Skip to main content
Top
Published in: Current Hypertension Reports 3/2011

01-06-2011

Does Blood Pressure Variability Modulate Cardiovascular Risk?

Author: Peter M. Rothwell

Published in: Current Hypertension Reports | Issue 3/2011

Login to get access

Abstract

Exactly how hypertension causes end organ damage and vascular events is poorly understood. Yet the concept that underlying “usual” blood pressure (BP) accounts for all BP-related risk of vascular events and for the benefits of BP-lowering drugs has come to underpin clinical guidelines on the diagnosis and treatment of hypertension. This article reviews evidence that variability in BP also predicts risk of stroke and other vascular events independently of mean BP and evidence that drug-class effects on variability in BP explain differences in the effectiveness of BP-lowering drugs in preventing stroke.
Literature
1.
go back to reference Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697–716.PubMedCrossRef Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697–716.PubMedCrossRef
2.
go back to reference Mancia G, De Backer G, Dominiczak A, et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.PubMedCrossRef Mancia G, De Backer G, Dominiczak A, et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.PubMedCrossRef
3.
go back to reference Beckett LA, Rosner B, Roche AF, Guo S. Serial changes in blood pressure from adolescence into adulthood. Am J Epidemiol. 1992;135:1166–77.PubMed Beckett LA, Rosner B, Roche AF, Guo S. Serial changes in blood pressure from adolescence into adulthood. Am J Epidemiol. 1992;135:1166–77.PubMed
4.
go back to reference Staessen JA, Wang JG, Thijs L. Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet. 2001;358:1305–15.PubMedCrossRef Staessen JA, Wang JG, Thijs L. Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet. 2001;358:1305–15.PubMedCrossRef
5.
go back to reference Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. doi:10.1136/bmj.b1665.PubMedCrossRef Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. doi:10.​1136/​bmj.​b1665.PubMedCrossRef
6.
go back to reference Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895–905.PubMedCrossRef Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895–905.PubMedCrossRef
7.
go back to reference Rothwell PM, Howard SC, Dolan E. et al; on behalf of the ASCOT-BPLA and MRC Trial Investigators. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9:469–80.PubMedCrossRef Rothwell PM, Howard SC, Dolan E. et al; on behalf of the ASCOT-BPLA and MRC Trial Investigators. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9:469–80.PubMedCrossRef
8.
go back to reference Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010;375:906–15.PubMedCrossRef Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010;375:906–15.PubMedCrossRef
9.
go back to reference Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375:938–48.PubMedCrossRef Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375:938–48.PubMedCrossRef
10.
go back to reference Sokolow M, Werdegar D, Kain HK, Hinman AT. Relationship between level of BP measured casually and by portable recorders and severity of complications in essential hypertension. Circulation. 1966;34:279–98.PubMed Sokolow M, Werdegar D, Kain HK, Hinman AT. Relationship between level of BP measured casually and by portable recorders and severity of complications in essential hypertension. Circulation. 1966;34:279–98.PubMed
11.
go back to reference Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour BP variability. J Hypertens. 1993;11:1133–37.PubMedCrossRef Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour BP variability. J Hypertens. 1993;11:1133–37.PubMedCrossRef
12.
go back to reference Pessina AC, Palatini P, Sperti G, et al. Cordone. Evaluation of hypertension and related target organ damage by average day-time BP. Clin Exp Hypertens. 1985;A7:267–78.CrossRef Pessina AC, Palatini P, Sperti G, et al. Cordone. Evaluation of hypertension and related target organ damage by average day-time BP. Clin Exp Hypertens. 1985;A7:267–78.CrossRef
13.
go back to reference Veerman DP, de Blok K, Delemarre BJ, van Montfrans GA. Office, nurse, basal and ambulatory BP as predictors of hypertensive target organ damage in male and female patients. J Hum Hypertens. 1996;10:9–15.PubMed Veerman DP, de Blok K, Delemarre BJ, van Montfrans GA. Office, nurse, basal and ambulatory BP as predictors of hypertensive target organ damage in male and female patients. J Hum Hypertens. 1996;10:9–15.PubMed
14.
