J Korean Diabetes.  2014 Dec;15(4):206-210. 10.4093/jkd.2014.15.4.206.

Blood Pressure Variability and Cardiovascular Risk

• Lee HY

• KMID: 2173865
• DOI: http://doi.org/10.4093/jkd.2014.15.4.206

Abstract

Blood pressure values are characterized by marked fluctuations occurring not only within a 24-hour period, but also on a day-to-day and even visit-to-visit basis. Such blood pressure fluctuation was once considered 'background noise' or a randomly occurring phenomenon; however, recently it is widely accepted that these variations are the result of complex interactions between extrinsic environmental and behavioral factors and intrinsic cardiovascular regulatory mechanisms. Although adverse cardiovascular consequences of hypertension largely depend on absolute blood pressure values, variations in blood pressure also have predictive value for cardiovascular events. Post-hoc analyses of large intervention trials in hypertension have shown that within-patient visit-to-visit blood pressure variation is strongly prognostic for cardiovascular morbidity and mortality, especially in high-risk patients, suggesting that antihypertensive treatment should be targeted not only towards reducing mean blood pressure levels but also to stabilizing blood pressure variability.

Keyword

Blood pressure; Variability; Antihypertensive; Hypertension

MeSH Terms

Blood Pressure*
Humans
Hypertension
Mortality

Figure

• 

  Fig. 1. Factors affecting blood pressure variability. Adapted from Parati G, et al. Hypertension 2012;59:1091–3 [8].

Reference

References

1. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010; 375:895–905.

2. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, Murata M, Kuroda T, Schwartz JE, Shimada K. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003; 107:1401–6.

3. Palatini P, Reboldi G, Beilin LJ, Casiglia E, Eguchi K, Imai Y, Kario K, Ohkubo T, Pierdomenico SD, Schwartz JE, Wing L, Verdecchia P. Added predictive value of night-time blood pressure variability for cardiovascular events and mortality: the Ambulatory Blood Pressure-International Study. Hypertension. 2014; 64:487–93.

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; 57:160–6.

5. Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Imai Y, Wang J, Ibsen H, O'Brien E, Staessen JA. International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010; 55:1049–57.

6. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J. ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005; 366:895–906.

7. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Poulter NR, Sever PS. ASCOT-BPLA and MRC Trial Investigators. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010; 9:469–80.

8. Parati G, Bilo G. Calcium antagonist added to angiotensin receptor blocker: a recipe for reducing blood pressure variability?: evidence from day-by-day home blood pressure monitoring. Hypertension. 2012; 59:1091–3.