Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients

Masugata, Hisashi; Senda, Shoichi; Murao, Koji; Inukai, Michio; Hosomi, Naohisa; Iwado, Yasuyoshi; Noma, Takahisa; Kohno, Masakazu; Himoto, Takashi; Goda, Fuminori

doi:10.1038/hr.2011.54

Cited by 55 publications

(35 citation statements)

References 34 publications

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“…16 Recent studies have highlighted the prognostic importance of long-term BPV in SBP. 3,4,17 However, our series revealed a significantly independent association of the variability of DBP with deep CMB progression, despite the mean DBP being normal in the elderly cohort. This finding implies that controlling the variability of DBP is essential to protecting against the evolution and development of CMB or cerebral hemorrhage in the deep hemisphere.…”

Section: Discussionmentioning

confidence: 64%

Different Impacts of Blood Pressure Variability on the Progression of Cerebral Microbleeds and White Matter Lesions

Liu

Sun

et al. 2012

Stroke

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Recent studies have proposed that the usual blood pressure (BP) hypothesis is limited, 2 and they have indicated that visit-to-visit variability in systolic blood pressure (SBP) is a powerful predictor of stroke, independent of mean BP. 3 However, there are few studies based on the clinical significance of long-term BP variability (BPV). 3,4Background and Purpose-Cerebral microbleeds (CMB) and white matter lesions (WML) are cerebral small vessel diseases. Hypertension is considered the most important risk factor. Its mechanism is not yet clarified. Our study assessed the association of blood pressure variability (BPV) with CMB and WML progression. Methods-Patients with a history of ischemic stroke within 1 to 6 months were consecutively recruited and followedup for 12 to 18 months. Blood pressure was measured monthly and controlled to a target level. BPV was quantified by the maximum, standard deviation, coefficient of variation, successive variation, standard deviation independent of mean, and successive variation independent of mean. Magnetic resonance imaging was performed at baseline and the end of the study. CMB and WML were rated using Microbleed Anatomic Rating Scale and Age-Related White Matter Changes scales, respectively. Multiple logistic analyses assessed BPV associations with CMB and WML development. Results-Of 720 patients recruited, 500 and 584 had follow-up results for CMB and WML, respectively; 13.2% and 48.1%showed CMB and WML progression, respectively, over a median of 14 months. Patients with CMB had a higher mean, maximum, standard deviation, coefficient of variation, successive variation, standard deviation independent of the mean, and successive variation independent of the mean in either systolic blood pressure or diastolic blood pressure (P<0.05). Systolic blood pressure variability was an independent risk factor for deep and infratentorial CMB progression, whereas diastolic blood pressure variability was independently associated with CMB development in deep regions. WML progression was not significantly associated with BPV between visits. Conclusion-BPV

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Section: Discussionmentioning

confidence: 64%

Different Impacts of Blood Pressure Variability on the Progression of Cerebral Microbleeds and White Matter Lesions

Liu

Sun

et al. 2012

Stroke

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confidence: 99%

“…here is a growing body of evidence that visit-to-visit blood pressure (BP) variability (BPV) in a clinical setting was significantly associated with target organ damage [1][2][3][4][5][6] and that it could predict cardiovascular events independent of mean office BP level. [7][8][9][10] One drawback of the application of visit-to-visit office BPV for the routine clinical management of hypertension is that obtaining it requires several office visits over a period of time.…”

mentioning

confidence: 99%

“…2012;59:1132-1138.) • Online Data Supplement Key Words: home blood pressure Ⅲ day-by-day home blood pressure variability Ⅲ calcium channel blocker Ⅲ thiazide diuretic Ⅲ angiotensin II receptor blocker Ⅲ pulse wave velocity T here is a growing body of evidence that visit-to-visit blood pressure (BP) variability (BPV) in a clinical setting was significantly associated with target organ damage [1][2][3][4][5][6] and that it could predict cardiovascular events independent of mean office BP level.7-10 One drawback of the application of visit-to-visit office BPV for the routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to evaluate day-by-day home BPV, because this selfmeasurement makes it possible to obtain multiple BP values in a relatively short period under well-controlled conditions.…”

mentioning

confidence: 99%

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Combined Effect of Angiotensin II Receptor Blocker and Either a Calcium Channel Blocker or Diuretic on Day-by-Day Variability of Home Blood Pressure

