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Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women

Journal of Human Hypertension volume 29, pages 719–725 (2015)Cite this article

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Abstract

Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47–73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP.

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References

  1. Carlberg B, Lindholm LH . Stroke and blood-pressure variation: new permutations on an old theme. Lancet 2010; 375 (9718): 867–869.

    Article  Google Scholar 

  2. Zanchetti A . Wars, war games, and dead bodies on the battlefield: variations on the theme of blood pressure variability. Stroke 2011; 42 (10): 2722–2724.

    Article  Google Scholar 

  3. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlof B et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375 (9718): 895–905.

    Article  Google Scholar 

  4. Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S . The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 2011; 57 (2): 160–166.

    Article  CAS  Google Scholar 

  5. Okada H, Fukui M, Tanaka M, Matsumoto S, Mineoka Y, Nakanishi N et al. Visit-to-visit blood pressure variability is a novel risk factor for the development and progression of diabetic nephropathy in patients with type 2 diabetes. Diabetes Care 2013; 36 (7): 1908–1912.

    Article  CAS  Google Scholar 

  6. Yokota K, Fukuda M, Matsui Y, Hoshide S, Shimada K, Kario K . Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney disease. Hypertens Res 2013; 36 (2): 151–157.

    Article  CAS  Google Scholar 

  7. Leoncini G, Viazzi F, Storace G, Deferrari G, Pontremoli R . Blood pressure variability and multiple organ damage in primary hypertension. J Hum Hypertens 2013; 27 (11): 663–670.

    Article  CAS  Google Scholar 

  8. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G . Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hum Hypertens 1987; 5 (1): 93–98.

    Article  CAS  Google Scholar 

  9. Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G et al. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension 2007; 50 (2): 325–332.

    Article  CAS  Google Scholar 

  10. Zakopoulos NA, Tsivgoulis G, Barlas G, Spengos K, Manios E, Ikonomidis I et al. Impact of the time rate of blood pressure variation on left ventricular mass. J Hum Hypertens 2006; 24 (10): 2071–2077.

    Article  CAS  Google Scholar 

  11. Sega R, Corrao G, Bombelli M, Beltrame L, Facchetti R, Grassi G et al. Blood pressure variability and organ damage in a general population: results from the PAMELA study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertension 2002; 39 (2 Pt 2): 710–714.

    Article  CAS  Google Scholar 

  12. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension 2000; 36 (5): 901–906.

    Article  CAS  Google Scholar 

  13. Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Bjorklund-Bodegard K et al. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension 2010; 55 (4): 1049–1057.

    Article  CAS  Google Scholar 

  14. Roman MJ, Pickering TG, Schwartz JE, Pini R, Devereux RB . Relation of blood pressure variability to carotid atherosclerosis and carotid artery and left ventricular hypertrophy. Arterioscler Thromb Vasc Biol 2001; 21 (9): 1507–1511.

    Article  CAS  Google Scholar 

  15. Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Porcellati C . Lack of association between blood pressure variability and left ventricular mass in essential hypertension. Am J Hypertens 1998; 11 (5): 515–522.

    Article  CAS  Google Scholar 

  16. Mena L, Pintos S, Queipo NV, Aizpurua JA, Maestre G, Sulbaran T . A reliable index for the prognostic significance of blood pressure variability. J Hum Hypertens 2005; 23 (3): 505–511.

    Article  CAS  Google Scholar 

  17. Pierdomenico SD, Di Nicola M, Esposito AL, Di Mascio R, Ballone E, Lapenna D et al. Prognostic value of different indices of blood pressure variability in hypertensive patients. Am J Hypertens 2009; 22 (8): 842–847.

    Article  Google Scholar 

  18. Bilo G, Giglio A, Styczkiewicz K, Caldara G, Maronati A, Kawecka-Jaszcz K et al. A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J Hum Hypertens 2007; 25 (10): 2058–2066.

    Article  CAS  Google Scholar 

  19. Kearney PM, Harrington JM, Mc Carthy VJ, Fitzgerald AP, Perry IJ . Cohort profile: The Cork and Kerry Diabetes and Heart Disease Study. Int J Epidemiol 2013; 42 (5): 1253–1262.

