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Hemodynamic Determinants of the Short-Term Blood Pressure Variability: Differential Roles of Arterial Stiffness and
Pai-Feng Hsu1,2,3, Hao-Min Cheng1,2,3,4, Shih-Hsien Sung1,2,3
1Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
High diastolic blood pressure variability (BPV) predicts cardiovascular mortality. This study found wave reflection, not arterial stiffness, is the dominant factor associated with BPV in ambulatory blood pressure monitoring (ABPM).
Area of Science:
- Cardiovascular physiology
- Hypertension research
- Ambulatory blood pressure monitoring
Background:
- High 24-hour diastolic blood pressure variability (DBP) predicts cardiovascular mortality in untreated hypertensive individuals.
- This association is independent of office or 24-hour systolic blood pressure (SBP).
Purpose of the Study:
- To investigate hemodynamic factors independently associated with systolic and diastolic blood pressure variability (BPV) using 24-hour ambulatory blood pressure monitoring (ABPM).
Main Methods:
- Analysis of 24-hour ABPM data from 624 normotensive and 633 untreated hypertensive participants.
- Assessment of BPV using average real variability (ARV) for SBP (ARVs) and DBP (ARVd).
- Evaluation of hemodynamic variables: total peripheral resistance (TPR), carotid-femoral pulse wave velocity (cf-PWV), and amplitudes of forward (Pf) and backward (Pb) carotid pressure waves.
Main Results:
- Hemodynamic variables associated with 24-hour SBP included heart rate (HR), TPR, cf-PWV, Pf, and Pb.
- For ARVs, associated factors were 24-hour HR, Pf, and Pb.
- For ARVd, associated factors were 24-hour HR, cf-PWV, Pf, and Pb, with wave reflection (Pb) being the dominant determinant (>50% of variance).
Conclusions:
- Diastolic blood pressure variability (ARVd) is linked to fewer hemodynamic variables than 24-hour SBP.
- Wave reflection, not arterial stiffness, predominantly influences ambulatory BPV.
Background:
A high 24-hour ambulatory diastolic (DBP) but not systolic (SBP) blood pressure variability (BPV) is significantly predictive of long-term cardiovascular mortality in untreated hypertensive subjects, independent of office or 24-hour SBP. The present study was aimed to investigate hemodynamic factors that are independently associated with systolic and diastolic BPV from the 24-hour ambulatory blood pressure monitoring (ABPM).
Methods:
A cohort of 624 normotensive and 633 untreated hypertensive participants with baseline ABPM was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour SBP and DBP (ARVs and ARVd, respectively). Hemodynamic variables including total peripheral resistance (TPR), carotid-femoral pulse wave velocity (cf-PWV), and amplitudes of the decomposed forward (Pf) and backward (Pb) carotid pressure waves were analyzed.
Results:
In multivariable analyses, hemodynamic variables independently associated with 24-hour SBP were 24-hour heart rate (HR), TPR, cf-PWV, Pf, and Pb (model r2 = 0.535). Hemodynamic factors independently associated with ARV were 24-hour HR, Pf, and Pb for ARVs, and 24-hour HR, cf-PWV, Pf, and Pb for ARVd (model R2 = 0.345 and 0.220, respectively). Addition of 24-hour SBP to the ARV models only slightly improved variance explained by the models (R2 = 0.383 and 0.224, respectively). Pb accounted for >50% of total variance of ARVs and ARVd, whereas cf-PWV was a minor determinant of ARVd (<5% of total variance).
Conclusions:
ARVd was associated with fewer hemodynamic variables than to 24-hour SBP. Among those hemodynamic variables wave reflection but not arterial stiffness had the dominant independent association with ARV.
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