go back to reference Veerman DP, de Blok K, van Montfrans A. Relationship of steady state and ambulatory BP variability to left ventricular mass and urinary albumin excretion in essential hypertension. Am J Hypertens. 1996;9:455–60.PubMedCrossRef Veerman DP, de Blok K, van Montfrans A. Relationship of steady state and ambulatory BP variability to left ventricular mass and urinary albumin excretion in essential hypertension. Am J Hypertens. 1996;9:455–60.PubMedCrossRef
15.
go back to reference Mancia G, Parati G, Hennig M, et al. ELSA Investigators. Relation between BP variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens. 2001;19:1981–89.PubMedCrossRef Mancia G, Parati G, Hennig M, et al. ELSA Investigators. Relation between BP variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens. 2001;19:1981–89.PubMedCrossRef
16.
go back to reference Sega R, Corrao G, Bombelli M, et al. BP variability and organ damage in a general population: results from the PAMELA study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertension. 2002;39:710–14.PubMedCrossRef Sega R, Corrao G, Bombelli M, et al. BP variability and organ damage in a general population: results from the PAMELA study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertension. 2002;39:710–14.PubMedCrossRef
17.
go back to reference Tatasciore A, Renda G, Zimarino M, et al. Awake systolic BP variability correlates with target-organ damage in hypertensive subjects. Hypertension. 2007;50:325–32.PubMedCrossRef Tatasciore A, Renda G, Zimarino M, et al. Awake systolic BP variability correlates with target-organ damage in hypertensive subjects. Hypertension. 2007;50:325–32.PubMedCrossRef
18.
go back to reference Roman MJ, Pickering TG, Schwartz JE, Pini R, Devereux RB. Relation of BP variability to carotid atherosclerosis and carotid artery and left ventricular hypertrophy. Atheroscler Thromb Vasc Biol. 2001;21:1507–11.CrossRef Roman MJ, Pickering TG, Schwartz JE, Pini R, Devereux RB. Relation of BP variability to carotid atherosclerosis and carotid artery and left ventricular hypertrophy. Atheroscler Thromb Vasc Biol. 2001;21:1507–11.CrossRef
19.
go back to reference Tohgi H, Chiba K, Kimura M. Twenty-four-hour variation of BP in vascular dementia of the Binswanger type. Stroke. 1991;22:603–8.PubMed Tohgi H, Chiba K, Kimura M. Twenty-four-hour variation of BP in vascular dementia of the Binswanger type. Stroke. 1991;22:603–8.PubMed
20.
go back to reference Mart-Fabregas J, Valencia C, Pujol J, et al. BP variability and leukoaraiosis amount in cerebral small-vessel disease. Acta Neurol Scand. 2001;104:358–63.CrossRef Mart-Fabregas J, Valencia C, Pujol J, et al. BP variability and leukoaraiosis amount in cerebral small-vessel disease. Acta Neurol Scand. 2001;104:358–63.CrossRef
21.
go back to reference Shimada K, Kawamoto A, Matsubayashi K, Ozawa T. Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure. Hypertension. 1990;16:692–9.PubMed Shimada K, Kawamoto A, Matsubayashi K, Ozawa T. Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure. Hypertension. 1990;16:692–9.PubMed
22.
go back to reference Goldstein IB, Bartzokis G, Hance DB, Shapiro D. Relationship between BP and subcortical lesions in healthy elderly people. Stroke. 1998;29:765–72.PubMed Goldstein IB, Bartzokis G, Hance DB, Shapiro D. Relationship between BP and subcortical lesions in healthy elderly people. Stroke. 1998;29:765–72.PubMed
23.
go back to reference Skoog I. A review on BP and ischaemic white matter lesions. Dement Geriatr Cogn Disord 1989(suppl 1): 13–19. Skoog I. A review on BP and ischaemic white matter lesions. Dement Geriatr Cogn Disord 1989(suppl 1): 13–19.
