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Published on: January 15, 2022
Time rate of blood pressure variation: a new factor associated with coronary atherosclerosis
Efstathios Manios1, Kimon Stamatelopoulos, Georgios Tsivgoulis
1Department of Clinical Therapeutics, University of Athens, Greece.
Insights
Steeper blood pressure (BP) variations, measured by ambulatory BP monitoring (ABPM), are linked to more severe coronary artery disease in normotensive individuals. This rate of BP change is an independent predictor of coronary lesion severity.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Previous research indicates a link between blood pressure (BP) variation rate and carotid atherosclerosis.
- This association exists independently of peripheral and central BP levels.
Purpose of the Study:
- To investigate the relationship between the rate of BP variation and the severity/topography of coronary artery lesions.
- The study focused on normotensive patients with suspected coronary artery disease.
Main Methods:
- Ambulatory BP monitoring (ABPM) and coronary angiography were performed on 162 patients.
- Coronary lesion severity and topography were quantified using the Gensini score.
- The time rate of BP variation was calculated as the first derivative of BP values over time.
Main Results:
- Patients with coronary artery disease (n=123) exhibited a significantly higher daytime rate of systolic BP variation compared to controls (n=39).
- The daytime rate of systolic BP variation was an independent determinant of the Gensini score, alongside diabetes, daytime systolic BP, smoking, and hypercholesterolemia.
- A 0.1 mmHg/min increase in daytime systolic BP variation rate correlated with a 4.935 increment in the Gensini score.
Conclusions:
- Accelerated BP variations may increase arterial wall stress.
- The rate of BP variation may play an additive role alongside traditional risk factors in assessing coronary artery lesion severity.
- This highlights the potential of BP variation rate as a marker in normotensive individuals with suspected coronary artery disease.
Objectives:
Previous studies have demonstrated that the time rate of blood pressure (BP) variation was associated with early carotid atherosclerosis, independent of peripheral and central BP levels. We evaluated the association between the rate of BP variation, derived from ambulatory BP monitoring (ABPM) data analysis, and the severity and topography of coronary artery lesion in a cohort of normotensive patients with suspected coronary artery disease.
Methods:
ABPM and coronary angiography were performed in 162 normotensive patients with suspected coronary artery disease. The topography and severity of coronary artery lesions were assessed by Gensini score. The time rate of BP variation was defined as the first derivative of the BP values against time.
Results:
Patients with coronary artery disease (n = 123) presented significantly (P = 0.005) higher daytime rate of systolic BP variation than control patients (n = 39). Multiple linear regression models revealed independent determinants of Gensini score in the following rank order: diabetes mellitus (β: +0.286, P < 0.001), daytime rate of systolic BP variation (β: +0.277, P < 0.001), daytime systolic BP (β: +0.216, P = 0.002), smoking (β: +0.178, P = 0.008) and hypercholesterolemia (β: +0.158, P = 0.020). A 0.1 mmHg/min increase in the daytime rate of systolic BP variation correlated with an increment of 4.935 in the Gensini score (95% CI 2.432-7.438).
Conclusion:
Steeper BP variations may produce a greater stress on the arterial wall and may have an additive role to vascular risk factors and BP parameters in the detection of the severity of coronary artery lesions in normotensive individuals with suspected coronary artery disease.
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