Can Ambulatory Blood Pressure Variability Contribute to Individual Cardiovascular Risk Stratification?

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Risk Assessment

Background:

• Blood pressure variability (BPV) is increasingly recognized as a significant factor in cardiovascular health.
• Understanding normal ranges for BPV metrics like average real variability (ARV) is crucial for risk stratification.
• Current guidelines primarily focus on average blood pressure levels, potentially overlooking the impact of variability.

Purpose of the Study:

• To establish the normal range for average real variability (ARV) in treated hypertensive patients.
• To determine if ARV can serve as an independent cardiovascular risk factor.
• To investigate the relationship between ARV levels and other cardiovascular risk indicators.

Main Methods:

• An observational study involving 110 treated hypertensive patients undergoing antihypertensive treatment adjustment.
• 24-hour ambulatory blood pressure monitoring to assess circadian blood pressure and calculate ARV.
• Classification of patients into low, medium, and high ARV groups using the fuzzy c-means algorithm.
• Comparison of cardiovascular risk markers, including glomerular filtration rate, across different ARV groups using ANOVA.

Main Results:

• Normal ARV ranges were defined: low (<9.8 mmHg), medium (9.8-12.8 mmHg), and high (>12.8 mmHg).
• Significant differences in mean systolic blood pressure (p=0.0113) and glomerular filtration rate (p=0.0261) were observed between ARV groups.
• Higher ARV levels correlated with increased systolic blood pressure and reduced kidney function.

Conclusions:

• Elevated average real variability (ARV) is identified as an additional cardiovascular risk factor.
• Managing blood pressure variability may be as vital as achieving target blood pressure levels.
• Further research is needed to establish universally accepted ARV threshold values for clinical practice.