24.
go back to reference Puisieux F, Monaca P, Deplanque D, et al. Relationship between leuko-araiosis and BP variability in the elderly. Eur Neurol. 2001;46:115–20.PubMedCrossRef Puisieux F, Monaca P, Deplanque D, et al. Relationship between leuko-araiosis and BP variability in the elderly. Eur Neurol. 2001;46:115–20.PubMedCrossRef
25.
go back to reference Goldstein IB, Bartzokis G, Guthrie D, Shapiro D. Ambulatory BP and brain atrophy in the healthy elderly. Neurology. 2002;59:713–19.PubMed Goldstein IB, Bartzokis G, Guthrie D, Shapiro D. Ambulatory BP and brain atrophy in the healthy elderly. Neurology. 2002;59:713–19.PubMed
26.
go back to reference Goldstein IB, Bartzokis G, Guthrie D, Shapiro D. Ambulatory BP and the brain: a 5-year follow-up. Neurology. 2005;64:1846–52.PubMedCrossRef Goldstein IB, Bartzokis G, Guthrie D, Shapiro D. Ambulatory BP and the brain: a 5-year follow-up. Neurology. 2005;64:1846–52.PubMedCrossRef
27.
go back to reference Kanemaru A, Kanemaru K, Kuwajima I. The effects of short-term BP variability and nighttime BP levels on cognitive function. Hypertens Res. 2001;24:19–24.PubMedCrossRef Kanemaru A, Kanemaru K, Kuwajima I. The effects of short-term BP variability and nighttime BP levels on cognitive function. Hypertens Res. 2001;24:19–24.PubMedCrossRef
28.
go back to reference Kawamoto A, Shimada K, Matsubayashi K, et al. Factors associated with silent multiple lacunar lesions on magnetic resonance imaging in asymptomatic elderly hypertensive patients. Clin Exp Pharmacol Physiol. 1991;18:605–10.PubMedCrossRef Kawamoto A, Shimada K, Matsubayashi K, et al. Factors associated with silent multiple lacunar lesions on magnetic resonance imaging in asymptomatic elderly hypertensive patients. Clin Exp Pharmacol Physiol. 1991;18:605–10.PubMedCrossRef
29.
go back to reference Sierra C, de La Sierra A, Mercader J, et al. Silent cerebral white matter lesions in middle-aged essential hypertensive patients. J Hypertens. 2002;20:519–24.PubMedCrossRef Sierra C, de La Sierra A, Mercader J, et al. Silent cerebral white matter lesions in middle-aged essential hypertensive patients. J Hypertens. 2002;20:519–24.PubMedCrossRef
30.
go back to reference Pickering TG, James GD. Ambulatory BP and prognosis. J Hypertens. 1994;12 suppl 8:S29–33. Pickering TG, James GD. Ambulatory BP and prognosis. J Hypertens. 1994;12 suppl 8:S29–33.
31.
go back to reference James GD, Pickering TG, Laragh JH. Ambulatory BP variation is related to plasma renin activity in borderline hypertensive men. Am J Hypertens. 1991;4:525–28.PubMed James GD, Pickering TG, Laragh JH. Ambulatory BP variation is related to plasma renin activity in borderline hypertensive men. Am J Hypertens. 1991;4:525–28.PubMed
32.
go back to reference Kikuya M, Hozawa A, Ohokubo T, et al. Prognostic significance of BP and heart rate variabilities: the Ohasama study. Hypertension. 2000;36:901–6.PubMed Kikuya M, Hozawa A, Ohokubo T, et al. Prognostic significance of BP and heart rate variabilities: the Ohasama study. Hypertension. 2000;36:901–6.PubMed
33.
go back to reference Pringle E, Phillips C, Thijs L, et al. Syst-Eur investigators. Systolic BP variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens. 2003;21:2251–7.PubMedCrossRef Pringle E, Phillips C, Thijs L, et al. Syst-Eur investigators. Systolic BP variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens. 2003;21:2251–7.PubMedCrossRef
34.
go back to reference Jokiniitty JM, Majahalme SK, Kahonen MA, Tuomisto MT, Turjanmaa VM. Prediction of blood pressure level and need for antihypertensive medication: 10 years of follow-up. J Hypertens. 2001;19:1193–201.PubMedCrossRef Jokiniitty JM, Majahalme SK, Kahonen MA, Tuomisto MT, Turjanmaa VM. Prediction of blood pressure level and need for antihypertensive medication: 10 years of follow-up. J Hypertens. 2001;19:1193–201.PubMedCrossRef
35.
go back to reference Sander D, Kukla C, Klingelhoffer J, Winbeck K, Conrad B. Relationship between circadian BP patterns and progression of early carotid atherosclerosis: A 3-year follow-up study. Circulation. 2000;102:1536–41.PubMed Sander D, Kukla C, Klingelhoffer J, Winbeck K, Conrad B. Relationship between circadian BP patterns and progression of early carotid atherosclerosis: A 3-year follow-up study. Circulation. 2000;102:1536–41.PubMed
36.
