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Prognostic value of different indices of blood pressure variability in hypertensive patients

Sante D Pierdomenico1, Marta Di Nicola, Anna L Esposito

  • 1Dipartimento di Medicina e Scienze dell'Invecchiamento, Università Gabriele d'Annunzio, Chieti, Italy. pierdomenico@unich.it

American Journal of Hypertension
|June 6, 2009
PubMed

Insights

High average real variability (ARV) of daytime systolic blood pressure (BP) independently predicts cardiovascular risk in hypertensive patients. Standard deviation of BP did not show similar predictive value, suggesting ARV is a superior metric for risk assessment.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Prediction Models

Background:

  • The prognostic significance of blood pressure (BP) variability indices remains unclear in hypertensive patients.
  • Investigating the predictive value of BP variability, specifically standard deviation (s.d.) and average real variability (ARV), for cardiovascular events is crucial.

Purpose of the Study:

  • To determine the prognostic value of different BP variability indices (s.d. and ARV) for cardiovascular events in hypertensive patients.
  • To compare the predictive capabilities of s.d. versus ARV for cardiovascular risk.

Main Methods:

  • A cohort of 1,280 hypertensive patients (aged >=40 years) were assessed for fatal and nonfatal cardiovascular events over a mean follow-up of 4.75 years.
  • Patients were categorized into low or high BP variability groups based on median values of s.d. or ARV for daytime and nighttime systolic and diastolic BP.
  • Cox regression analysis was employed to evaluate cardiovascular risk, adjusting for relevant covariates.

Main Results:

  • A total of 104 cardiovascular events occurred during follow-up.
  • High ARV of daytime systolic BP was significantly associated with increased cardiovascular risk in both untreated and treated hypertensive patients (HR 2.07, 95% CI 1.31-3.28).
  • Other BP variability indices, including s.d. of BP and ARV of diastolic or nighttime BP, did not show independent predictive value for cardiovascular outcomes.

Conclusions:

  • High average real variability (ARV) of daytime systolic blood pressure is an independent predictor of cardiovascular risk in hypertensive individuals.
  • Standard deviation (s.d.) of BP was not found to be an independent predictor of cardiovascular outcomes.
  • ARV may be a more appropriate and useful index for assessing BP variability and predicting cardiovascular risk compared to s.d.
Abstract

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