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Increased Arterial Stiffness Amplifies the Association Between Home Blood Pressure Variability and Cardiac Overload:

Yusuke Ishiyama1, Satoshi Hoshide1, Hiroshi Kanegae2

  • 1From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan (Y.I., S.H., K.K.).

Hypertension (Dallas, Tex. : 1979)
|April 28, 2020
PubMed

Insights

Increased arterial stiffness amplifies the link between blood pressure variability and cardiac overload. This suggests that measuring arterial stiffness is crucial for assessing cardiovascular risk in patients with hypertension.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Vascular Medicine

Background:

  • Elevated blood pressure (BP) variability indicates hemodynamic stress, contributing to cardiac overload and poorer cardiovascular outcomes.
  • N-terminal pro-B-type natriuretic peptide (NT-proBNP) serves as a biomarker for cardiac overload.
  • Arterial stiffness, measured by brachial-ankle pulse wave velocity (baPWV), may exacerbate the relationship between BP variability and cardiac strain.

Purpose of the Study:

  • To investigate the association between day-by-day home BP variability and NT-proBNP levels.
  • To determine if arterial stiffness modifies this association.
  • To analyze the impact of different indices of systolic BP variability on cardiac overload markers.

Main Methods:

  • Analysis of data from 2115 participants in the Japan Morning Surge-Home Blood Pressure (J-HOP) Study without prevalent heart failure.
  • Assessment of home BP monitoring data, including systolic BP variability indices (SDSBP, CVSBP, ARVSBP).
  • Categorization of participants into lower (<1800 cm/s) and higher (≥1800 cm/s) baPWV groups to assess arterial stiffness.

Main Results:

  • The higher baPWV group exhibited significantly higher indices of systolic BP variability (SDSBP, CVSBP, ARVSBP) and NT-proBNP levels compared to the lower baPWV group (all P<0.001).
  • In the higher baPWV group, SDSBP was significantly associated with NT-proBNP levels after adjusting for cardiovascular risk factors (P=0.002), with similar findings for CVSBP and ARVSBP.
  • These associations between BP variability and NT-proBNP were not observed in the lower baPWV group, indicating a significant interaction (all P<0.05).

Conclusions:

  • Arterial stiffness significantly amplifies the association between home blood pressure variability and cardiac overload, as indicated by NT-proBNP levels.
  • Higher arterial stiffness is linked to increased BP variability and elevated cardiac strain.
  • These findings highlight the importance of assessing arterial stiffness in managing patients with hypertension and variable blood pressure.

Keywords:
Japanblood pressureheart failurehypertensionregression analysisvascular stiffness

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