go back to reference Eto M, Toba K, Akishita M, et al. Impact of BP variability on cardiovascular events in elderly patients with hypertension. Hypertens Res. 2005;28:1–7.PubMedCrossRef Eto M, Toba K, Akishita M, et al. Impact of BP variability on cardiovascular events in elderly patients with hypertension. Hypertens Res. 2005;28:1–7.PubMedCrossRef
37.
go back to reference Verdecchia P et al. Prognostic significance of BP variability in essential hypertension: univariate and multivariate assessment. BP Monitoring. 1996;1:3–11. Verdecchia P et al. Prognostic significance of BP variability in essential hypertension: univariate and multivariate assessment. BP Monitoring. 1996;1:3–11.
38.
go back to reference Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354:2368–74.PubMedCrossRef Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354:2368–74.PubMedCrossRef
39.
go back to reference Hansen TW, Thijs L, Li Y, et al. International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55:1049–57.PubMedCrossRef Hansen TW, Thijs L, Li Y, et al. International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55:1049–57.PubMedCrossRef
40.
go back to reference Veerabhadrappa P, Diaz KM, Feairheller DL, et al. Enhanced blood pressure variability in a high cardiovascular risk group of African Americans: FIT4Life Study. J Am Soc Hypertens. 2010;4:187–95.PubMedCrossRef Veerabhadrappa P, Diaz KM, Feairheller DL, et al. Enhanced blood pressure variability in a high cardiovascular risk group of African Americans: FIT4Life Study. J Am Soc Hypertens. 2010;4:187–95.PubMedCrossRef
41.
go back to reference Ko Y, Park JH, Yang MH, et al. The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke. Stroke. 2010;41:2512–8.PubMedCrossRef Ko Y, Park JH, Yang MH, et al. The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke. Stroke. 2010;41:2512–8.PubMedCrossRef
42.
go back to reference Armitage P, Fox W, Rose GA, Tinker CM. The variability of measurement of casual BP: ii Survey experience. Clin Sci. 1966;30:337–44.PubMed Armitage P, Fox W, Rose GA, Tinker CM. The variability of measurement of casual BP: ii Survey experience. Clin Sci. 1966;30:337–44.PubMed
43.
go back to reference Rosner B, Polk BF. The implications of BP variability for clinical and screening purposes. J Chron Dis. 1979;32:451–61.PubMedCrossRef Rosner B, Polk BF. The implications of BP variability for clinical and screening purposes. J Chron Dis. 1979;32:451–61.PubMedCrossRef
44.
go back to reference Hebel JR, Apostolides AY, Dischinger P, Entwistle G, Su S. Within-person variability in diastolic BP for a cohort of normotensives. J Chronic Dis. 1980;33:745–50.PubMedCrossRef Hebel JR, Apostolides AY, Dischinger P, Entwistle G, Su S. Within-person variability in diastolic BP for a cohort of normotensives. J Chronic Dis. 1980;33:745–50.PubMedCrossRef
45.
go back to reference Shepard DS. Reliability of BP measurements: implications for designing and evaluating programs to control hypertension. J Chronic Dis. 1981;34:191–209.PubMedCrossRef Shepard DS. Reliability of BP measurements: implications for designing and evaluating programs to control hypertension. J Chronic Dis. 1981;34:191–209.PubMedCrossRef
46.
go back to reference Rosner B, Polk BF. Predictive values of routine BP measurements in screening for hypertension. Am J Epidemiol. 1983;117:429–42.PubMed Rosner B, Polk BF. Predictive values of routine BP measurements in screening for hypertension. Am J Epidemiol. 1983;117:429–42.PubMed
47.
go back to reference Rosner B, Polk BF. The implications of BP variability for clinical and screening purposes. J Chron Dis. 1979;32:451–61.PubMedCrossRef Rosner B, Polk BF. The implications of BP variability for clinical and screening purposes. J Chron Dis. 1979;32:451–61.PubMedCrossRef
48.
go back to reference Cook NR, Rosner BA. Screening rules for determining BP status in clinical trials. Application to the trials of hypertension prevention. Am J Epidemiol. 1993;137:1341–52.PubMed Cook NR, Rosner BA. Screening rules for determining BP status in clinical trials. Application to the trials of hypertension prevention. Am J Epidemiol. 1993;137:1341–52.PubMed
49.
