blood pressure variability and cardiovascular risk
Evidence has been provided that independently of mean BP levels, BP variations in the short- and long-term are associated with the development, progression and severity of cardiac, vascular and renal organ damage, and with an increased risk of CV events . Although low estimated glomerular filtration rate (eGFR) is associated with cardiovascular disease (CVD) events and mortality, the clinical significance of variability in eGFR over time is uncertain. Papadogiannis DE(1), Protogerou AD. This study aimed to evaluate the associations between variability in eGFR and the risk of CVD events and all-cause mortality. blood pressure variability, but the association of long term (clinic) variability in blood pressure with future cardiovascular disease is found even in studies that avoid errors Mid-term and short term variability in blood pressure measured at home or by ambulatory monitoring, respectively, has been little studied comparatively, but Effects of blood pressure variability were related to . Among 7099 individuals without hypertension at baseline, low heart rate variability predicted greater risk of incident hypertension over 9 years of follow-up. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70-82 years with a history of, or risk factors for cardiovascular disease. Journal of hypertension. The adverse cardiovascular consequences of high blood pressure (BP) not only depend on absolute BP values, but also on BP variability (BPV). 3,4 Meanwhile, visit-to-visit BP variability has emerged as a . Blood pressure variability as assessed by out-of-office monitoring has matured into a valuable parameter for the management of patients with . To investigate whether BP variability predicts cardiovascular events and . Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. this data further emphasizes that studies must be done before it is determined that individuals with greater blood pressure variability should be treated more aggressively, even though stevens and colleagues meta-analysis confirms that it is associated with greater risk of adverse cardiovascular outcomes. a body of empirical work indicates that oscillations in bp between consecutive measures hold additional prognostic significance, alongside mean bp level, for the risk of cardiovascular diseases and subclinical target organ damage.6,7previous meta-analyses have reported associations of high bp variability (bpv) with stroke and cerebral small … Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. Is BP variability measurement of any additive value, in terms of CV risk assessment strategies? Increased BP variability causes target organ damage, e.g., endothelial dysfunction, vascular and cardiac hypertrophy, kidney disease and cerebral vascular dysfunction.These insults lead to myocardial infarction, stroke, and heart and kidney failure. Increased long term variability in systolic blood pressure was associated with risk of all cause mortality (hazard ratio 1.15, 95% confidence interval 1.09 to 1.22), cardiovascular disease mortality (1.18, 1.09 to 1.28), cardiovascular disease events (1.18, 1.07 to 1.30), coronary heart disease (1.10, 1.04 to 1.16), and stroke (1.15, 1.04 to 1.27). Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. 10.1097/hjh.0000000000001159 . doi: 10.1371/journal.pone.0052438 Crossref Medline Google Scholar; 21. de Havenon A, Majersik JJ, Stoddard G, Wong KH, McNally JS, Smith AG, et al.. In this issue, Stevens and colleagues (doi: 10.1136/bmj.i4098) use meta-analysis to synthesise evidence on the affect of variability in blood pressure on this risk. Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. [] originally observed variability in visit-to-visit systolic blood pressure (SBP) was related to incidence of coronary heart disease in a population with or without hypertension.Several studies, after this finding, have reported that a blood pressure (both systolic and diastolic) variability in people with diabetes is an independent predictor of both macro- and . Introduction. Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon. Epub 2016/12/03. . Physical training and heart rate and blood pressure variability: a 5-yr randomized trial Arja L. T. Uusitalo,1 Tomi Laitinen,1 Sari B. Va¨isa¨nen,2 Esko La¨nsimies,1 and Rainer Rauramaa1,2 1Department of Clinical Physiology and Nuclear Medicine, Kuopio University and University Hospital, and 2Kuopio Research Institute of Exercise Medicine and Department of Physiology, University of Kuopio . 1, 2 It gives the opportunity to estimate the average BP level, circadian BP variations, and BP variability. PMID: 20566957 [PubMed - indexed for MEDLINE] Publication Types: Comment; Letter; Research Support, Non-U.S. Gov't; MeSH Terms. We assessed if variability was associated with increased risk of cardiovascular events and death in hypertensive patients at different risk levels. AU - Killeen, Anthony A. Recently, increased blood pressure variability (BPV) has emerged as a strong risk factor for cardiovascular morbidity and mortality. Request PDF | Indices of Blood Pressure Variability and Cardiovascular Risk | To the Editor: I read with interest the article by Hansen et al1 evaluating the relation between blood pressure (BP . This is true for blood pressure, LDL, glycemia, and body weight, but not heart rate. Publication types 2003; 21 :2251‐2257. As there may be an association between within-visit blood pressure (BP) variability and cardiovascular disease (CVD), we investigated the clinical significance of this BP variability in non-dialysis chronic kidney disease (CKD) patients. doi: 10.1136/bmj.i4190. 