Cardiovascular risk stratification and blood pressure variability on ambulatory and home blood pressure measurement

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Risk Stratification

Background:

• Biological processes exhibit variability, notably blood pressure (BP).
• Physicians question the clinical significance and impact of BP variability on practice.
• Understanding BP variability's role in cardiovascular risk is crucial.

Purpose of the Study:

• To assess the utility of various BP variability indices in cardiovascular risk stratification.
• To review indices derived from ambulatory BP monitoring and home BP measurements.
• To provide clear guidance for clinical practice regarding BP variability.

Main Methods:

• Review of indices from ambulatory BP monitoring (day-to-night ratio, morning surge, short-term variability).
• Review of indices from home BP measurement (standardized conventional and self-measurement).
• Summarization of recent findings to inform clinical practice.

Main Results:

• BP variability, from both ambulatory and home measurements, offers limited added value for cardiovascular risk prediction beyond BP levels.
• The primary modifiable risk factor identified remains the BP level itself.
• Elevated BP level is a key determinant for improving hypertension control and mitigating adverse health outcomes.

Conclusions:

• BP variability indices do not substantially enhance cardiovascular risk prediction beyond established BP levels.
• Practitioners should prioritize BP level as the main modifiable risk factor.
• Focusing on BP level control is essential for improving hypertension management and patient outcomes.