go back to reference Markovic N, Olomu IN, Bunker CH, et al. Adequacy of a single visit for classification of hypertensive status in a Nigerian civil servant population. Int J Epidemiol. 1994;23:723–9.PubMedCrossRef Markovic N, Olomu IN, Bunker CH, et al. Adequacy of a single visit for classification of hypertensive status in a Nigerian civil servant population. Int J Epidemiol. 1994;23:723–9.PubMedCrossRef
50.
go back to reference Klungel OH, de Boer A, Paes AHP, et al. Estimating the prevalence of hypertension corrected for the effect of within-person variability in BP. J Clin Epidemiol. 2000;53:1158–63.PubMedCrossRef Klungel OH, de Boer A, Paes AHP, et al. Estimating the prevalence of hypertension corrected for the effect of within-person variability in BP. J Clin Epidemiol. 2000;53:1158–63.PubMedCrossRef
51.
go back to reference Klungel OH, de Boer A, Paes AH, et al. Influence of correction for within-person variability in BP on the prevalence, awareness, treatment, and control of hypertension. Am J Hypertens. 2000;13:88–91.PubMedCrossRef Klungel OH, de Boer A, Paes AH, et al. Influence of correction for within-person variability in BP on the prevalence, awareness, treatment, and control of hypertension. Am J Hypertens. 2000;13:88–91.PubMedCrossRef
52.
go back to reference Wittes J, Lakatos E, Black D, et al. Selecting screening criteria for clinical trials: an example from the Systolic Hypertension in the Elderly Program. Control Clin Trials. 1999;20:121–32.PubMedCrossRef Wittes J, Lakatos E, Black D, et al. Selecting screening criteria for clinical trials: an example from the Systolic Hypertension in the Elderly Program. Control Clin Trials. 1999;20:121–32.PubMedCrossRef
53.
go back to reference Alli C, Mariotti G, Avanzini F, et al. Long-term prognostic impact of repeated measurements over 1 year of pulse pressure and systolic BP in the elderly. J Hum Hypertens. 2005;19:355–63.PubMedCrossRef Alli C, Mariotti G, Avanzini F, et al. Long-term prognostic impact of repeated measurements over 1 year of pulse pressure and systolic BP in the elderly. J Hum Hypertens. 2005;19:355–63.PubMedCrossRef
54.
go back to reference Imai Y, Ohkubo T, Tsuji I, et al. Relationships among BPs obtained using different measurement methods in the general population of Ohasama, Japan. Hypertens Res. 1999;22:261–72.PubMedCrossRef Imai Y, Ohkubo T, Tsuji I, et al. Relationships among BPs obtained using different measurement methods in the general population of Ohasama, Japan. Hypertens Res. 1999;22:261–72.PubMedCrossRef
55.
go back to reference Mancia G, Parati G, Bilo G, et al. Assessment of long-term antihypertensive treatment by clinic and ambulatory BP: data from the European Lacidipine Study on Atherosclerosis. J Hypertens. 2007;25:1087–94.PubMedCrossRef Mancia G, Parati G, Bilo G, et al. Assessment of long-term antihypertensive treatment by clinic and ambulatory BP: data from the European Lacidipine Study on Atherosclerosis. J Hypertens. 2007;25:1087–94.PubMedCrossRef
56.
go back to reference Wizner B, Dechering DG, Thijs L, et al. Short-term and long-term repeatability of the morning BP in older patients with isolated systolic hypertension. J Hypertens. 2008;26:1328–35.PubMedCrossRef Wizner B, Dechering DG, Thijs L, et al. Short-term and long-term repeatability of the morning BP in older patients with isolated systolic hypertension. J Hypertens. 2008;26:1328–35.PubMedCrossRef
57.
go back to reference Brueren MM, van Limpt P, Schouten HJ, et al. Is a series of BP measurements by the general practitioner or the patient a reliable alternative to ambulatory BP measurement? A study in general practice with reference to short-term and long-term between-visit variability. Am J Hypertens. 1997;10:879–85.PubMedCrossRef Brueren MM, van Limpt P, Schouten HJ, et al. Is a series of BP measurements by the general practitioner or the patient a reliable alternative to ambulatory BP measurement? A study in general practice with reference to short-term and long-term between-visit variability. Am J Hypertens. 1997;10:879–85.PubMedCrossRef
58.
