BPV (DBPV) and their determinants were estimated by mixed-effect linear models, adjusted for age, sex, and cardiovascular risk factors. One hundred eighty-eight of 310 surviving, eligible patients had repeat assessments after a median of 5.8 years. Pulse wave velocity was highly reproducible but SBPV and DBPV were not (intraclass correlation coefficient: 0.71, 0.10, and 0.16, respectively), however, all 3 progressed significantly (pulse wave velocity, 2.39%, P <0.0001; SBPV, 8.36%, P <0.0001; DBPV, 9.7, P <0.0001). Rate of progression of pulse wave velocity, SBPV, and DBPV all increased significantly with age ( P <0.0001), with an increasingly positive skew and were particularly associated with female sex (pulse wave velocity P =0.00035; SBPV P <0.0001; DBPV P <0.0001) and aortic mean SBP (SBPV P =0.037, DBPV P <0.0001). Beat-to-beat BP variability progresses significantly in high-risk patients, particularly in older individuals with elevated aortic systolic pressure. Beat-to-beat BPV and its progression represent potential new therapeutic targets to reduce cardiovascular risk.

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index

“…Webb and coworkers have demonstrated that 5‐min BbB BPV progressed with increasing age, and had a similar predictive power of recurrent stroke and CVEs compared with that of day‐to‐day BPV in patients with cerebrovascular events. 41 , 42 Furthermore, Wei and coworkers have demonstrated that 10‐min BbB BPV variables were associated with LVMI independently of the BP level (the effect sizes were +2.97–3.53 g/m 2 ) in 128 untreated hypertensive patients. 43 The BbB BP measurements in this study were collected under an overnight sleep condition and might have a different meaning from BbB BPV variables in previous studies.…”

Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy

“…However, unlike traditional methods, our approach can detect harmful patterns of BP variability within minutes, and thus can provide a real-time measure to guide BP management in individual patients. [11][12][13] Autonomic dysfunction is common in stroke 14 ; despite strong conceptual reasons, we found no association between HF BP variability and injury to the structures of the central autonomic network or infarct volume.…”

Association of Post-operative Systolic Blood Pressure Variability With Mortality After Coronary Artery Bypass Grafting

“…Although various studies have reported the relationship between higher BPV and the risk of cardiovascular events, the measurement, and assessment of BPV have not been standardized, and BPV could be measured in various ways, including visit-to-visit, day-to-day and beat-to-beat variability (17). Each has its strength and limits.…”