2012; 7:e52438. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline . Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. Blood Pressure/physiology* Cardiovascular Diseases/epidemiology* Diastole; Humans . In the Copenhagen heart study,11 the risk ratio (RR) for stroke due to ISH (SBP = 160 mm Hg, DBP <90 mm Hg) in men was 2.7, but for diastolic hypertension (DBP = 90 mm Hg irrespective of SBP) it was 1.7 compared with normotensives. 2018;39:2243-51 Results from this study strongly suggest that the role of blood pressure variability in cardiovascular risk is more pronounced in individuals with low baseline blood pressure levels. Cross-tabulation analysis of blood pressure variability (SBP VIM and SBP MMD) and FRS. Evidence has been provided that independently of mean . Higher long-term visit-to-visit blood pressure variability (BPV) has been shown to have negative effects on multiple organ systems, independent of presence, or severity of hypertension. Uncontrolled daytime blood pressure (yes/no) was a stronger independent risk factor, 1.67 (1.00-2.78). Individuals with hypertension had decreased heart rate variability at baseline, and this association was present across the full blood pressure range. Fares, PhD, Rafic Hariri School of Nursing, The American University of Beirut, P.O. blood pressure is a leading risk factor for cardiovascular disease.12most studies have used mean blood pressure as the indicator of risk, measured in clinic or "out of office" settings.345however, blood pressure shows noticeable oscillations over the short and long term.6historically, variability in blood pressure has been viewed as inhibiting … 1,2 Although the mechanism(s) of hypertensive end-organ damage has not been elucidated, numerous prior studies have attested to the relationship between elevated BP and the risk of cardiovascular events. Variability is a phenomenon attributed to most biological processes and is a particular feature of blood pressure (BP) that concerns many physicians regarding the clinical meaning and the impact on their clinical practice. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population The smoothness index: A new, reproducible and clinically relevant measure of the homogeneity of the blood pressure reduction with treatment for hypertension Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease: a systematic review and meta-analysis. Although the underlying mechanism is not fully understood, artery remodeling is thought to be closely involved in the relati … It has also been reported that a larger variability in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over time is associated with a higher risk of dementia during a follow-up of up to 8 . J Hypertens . Potential factors involved in the pathogenesis of short-term and long-term blood pressure (BP) variability (determinants, upper part of the figure) as well as potential adverse effects of the two phenomena on cardiovascular (CV) risk, development and progression of target organ damage (TOD), risk of coronary heart disease (CHD) and cerebrovascular (CBV) events (outcomes, lower part of the figure). Mark W. Chapleau, in Primer on the Autonomic Nervous System (Third Edition), 2012 Decreased BRS and Cardiovascular Risk. 3,4 Meanwhile, visit-to-visit BP variability has emerged as a . AU - Agarwal, Adhish. blood pressure is a leading risk factor for cardiovascular disease. Apart from the well-known role of hypertension in cerebrovascular disease, visit-to-visit blood pressure (BP) variability is emerging as an independent risk factor for stroke. To . The adverse cardiovascular consequences of high blood pressure (BP) not only depend on absolute BP values, but also on BP variability (BPV). 2018; 39:2243-2251. doi: 10.1093/eurheartj/ehx760 Crossref Medline Google Scholar; 11. Mehlum et al., 2018;39: 2243-2251. 2017; 35 (1):10-7. Correspondence to Souha A. PLoS One. In this review, we assessed the role of different indices of BP variability in cardiovascular risk stratification. Despite advanced prevention and treatment, blood pressure (BP) is a dominant contributor to cardiovascular disease. Despite advanced prevention and treatment, blood pressure (BP) is a dominant contributor to cardiovascular disease. AU - Jotwani, Vasantha. The aim of our study was to evaluate visit-to-visit blood pressure variability (BPV) and the as- sociation of this parameter with cardiovascular risk determinants, according to the SEPHAR II survey. Blood Pressure Variability, Cardiovascular Risk, and Risk for Renal Disease Progression Gianfranco Parati, Juan E. Ochoa & Grzegorz Bilo Current Hypertension Reports ISSN 1522-6417 Volume 14 Number 5 Curr Hypertens Rep (2012) 14:421-431 DOI 10.1007/s11906-012-0290-7 1 23 Your article is protected by copyright and all rights are held exclusively by Springer Science+Business Media, LLC. Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease: A systematic review and meta . Mehlum MH, Liestol K, Kjeldsen SE, Julius S, Hua TA, Rothwell PM, et al. AU - Cohen, Debbie L. AU - Cushman, William C. AU - Ishani, Areef. Pierdomenico SD. term prognostic value of blood pressure variability (BPV) in the general population (2012 individuals randomly selected from the population of Monza, Milan), the adjusted (for age, sex, 24-hour mean blood pressure and other risk factors) risk of cardiovascular death was not related to the 24-hour, day, or night blood pressure Variability of cardiovascular risk factors is associated with cardiovascular risk independent of absolute value. E-mail: sf31@aub.edu.lb. Physical training and heart rate and blood pressure variability: a 5-yr randomized trial Arja L. T. Uusitalo,1 Tomi Laitinen,1 Sari B. Va¨isa¨nen,2 Esko La¨nsimies,1 and Rainer Rauramaa1,2 1Department of Clinical Physiology and Nuclear Medicine, Kuopio University and University Hospital, and 2Kuopio Research Institute of Exercise Medicine and Department of Physiology, University of Kuopio . 2,3 One study 3 reported that cardiovascular mortality was not associated with SD but with residual diastolic BP variability, evaluated by . Blood pressure (BP) variability is associated with several cardiovascular (CV) risk factors. 3 4 5 however, blood pressure shows noticeable oscillations over the short and long term. [Google Scholar] most studies have concluded that the association between blood pressure variability and risk of cardiovascular events is higher among patients with high baseline risk. Exactly how hypertension causes end organ damage and vascular events is poorly understood. T1 - Estimated GFR Variability and Risk of Cardiovascular Events and Mortality in SPRINT (Systolic Blood Pressure Intervention Trial) AU - Malhotra, Rakesh. Eur Heart J. Author information: (1)Hypertension Center, 1st Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon Hospital, 17 Agiou Thoma Street, Athens 11527, Greece. Blood pressure variability and cardiovascular risk BMJ. Wang J, Shi X, Ma C, Zheng H, Xiao J, Bian H, et al. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management. Blood pressure variability and cardiovascular risk. Long-term blood pressure variations contribute to an increased risk of cardiovascular events during cold season, requiring personalized management of antihypertensive medications in a single . We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70-82 years with a history of, or risk factors for cardiovascular disease. Conclusions: There was a 67% increase in the risk of a cardiovascular event if daytime ambulatory blood pressure was uncontrolled in women with resistant hypertension. 1-5 Several studies have shown a specific association between higher long-term visit-to-visit BPV and increased risk of cardiovascular disease or stroke. 1, 2 There is growing evidence that average ambulatory BP and circadian BP variations are superior to clinic BP in predicting cardiovascular risk in both untreated 3-10 and treated . Aims: Blood pressure variability is associated with increased risk of cardiovascular events, particularly in high-risk patients. 6-8 Prior research has also demonstrated that . Conclusions: In elderly treated hypertensive patients, high average real variability of 24-hour systolic blood pressure is associated with higher cardiovascular risk independently of other risk . If the goal of the hypertension community is to optimize personalized cardiovascular risk assessment and to attenuate fully such risk, future efforts should be directed at determining which representation of blood pressure variability estimates individual cardiovascular risk best, establishing "normal" and "high- risk" variability distributions . The association of ambulatory blood pressure (BP) variability with mortality and cardiovascular events is controversial. Conclusions: Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. Author Jeff Whittle 1 Affiliation 1 Primary Care, Clement J Zablocki VA . [ PubMed ] [ Google Scholar ] Abstract OBJECTIVES: As there is uncertainty about the extent to which baseline blood pressure level or cardiovascular risk modifies the relationship between blood pressure variability (BPv) and cardiovascular disease, we comprehensively examined the role of BPv in cardiovascular disease risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial. CAS Article Google Scholar 10. Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. As mentioned, the increased BP variability in the 24 h was associated, in numerous studies, with organ damage and an increased cardiovascular risk, even independently of mean pressure values 2, 3; in other studies, however, pressure variability was associated with only a moderate increase in cardiovascular risk, confirming a prevalent role of . Although the diagnosis of high BP appears to . 2016 Aug 10;354:i4190. Methods: Following a selection based on the multi-stratified proportional sampling procedure, a total of Grove et al. Therefore, it is mandatory to use ABP to evaluate control and to guide . Beat-to-beat blood pressure variability: an early predictor of disease and cardiovascular risk. The third tertile of blood pressure variability combined with the high-risk category of FRS had the highest incidence of all-cause mortality. Blood pressure variability: a confounder and a cardiovascular risk factor. Wang J, Shi X, Ma C, Zheng H, Xiao J, Bian H, et al. The adverse cardiovascular consequences of high blood pressure (BP) not only depend on absolute BP values, but also on BP variability (BPV). 1 They find consistent evidence that increased variability across clinic visits over months to years is associated with an increased cardiovascular risk. This commentary refers to 'Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks', by M.H. High blood pressure (BP) is a leading cause of cardiovascular (CV) disease. Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. To the Editor: I read with interest the article by Hansen et al 1 evaluating the relation between blood pressure (BP) variability and risk. In the last decade, visit-to-visit variability in blood pressure has evolved from being regarded as merely a hindrance to proper monitoring of mean blood pressure to being recognized as a potential additional risk factor for cardiovascular disease (CVD) and mortality (1,2).Results from several cohort studies (3-6) reveal that visit-to-visit variability in systolic (SBP) and diastolic blood . 6 historically, variability in blood pressure has been viewed as … AU - Kitzman, Dalane W. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70-82 years with a history of, or risk factors for cardiovascular disease. We assessed if variability was associated with increased risk of cardiovascular events and death in hypertensive patients at different risk levels. While blood pressure variability may be associated with morbidity through mechanisms that do not benefit from achieving lower mean blood pressures, prior work suggests that age and frailty, as well as having diabetes or cardiovascular disease,2 are all associated with greater risk of complications of hypertension and greater absolute benefit of . Indices of blood pressure variability and cardiovascular risk. Systolic blood pressure is a bigger risk factor than DBP for cardiovascular disease in older people. Blood pressure variability: a confounder and a cardiovascular risk factor. Treatment should focus not only on reduction of absolute values, but also on their variability. Blood pressure variability and cardiovascular risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). As the tertiles of BPV and FRS increased, the incidence of all-cause mortality increased significantly. J Hypertens . We reviewed the indices of BP variability derived from . (1) indeed, i am not aware of a study … A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR 1.16, P = 0.001; CV-DBP: HR 1.09, P = 0.04). © 2020 by the American Diabetes Association. Comment on Hypertension. AU - Katz, Ronit. Eur Heart J. 1 , 2 Importantly, this association is independent of isolated blood pressure measurements. Blood pressure. An increased blood pressure variability has been reported to contribute independently to the higher cardiovascular risk of hypertensive patients; reducing this variability has therefore become an . Evidence has been provided that independently of mean BP levels, BP variations in the short- and long-term are associated with the development, progression and severity of cardiac, vascular and renal organ damage, and with an increased risk of CV events and mortality. Blood Pressure Variability and Cardiovascular Risk. Multiple studies in a variety of settings have demonstrated that lower estimated glomerular filtration rate (eGFR) is strongly associated with cardiovascular disease (CVD) and all-cause mortality.1, 2, 3 In clinical practice, some patients have greater visit-to-visit variability in eGFR than others, and much less is known about the clinical significance of this eGFR variability. Aims:Blood pressure variability is associated with increased risk of cardiovascular events, particularly in high-risk patients. Evidence has been provided that independently of mean BP levels, BP variations in the short- and long-term are associated with the development, progression and severity of cardiac, vascular and renal organ damage, and with an increased risk of CVevents . 2003 ; 21:2251-2257. Yet the concept that underlying "usual" blood pressure (BP) accounts for all BP-related risk of vascular events and for the benefits of BP-lowering drugs has come to underpin clinical guidelines on the diagnosis and treatment of hypertension. This article reviews evidence that variability in BP also . Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens RJ, McManus RJ. In the analyses with one SD difference in baseline, mean and variability in blood pressure in the short-term follow-up cohort, one SD difference in variability in diastolic blood pressure predicted an increased risk in coronary events and heart failure hospitalisation (HR 1.11, 95% CI 1.01-1.21 and 1.20, 95% CI 1.05-1.38, respectively), no . 1,2 Although the mechanism(s) of hypertensive end-organ damage has not been elucidated, numerous prior studies have attested to the relationship between elevated BP and the risk of cardiovascular events. Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. d_papadogiannis@yahoo.com The prognostic value of BP variability, expressed as SD, was previously evaluated achieving contrasting results. Noninvasive ambulatory blood pressure (BP) monitoring is progressively more used in clinical practice. Introduction. 1 , 2 However, there are fewer data regarding the relationship between BPV and earlier stages of the development of cardiovascular disease (CVD), including subclinical . Blood pressure variability emerges as a risk factor for ischemic stroke, with effects beyond absolute blood pressure levels alone [7,8]. 4,6,7,11,14,18,19 in the present analysis, we aimed to assess if the risk associated with increased blood pressure variability is similar among patients at different levels of … 2010 Apr;55(4):1049-57. 1 2 most studies have used mean blood pressure as the indicator of risk, measured in clinic or "out of office" settings.
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