Abstract
High blood pressure (BP) variability is associated with the increased risk of cardiovascular and renal damage together with increased cardiovascular mortality. The aim of our study was to investigate the relationship between BP variability and subclinical target organ damage (TOD) in patients with controlled essential hypertension. One hundred patients with controlled essential hypertension were randomly selected from outpatient clinic of Beni-Suef University hospital. All patients were subjected to full history taking, physical examination, three separate office BP measurements for assessment of long-term BP variability, ambulatory BP monitoring for short-term variability, and finally different investigations for subclinical TOD. We had 73 patients with subclinical TOD. Long-term visit-to-visit variability was evaluated by measuring SD (standard deviation) and CV (coefficient of variance) of systolic and diastolic BP. None of the parameters of long-term BP variability were significantly higher among patients with TOD compared with those without TOD. For short-term variability evaluated by ambulatory BP monitoring, average real variability (ARV) was the only parameter that had a significant consistent association with TOD in contrast to SD and CV. Finally, Daytime systolic ARV, nighttime diastolic ARV, and age were independent predictors of TOD (P values = 0.014, 0.018, 0.047, and 0.02, respectively). We concluded that ARV could be an appropriate index of BP variability and a more useful predictor of TOD in contrast to other parameters of BP variability
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References
Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. J Am Med Assoc. 2017;317:165–82.
Grassi G, Bombelli M, Brambilla G, Trevano FQ, Dell’oro R, Mancia G. Total cardiovascular risk, blood pressure variability and adrenergic overdrive in hypertension: evidence, mechanisms and clinical implications. Curr Hypertens Rep. 2012;14:333–8.
Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.
Chenniappan M. Blood pressure variability: assessment, prognostic significance and management. J Assoc Physicians India. 2015;63:47–53.
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;22:842–7.
Mena LJ, Felix VG, Melgarejo JD, Maestre GE. 24-hour blood pressure variability assessed by average real variability: a systematic review and meta-analysis. J Am Heart Assoc. 2017;6:e006895. 19
Sebo P, Pechere-Bertschi A, Herrmann FR, Haller DM, Bovier P. Blood pressure measurements are unreliable to diagnose hypertension in primary care. J Hypertens. 2014;32:509–17.
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 Hypertens. 1987;5:93–98.
Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens. 1993;11:1133–7.
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;36:901–6.
Sander D, Kukla C, Klingelh€ofer J, Winbeck K, Conrad B. Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: a 3-year follow-up study. Circulation. 2000;102:1536–41.
Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. J Hypertens. 2018;36:1953–2041.
Dodson PM, Lip GY, Eames SM, Gibson JM, Beevers DG. Hypertensive retinopathy: a review of existing classification systems and a suggestion for a simplified grading system. J Hum Hypertens. 1996;10:93–8.
De Jong P, Curhan G. Screening, monitoring, and treatment of albuminuria: public health perspectives. J Am Soc Nephrol. 2006;17:2120–6.
Devereux. RB. Detection of left ventricular hypertrophy by M-Mode echocardiography: anatomic validation, standardization and comparison to other methods. Hypertension. 1987;9 Suppl II :II-19–II-26.
Baldassarre D, Nyyssönen K, Rauramaa R, de Faire U, Hamsten A, Smit AJ, et al. Cross-sectional analysis of baseline data to identify the major determinants of carotid intima-media thickness in a European population: the IMPROVE study. Eur Heart J. 2010;31:614–22.
Verdecchia P, Borgioni C, Ciucci A, Gattobigio R, Schillaci G, Sacchi N, et al. Prognostic significance of blood pressure variability in essential hypertension. Blood Press Monit. 1996;1:3–11.
Pierdomenico SD, Lapenna D, Bucci A, Manente BM, Mancini M, Cuccurullo F, et al. Blood pressure variability and prognosis in uncomplicated mild hypertension. Am Heart J. 2005;149:934–8. https://doi.org/10.1016/j.ahj.2004.06.029
Pringle E, Phillips C, Thijs L, Davidson C, Staessen JA, de Leeuw PW, et al. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens. 2003;21:2251–7.
Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005;23:505–11.
Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46:156–61. https://doi.org/10.1161/01.HYP.0000170138.56903.7a
Palatini P, Mormino P, Canali C, Santonastaso M, De Venuto G, Zanata G, et al. Factors affecting ambulatory blood pressure reproducibility. Results of the HARVEST Trial. Hypertension and Ambulatory Recording Venetia Study. Hypertension. 1994;23:211–6. https://doi.org/10.1161/01.HYP.23.2.211
Eguchi K, Hoshide S, Hoshide Y, Ishikawa S, Shimada K, Kario K. Reproducibility of ambulatory blood pressure in treated and untreated hypertensive patients. J Hypertens. 2010;28:918–24.
Yamaguchi Y, Wada M, Sato H, Nagasawa H, Koyama S, Takahashi Y, et al. Impact of ambulatory blood pressure variability on cerebral small vessel disease progression and cognitive decline in community based elderly Japanese. Am J Hypertens. 2014;27:1257–67. https://doi.org/10.1093/ajh/hpu045
Mule G, Calcaterra I, Costanzo M, Morreale M, D’Ignoto F, Castiglia A, et al. Average real variability of 24-h systolic blood pressure is associated with microalbuminuria in patients with primary hypertension. J Hum Hypertens. 2016;30:164–70.
Xiong H, Wu D, Tian X, Lin WH, Li C, Zhang H, et al. The relationship between the 24 h blood pressure variability and carotid intima-media thickness: a compared study. Comput Math Methods Med. 2014;2014:303159.
Hsu PF, Cheng HM, Wu CH, Sung SH, Chuang SY, Lakatta EG, et al. High short-term blood pressure variability predicts long-term cardiovascular mortality in untreated hypertensives but not in normotensives. Am J Hypertens. 2016;29:806–13.
Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K, et al. Prognostic value of reading-to-reading blood pressure variability over 24 h in 8938 subjects from 11 populations. Hypertension. 2010;55:1049–57. https://doi.org/10.1161/HYPERTENSIONAHA.109.140798
Mustafa ER, Istrătoaie O, Mușetescu R. Blood pressure variability and left ventricular mass in hypertensive patients. Curr Health Sci J. 2016;42:47–50.
Filomena J, Riba-Llena I, Vinyoles E, Tovar JL, Mundet X, Castane X, et al. Short-term blood pressure variability relates to the presence of subclinical brain small vessel disease in primary hypertension. Hypertension. 2015;66:634–40. https://doi.org/10.1161/HYPERTENSIONAHA.115.05440
Madden JM, O’Flynn AM, Dolan E, Fitzgerald AP, Kearney P. Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women. J Hum Hypertens. 2015;29:719–25.
Parati G, Ochoa JE, Lombardi C, Bilo G. Blood pressure variability: assessment, predictive value, and potential as a therapeutic target. Curr Hypertens Rep. 2015;17:23. https://doi.org/10.1007/s11906-015-0537-1
Parati G, Valentini M. Prognostic relevance of blood pressure variability. Hypertension. 2006;47:137–8. https://doi.org/10.1161/01.HYP.0000198542.51471.c4
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The authors wish to thank nurses of Echo lab and outpatient clinic for their help and cooperation.
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El Mokadem, M., Boshra, H., Abd el Hady, Y. et al. Correlation between blood pressure variability and subclinical target organ damage in patients with essential hypertension. J Hum Hypertens 34, 641–647 (2020). https://doi.org/10.1038/s41371-019-0286-8
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DOI: https://doi.org/10.1038/s41371-019-0286-8
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