go back to reference Hata Y, Kimura Y, Muratani H, et al. Office BP variability as a predictor of brain infarction in elderly hypertensive patients. Hypertens Res. 2000;23:553–60.PubMedCrossRef Hata Y, Kimura Y, Muratani H, et al. Office BP variability as a predictor of brain infarction in elderly hypertensive patients. Hypertens Res. 2000;23:553–60.PubMedCrossRef
59.
go back to reference Hata Y, Muratani H, Kimura Y, et al. Office BP variability as a predictor of acute myocardial infarction in elderly patients receiving antihypertensive therapy. J Hum Hypertens. 2002;16:141–6.PubMedCrossRef Hata Y, Muratani H, Kimura Y, et al. Office BP variability as a predictor of acute myocardial infarction in elderly patients receiving antihypertensive therapy. J Hum Hypertens. 2002;16:141–6.PubMedCrossRef
60.
go back to reference Tozawa M, Iseki K, Yoshi S, Fukiyama K. BP variability as an adverse prognostic risk factor in end-stage renal disease. Nephrol Dial Transplant. 1999;14:1976–81.PubMedCrossRef Tozawa M, Iseki K, Yoshi S, Fukiyama K. BP variability as an adverse prognostic risk factor in end-stage renal disease. Nephrol Dial Transplant. 1999;14:1976–81.PubMedCrossRef
61.
go back to reference Havlik RJ, Foley DJ, Sayer B, et al. Variability in midlife systolic BP is related to late-life brain white matter lesions: the Honolulu-Asia Aging study. Stroke. 2002;33:26–30.PubMedCrossRef Havlik RJ, Foley DJ, Sayer B, et al. Variability in midlife systolic BP is related to late-life brain white matter lesions: the Honolulu-Asia Aging study. Stroke. 2002;33:26–30.PubMedCrossRef
62.
go back to reference Wingfield D, Grodzicki T, Palmer AJ, Wells F, Bulpitt CJ, on behalf of the General Practice Hypertension Study Group. Transiently elevated diastolic BP is associated with a gender-dependent effect on cardiovascular risk. J Hum Hypertens. 2005;19:347–54.PubMedCrossRef Wingfield D, Grodzicki T, Palmer AJ, Wells F, Bulpitt CJ, on behalf of the General Practice Hypertension Study Group. Transiently elevated diastolic BP is associated with a gender-dependent effect on cardiovascular risk. J Hum Hypertens. 2005;19:347–54.PubMedCrossRef
63.
go back to reference Kikuya M, Ohkubo T, Metoki H, et al. Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis: the Ohasama study. Hypertension. 2008;52:1045–50.PubMedCrossRef Kikuya M, Ohkubo T, Metoki H, et al. Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis: the Ohasama study. Hypertension. 2008;52:1045–50.PubMedCrossRef
64.
go back to reference Muntner P, Shimbo D, Tonelli M, et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011;57:160–6.PubMedCrossRef Muntner P, Shimbo D, Tonelli M, et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011;57:160–6.PubMedCrossRef
65.
go back to reference Kilpatrick ES, Rigby AS, Atkin SL. The role of blood pressure variability in the development of nephropathy in type 1 diabetes. Diabetes Care. 2010;33:2442–7.PubMedCrossRef Kilpatrick ES, Rigby AS, Atkin SL. The role of blood pressure variability in the development of nephropathy in type 1 diabetes. Diabetes Care. 2010;33:2442–7.PubMedCrossRef
66.
go back to reference Geeganage C, Tracy M, England T, et al. TAIST Investigators. Relationship between baseline blood pressure parameters (including mean pressure, pulse pressure, and variability) and early outcome after stroke: data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). Stroke. 2011;42:491–3.PubMedCrossRef Geeganage C, Tracy M, England T, et al. TAIST Investigators. Relationship between baseline blood pressure parameters (including mean pressure, pulse pressure, and variability) and early outcome after stroke: data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). Stroke. 2011;42:491–3.PubMedCrossRef
67.