    Article  Google Scholar 

  20. Fagard RH, Staessen JA, Thijs L . Optimal definition of daytime and night-time blood pressure. Blood Press Monit 1997; 2 (6): 315–321.

    CAS  PubMed  Google Scholar 

  21. Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375 (9731): 2073–2081.

    Article  Google Scholar 

  22. Dahlof B, Devereux RB, Julius S, Kjeldsen SE, Beevers G, de Faire U et al. Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. losartan intervention for endpoint reduction in hypertension. Hypertension 1998; 32 (6): 989–997.

    Article  CAS  Google Scholar 

  23. Gillett MJ . International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: Diabetes Care 2009; 32(7): 1327-1334. Clin Biochem Rev 2009; 30 (4): 197–200.

    PubMed  PubMed Central  Google Scholar 

  24. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hum Hypertens 2013; 31 (7): 1281–1357.

    Article  CAS  Google Scholar 

  25. Hansen TW, Li Y, Staessen JA . Blood pressure variability remains an elusive predictor of cardiovascular outcome. Am J Hypertens 2009; 22 (1): 3–4.

    Article  Google Scholar 

  26. de la Sierra A, Redon J, Banegas JR, Segura J, Parati G, Gorostidi M et al. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension 2009; 53 (3): 466–472.

    Article  CAS  Google Scholar 

  27. Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension 2008; 51 (1): 55–61.

    Article  CAS  Google Scholar 

  28. Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K . Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001; 38 (4): 852–857.

    Article  CAS  Google Scholar 

  29. Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Bjorklund-Bodegard K et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet 2007; 370 (9594): 1219–1229.

    Article  Google Scholar 

  30. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 2002; 20 (11): 2183–2189.

    Article  CAS  Google Scholar 

  31. Webb AJ, Fischer U, Mehta Z, Rothwell PM . Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet 2010; 375 (9718): 906–915.

    Article  CAS  Google Scholar 

  32. Webb AJ, Fischer U, Rothwell PM . Effects of beta-blocker selectivity on blood pressure variability and stroke: a systematic review. Neurology 2011; 77 (8): 731–737.

    Article  CAS  Google Scholar 

  33. Hata Y, Kimura Y, Muratani H, Fukiyama K, Kawano Y, Ashida T et al. Office blood pressure variability as a predictor of brain infarction in elderly hypertensive patients. Hypertens Res 2000; 23 (6): 553–560.

    Article  CAS  Google Scholar 

  34. Okada H, Fukui M, Tanaka M, Inada S, Mineoka Y, Nakanishi N et al. Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes. Atherosclerosis 2012; 220 (1): 155–159.

    Article  CAS  Google Scholar 

  35. Rossignol P, Kessler M, Zannad F . Visit-to-visit blood pressure variability and risk for progression of cardiovascular and renal diseases. Curr Opin Nephrol Hypertens 2013; 22 (1): 59–64.

    Article  CAS  Google Scholar 

  36. O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 2013; 31 (9): 1731–1768.

    Article  CAS  Google Scholar 

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Acknowledgements

This research was funded by the Health Research Board PhD/2007/16. The Cork and Kerry Diabetes and Heart Disease Study was funded by a research grant from the Irish Health Research Board (ref. HRC 2007/13). We especially thank all participants in the study, the study nurses and administrators and the staff at the LivingHealth Clinic.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, University College Cork, Cork City, Ireland

    J M Madden, A M O'Flynn & P M Kearney

  2. Stroke and Hypertension unit, Connolly Hospital, Blanchardstown, Dublin, Ireland

    E Dolan

  3. Department of Statistics, University College Cork, Cork City, Ireland

    A P Fitzgerald

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  1. J M Madden
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  2. A M O'Flynn
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  3. E Dolan
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  4. A P Fitzgerald
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Correspondence to J M Madden.

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Supplementary Information accompanies this paper on the Journal of Human Hypertension website

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Madden, J., O'Flynn, A., Dolan, E. et al. Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women. J Hum Hypertens 29, 719–725 (2015). https://doi.org/10.1038/jhh.2015.18

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