From Clinical Considerations to Theory - Blood Pressure Variability Profiles and Patterns

Area of Science:

• Cardiology
• Hypertension Research
• Chronobiology

Background:

• Blood pressure variability (BPV) is linked to adverse cardiovascular (CV) events, endothelial dysfunction, and increased morbidity/mortality.
• Various BPV indicators correlate with elevated CV risk.

Purpose of the Study:

• To investigate blood pressure variability (BPV) and dipping patterns in hypertensive patients with seemingly controlled average blood pressure.
• To assess the relationship between different BPV indicators and patient groups (dippers vs. non-dippers).

Main Methods:

• Included 744 hypertensive patients with uncontrolled hypertension, monitored via 24-hour ambulatory blood pressure monitoring (ABPM).
• Excluded patients with secondary hypertension, significant CV disease, or reduced estimated glomerular filtration rate.
• Analyzed BPV using dipping pattern, BP load, SD of 24-hour mean BP, average weighted SD, and average real variability (ARV).

Main Results:

• Patients with normal average 24-hour BP (<135/85 mmHg) exhibited significant BPV and abnormal dipping profiles.
• Nighttime systolic BP load was higher in non-dippers, while mean diastolic BP was higher in dippers.
• While some BPV indicators like SBP load and weighted SD differed significantly, others like SBP SD and ARV did not between extreme groups.

Conclusions:

• Hypertensive patients in an emergency setting may present with normal mean BP but high BPV and abnormal dipping.
• These findings underscore the importance of tailored antihypertensive drug therapy considering individual chronobiology.
• Strictly controlled, individualized treatment is necessary to manage high BPV and abnormal dipping profiles effectively.