go back to reference Wizner B, Dechering DG, Thijs L, et al. Short-term and long-term repeatability of the morning BP in older patients with isolated systolic hypertension. J Hypertens. 2008;26:1328–35.PubMedCrossRef Wizner B, Dechering DG, Thijs L, et al. Short-term and long-term repeatability of the morning BP in older patients with isolated systolic hypertension. J Hypertens. 2008;26:1328–35.PubMedCrossRef
68.
go back to reference Kario K, Shimada K, Pickering TG. Clinical implication of morning BP surge in hypertension. J Cardiovasc Pharmacol. 2003;42 Suppl 1:S87–91.PubMedCrossRef Kario K, Shimada K, Pickering TG. Clinical implication of morning BP surge in hypertension. J Cardiovasc Pharmacol. 2003;42 Suppl 1:S87–91.PubMedCrossRef
69.
go back to reference Koton S, Tanne D, Bornstein NM, Green MS. Triggering risk factors for ischemic stroke: a case-crossover study. Neurology. 2004;63:2006–10.PubMed Koton S, Tanne D, Bornstein NM, Green MS. Triggering risk factors for ischemic stroke: a case-crossover study. Neurology. 2004;63:2006–10.PubMed
70.
go back to reference Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet. 2007;370:1089–100.PubMedCrossRef Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet. 2007;370:1089–100.PubMedCrossRef
71.
go back to reference Kazuomi K. Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk. Circ J. 2009;73:1002–7.CrossRef Kazuomi K. Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk. Circ J. 2009;73:1002–7.CrossRef
72.
go back to reference Fessel J, Robertson D. Orthostatic hypertension: when pressor reflexes overcompensate. Nat Clin Pract Nephrol. 2006;2:424–31.PubMedCrossRef Fessel J, Robertson D. Orthostatic hypertension: when pressor reflexes overcompensate. Nat Clin Pract Nephrol. 2006;2:424–31.PubMedCrossRef
73.
go back to reference Pavek K, Taube A. Personality characteristics influencing determinacy of day and night blood pressure and heart rate. Blood Press. 2009;18:30–5.PubMedCrossRef Pavek K, Taube A. Personality characteristics influencing determinacy of day and night blood pressure and heart rate. Blood Press. 2009;18:30–5.PubMedCrossRef
74.
go back to reference Brondolo E, Grantham KI, Karlin W, et al. Trait hostility and ambulatory blood pressure among traffic enforcement agents: the effects of stressful social interactions. J Occup Health Psychol. 2009;14:110–21.PubMedCrossRef Brondolo E, Grantham KI, Karlin W, et al. Trait hostility and ambulatory blood pressure among traffic enforcement agents: the effects of stressful social interactions. J Occup Health Psychol. 2009;14:110–21.PubMedCrossRef
75.
go back to reference Federowski A, Stavenow L, Hedblad B, et al. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Prevention Project). Eur Heart J. 2010;31:85–91.CrossRef Federowski A, Stavenow L, Hedblad B, et al. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Prevention Project). Eur Heart J. 2010;31:85–91.CrossRef
76.
go back to reference Hossain M, Ooi WL, Lipsitz LA. Intra-individual postural blood pressure variability and stroke in elderly nursing home residents. J Clin Epidemiol. 2001;54:488–94.PubMedCrossRef Hossain M, Ooi WL, Lipsitz LA. Intra-individual postural blood pressure variability and stroke in elderly nursing home residents. J Clin Epidemiol. 2001;54:488–94.PubMedCrossRef
77.
go back to reference Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women's Heart and Health Study. Age Ageing. 2010;39:51–6.PubMedCrossRef Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women's Heart and Health Study. Age Ageing. 2010;39:51–6.PubMedCrossRef
78.
go back to reference Verdecchia P, O'Brien E, Pickering T, et al. European Society of Hypertension Working Group on Blood Pressure Monitoring. When can the practicing physician suspect white coat hypertension? Statement from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Am J Hypertens. 2003;16:87–91.PubMedCrossRef Verdecchia P, O'Brien E, Pickering T, et al. European Society of Hypertension Working Group on Blood Pressure Monitoring. When can the practicing physician suspect white coat hypertension? Statement from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Am J Hypertens. 2003;16:87–91.PubMedCrossRef
79.
go back to reference Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47:846–53.PubMedCrossRef Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47:846–53.PubMedCrossRef
80.
go back to reference Mancia G, Bombelli M, Facchetti R, et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertension. 2009;54:226–32.PubMedCrossRef Mancia G, Bombelli M, Facchetti R, et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertension. 2009;54:226–32.PubMedCrossRef
81.
