Antoine Cremer1,2,3, Julien Doublet1, Romain Boulestreau4, Julie Gaudissard1, Christophe Tzourio2,3, Philippe Gosse1. 1. Department of Cardiology and Hypertension, Bordeaux University hospital. 2. University Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219. 3. CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux. 4. CH de Pau, Service de cardiologie, Pau, France.
Abstract
OBJECTIVE: Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness. METHODS: Population: Bordeaux cohort of hypertensive patients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15' day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included. RESULTS: In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association. CONCLUSION: Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensive patients, independently of average 24-h BP and arterial stiffness.
OBJECTIVE: Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness. METHODS: Population: Bordeaux cohort of hypertensivepatients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15' day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included. RESULTS: In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association. CONCLUSION: Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensivepatients, independently of average 24-h BP and arterial stiffness.
Authors: Giuseppe Caminiti; Marco Alfonso Perrone; Maurizio Volterrani; Ferdinando Iellamo; Giuseppe Marazzi; Serena Selli; Alessio Franchini; Elvira Padua Journal: J Cardiovasc Dev Dis Date: 2022-05-27