Matsui

O’Rourke²,

Hoshide³

et al. 2012

Hypertension

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Abstract-Day-by-day home blood pressure (BP) variability (BPV) was reported to be associated with increased cardiovascular risk. We aimed to test the hypothesis that the angiotensin II receptor blocker/calcium-channel blocker combination decreases day-by-day BPV more than the angiotensin II receptor blocker/diuretic combination does and investigated the mechanism underlying the former reduction. We enrolled 207 hypertensive subjects treated with olmesartan monotherapy for 12 weeks. The subjects were randomly assigned to treatment with hydrochlorothiazide (nϭ104) or azelnidipine (nϭ103) for 24 weeks. Home BP was taken in triplicate with a memory-equipped device in the morning and evening, respectively, for 5 consecutive days before each visit. Visits occurred at 4-week intervals. Home BPV was defined as within-individual SD of the 5-day home BP. Arterial stiffness was assessed by aortic pulse wave velocity at baseline and 24 weeks later. The reductions in home systolic BP were similar between the 2 groups, whereas the SD of home systolic BP decreased more in the azelnidipine group than in the hydrochlorothiazide group during the follow-up period (follow-up mean: 6.3 versus 7.1 mm Hg; Pϭ0.007). In the azelnidipine group, the change in aortic pulse wave velocity was independently associated with the change in SD of home systolic BP (regression coefficientϮSEϭ0. 79Ϯ0.37; Pϭ0.036). This study demonstrated that the angiotensin II receptor blocker/calciumchannel blocker combination improved home BPV in addition to home BP reduction and that the reduction in home BPV was partly attributable to the arterial stiffness reduction by this combination. (Hypertension. 2012;59:1132-1138.) • Online Data Supplement Key Words: home blood pressure Ⅲ day-by-day home blood pressure variability Ⅲ calcium channel blocker Ⅲ thiazide diuretic Ⅲ angiotensin II receptor blocker Ⅲ pulse wave velocity T here is a growing body of evidence that visit-to-visit blood pressure (BP) variability (BPV) in a clinical setting was significantly associated with target organ damage [1][2][3][4][5][6] and that it could predict cardiovascular events independent of mean office BP level.7-10 One drawback of the application of visit-to-visit office BPV for the routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to evaluate day-by-day home BPV, because this selfmeasurement makes it possible to obtain multiple BP values in a relatively short period under well-controlled conditions. 11It was reported recently that the increased day-by-day home BPV, calculated as the SD of home BP, was associated with the severity of target organ damage in patients with hypertension 12 or diabetes mellitus 13 and with cardiovascular mortality in a community-dwelling population.14 After treat- Thus, these results 15,16 raised speculation that the difference in cardiovascular events that favored the CCB regimen was not explained by BP differences but, rather, by the favorable effect...

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“…Indeed, increasing values of day-by-day BPV have been associated with a higher prevalence and severity of target organ damage (ie, increased left ventricular mass index, carotid intima-media thickness, or urinary albumin:creatinine ratio) 40 and with fatal and nonfatal cardiovascular events. 9,41 Evidence has also been provided that increasing values of visit-to-visit BPV are significant predictors of cardiac (diastolic dysfunction) 42 ; vascular (increased carotid intima-media thickness and stiffness) 43 ; renal (development of micro-and macroalbuminuria and renal vascular atherosclerosis) [44][45][46][47][48] organ damage, fatal, and nonfatal cardiovascular events 10,[49][50][51][52][53] and all-cause mortality 11 independently of average BP values. 54 A recent study in 48 587 Japanese subjects without diabetes mellitus or CKD found visit-to-visit BPV to be associated with newonset CKD independently of average BP values and other clinical characteristics.…”

Section: Midterm Bpv (Day-by-day Assessment By Hbpm) Long-term (Visimentioning

confidence: 99%

Hypertension in Chronic Kidney Disease Part 2

et al. 2016

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Blood pressure (BP) is characterized by high variability, including changes beat-to-beat (very short term), within 24 hours (short term), from day to day (midterm), and between visits spaced by weeks, months, seasons, and even years (long term). These variations can be estimated by means of continuous beat-to-beat BP recordings, repeated conventional office BP measures, 24-hour ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM) over longer time windows (Table). A main advantage of ABPM over other BP measurement techniques is represented by its ability to track BP changes occurring in daily life conditions and during 24 hours, thus allowing assessment of overall BP variability (BPV) as well as identification of its specific components, such as nocturnal hypertension and altered day-to-night BP profiles (ie, morning BP rise, nondipping pattern of BP) which become manifest early in the course of chronic kidney disease (CKD). These alterations are even more significant in subjects with end-stage renal disease (ESRD) mainly, but not exclusively, because of the marked reduction in intravascular volume immediately after hemodialysis followed by the progressive increase in volemia throughout the interdialytic period, 2 combined with an enhanced sympathetic activity. The higher frequency of alterations in 24-hour BP profiles and BPV in subjects with CKD and in those with ESRD not only makes a proper assessment and achievement of BP control more difficult in these subjects but may be prognostically relevant on the background of the evidence from longitudinal and observational studies indicating that increased BPV may predict the development of cardiovascular and renal disease, over and above the contribution of elevated mean BP levels per se 3-11 ( Figure 1). The purpose of this review is to address the currently available evidence on the role of ABPM and HBPM for the assessment and management of alterations in circadian BP profiles and in BPV in patients with CKD. Mechanisms of BPVIn physiological conditions, BP fluctuations occurring on a beat-by-beat basis and within the 24 hours may represent a homeostatic response of neural (ie, central sympathetic drive and its reflex modulation by arterial and cardiopulmonary reflexes), humoral (catecholamines, insulin, angiotensin II, bradykinin, endothelin-1, and nitric oxide), vascular (ie, elastic properties of arteries), and rheological mechanisms (ie, blood viscosity) to environmental (weather changes), behavioral (ie, physical activity, sleep, postural changes), and emotional (ie, psychological stress) stimuli.

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Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients

Cited by 55 publications

References 34 publications

Different Impacts of Blood Pressure Variability on the Progression of Cerebral Microbleeds and White Matter Lesions

Different Impacts of Blood Pressure Variability on the Progression of Cerebral Microbleeds and White Matter Lesions

Combined Effect of Angiotensin II Receptor Blocker and Either a Calcium Channel Blocker or Diuretic on Day-by-Day Variability of Home Blood Pressure

Hypertension in Chronic Kidney Disease Part 2

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