Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension

Paolo Verdecchia, Fabio Angeli, Roberto Gattobigio, Cristian Rapicetta, Gianpaolo Reboldi

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Background: The independent prognostic value of daytime and night-time blood pressure (BP) variability estimated by noninvasive 24-h BP monitoring is unclear. Methods: We followed 2649 initially untreated subjects with essential hypertension for up to 16 years (mean, 6). Variability of BP was estimated by the standard deviation of daytime or night-time systolic BP (SBP) and diastolic BP (DBP). A BP variability either less than or equal to the group median or greater than the group median (12.7/10.4 mm Hg for daytime SBP/DBP and 10.8 and 8.9 mm Hg for night-time SBP/DBP) identified subjects at low or high BP variability. Results: During follow-up there were 167 new cardiac and 122 new cerebrovascular events. The rate of cardiac events (×100 person-years) was higher (all P <.05) in the subjects with high than in those with low BP variability (daytime SBP: 1.45 v 0.72, daytime DBP: 1.29 v 0.91; night-time SBP: 1.58 v 0.62; night-time DBP: 1.32 v 0.85). The rate of cerebrovascular events was also higher (all P <.05) in the subjects with high than in those with low BP variability. In a multivariate analysis, after adjustment for several confounders, a high night-time SBP variability was associated with a 51% (P = .024) excess risk of cardiac events. The relation of daytime BP variability to cardiac events and that of daytime and night-time BP variability to cerebrovascular events lost significance in the multivariate analysis. Conclusions: An enhanced variability in SBP during the night-time is an independent predictor of cardiac events in initially untreated hypertensive subjects.

Original languageEnglish
Pages (from-to)154-161
Number of pages8
JournalAmerican Journal of Hypertension
Volume20
Issue number2
DOIs
Publication statusPublished - Feb 2007

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Blood Pressure
Hypertension
Hypotension
Multivariate Analysis

Keywords

  • Arterial hypertension
  • blood pressure monitoring
  • blood pressure variability
  • epidemiology
  • hypertrophy
  • prognosis
  • pulse pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension. / Verdecchia, Paolo; Angeli, Fabio; Gattobigio, Roberto; Rapicetta, Cristian; Reboldi, Gianpaolo.

In: American Journal of Hypertension, Vol. 20, No. 2, 02.2007, p. 154-161.

Research output: Contribution to journalArticle

Verdecchia, Paolo ; Angeli, Fabio ; Gattobigio, Roberto ; Rapicetta, Cristian ; Reboldi, Gianpaolo. / Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension. In: American Journal of Hypertension. 2007 ; Vol. 20, No. 2. pp. 154-161.
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abstract = "Background: The independent prognostic value of daytime and night-time blood pressure (BP) variability estimated by noninvasive 24-h BP monitoring is unclear. Methods: We followed 2649 initially untreated subjects with essential hypertension for up to 16 years (mean, 6). Variability of BP was estimated by the standard deviation of daytime or night-time systolic BP (SBP) and diastolic BP (DBP). A BP variability either less than or equal to the group median or greater than the group median (12.7/10.4 mm Hg for daytime SBP/DBP and 10.8 and 8.9 mm Hg for night-time SBP/DBP) identified subjects at low or high BP variability. Results: During follow-up there were 167 new cardiac and 122 new cerebrovascular events. The rate of cardiac events (×100 person-years) was higher (all P <.05) in the subjects with high than in those with low BP variability (daytime SBP: 1.45 v 0.72, daytime DBP: 1.29 v 0.91; night-time SBP: 1.58 v 0.62; night-time DBP: 1.32 v 0.85). The rate of cerebrovascular events was also higher (all P <.05) in the subjects with high than in those with low BP variability. In a multivariate analysis, after adjustment for several confounders, a high night-time SBP variability was associated with a 51{\%} (P = .024) excess risk of cardiac events. The relation of daytime BP variability to cardiac events and that of daytime and night-time BP variability to cerebrovascular events lost significance in the multivariate analysis. Conclusions: An enhanced variability in SBP during the night-time is an independent predictor of cardiac events in initially untreated hypertensive subjects.",
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AB - Background: The independent prognostic value of daytime and night-time blood pressure (BP) variability estimated by noninvasive 24-h BP monitoring is unclear. Methods: We followed 2649 initially untreated subjects with essential hypertension for up to 16 years (mean, 6). Variability of BP was estimated by the standard deviation of daytime or night-time systolic BP (SBP) and diastolic BP (DBP). A BP variability either less than or equal to the group median or greater than the group median (12.7/10.4 mm Hg for daytime SBP/DBP and 10.8 and 8.9 mm Hg for night-time SBP/DBP) identified subjects at low or high BP variability. Results: During follow-up there were 167 new cardiac and 122 new cerebrovascular events. The rate of cardiac events (×100 person-years) was higher (all P <.05) in the subjects with high than in those with low BP variability (daytime SBP: 1.45 v 0.72, daytime DBP: 1.29 v 0.91; night-time SBP: 1.58 v 0.62; night-time DBP: 1.32 v 0.85). The rate of cerebrovascular events was also higher (all P <.05) in the subjects with high than in those with low BP variability. In a multivariate analysis, after adjustment for several confounders, a high night-time SBP variability was associated with a 51% (P = .024) excess risk of cardiac events. The relation of daytime BP variability to cardiac events and that of daytime and night-time BP variability to cerebrovascular events lost significance in the multivariate analysis. Conclusions: An enhanced variability in SBP during the night-time is an independent predictor of cardiac events in initially untreated hypertensive subjects.

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