82.
go back to reference Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD. Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke. 2008;39:2204–10.PubMedCrossRef Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD. Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke. 2008;39:2204–10.PubMedCrossRef
83.
go back to reference Duprez DA, Jacobs Jr DR, Lutsey PL, et al. Race/ethnic and sex differences in large and small artery elasticity–results of the multi-ethnic study of atherosclerosis (MESA). Ethn Dis. 2009;19:243–50.PubMed Duprez DA, Jacobs Jr DR, Lutsey PL, et al. Race/ethnic and sex differences in large and small artery elasticity–results of the multi-ethnic study of atherosclerosis (MESA). Ethn Dis. 2009;19:243–50.PubMed
84.
go back to reference Tozawa M, Iseki K, Yoshi S, Fukiyama K. Blood pressure variability as an adverse prognostic risk factor in end-stage renal disease. Nephrol Dial Transplant. 1999;14:1976–81.PubMedCrossRef Tozawa M, Iseki K, Yoshi S, Fukiyama K. Blood pressure variability as an adverse prognostic risk factor in end-stage renal disease. Nephrol Dial Transplant. 1999;14:1976–81.PubMedCrossRef
85.
go back to reference Fischer U, Bull L, Silver LE, Mehta Z, Rothwell PM. Acute phase blood pressure after TIA and stroke in relation to pre-morbid levels: a population based study. Cerebrovasc Dis. 2009;27 suppl 6:60 (Abstract). Fischer U, Bull L, Silver LE, Mehta Z, Rothwell PM. Acute phase blood pressure after TIA and stroke in relation to pre-morbid levels: a population based study. Cerebrovasc Dis. 2009;27 suppl 6:60 (Abstract).
86.
go back to reference The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcome in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.CrossRef The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcome in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.CrossRef
87.
go back to reference MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ. 1992;304:405–12.CrossRef MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ. 1992;304:405–12.CrossRef
88.
go back to reference Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed). 1985;291:97–104.CrossRef Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed). 1985;291:97–104.CrossRef
89.
go back to reference Angeli F, Verdicchia P, Reboldi GP, et al. Calcium channel blockade to prevent stroke in hypertension: a meta-analysis of 13 studies with 103,793 subjects. Am J Hypertens. 2004;17:817–22.PubMed Angeli F, Verdicchia P, Reboldi GP, et al. Calcium channel blockade to prevent stroke in hypertension: a meta-analysis of 13 studies with 103,793 subjects. Am J Hypertens. 2004;17:817–22.PubMed
90.
go back to reference Webb AJS, Rothwell PM. Blood pressure variability and risk of new-onset atrial fibrillation: a systematic review of randomized trials of antihypertensive drugs. Stroke. 2010;41:2091–3.PubMedCrossRef Webb AJS, Rothwell PM. Blood pressure variability and risk of new-onset atrial fibrillation: a systematic review of randomized trials of antihypertensive drugs. Stroke. 2010;41:2091–3.PubMedCrossRef
91.
go back to reference Web AJS, Fischer U, Rothwell PM. Detrimental effects of non-selective beta-blockers on blood pressure variability and risk of stroke: A systematic review. Neurology 2011 (in press). Web AJS, Fischer U, Rothwell PM. Detrimental effects of non-selective beta-blockers on blood pressure variability and risk of stroke: A systematic review. Neurology 2011 (in press).
92.
go back to reference Miao CY, Xie HH, Zhan LS, Su DF. BP variability is more important than BP level in determination of end-organ damage in rats. J Hypertens. 2006;24:1125–35.PubMedCrossRef Miao CY, Xie HH, Zhan LS, Su DF. BP variability is more important than BP level in determination of end-organ damage in rats. J Hypertens. 2006;24:1125–35.PubMedCrossRef
93.
go back to reference Shan ZZ, Dai SM, Su DF. Arterial baroreflex deficit induced organ damage in sinoaortic denervated rats. J Cardiovasc Pharmacol. 2001;38:427–37.PubMedCrossRef Shan ZZ, Dai SM, Su DF. Arterial baroreflex deficit induced organ damage in sinoaortic denervated rats. J Cardiovasc Pharmacol. 2001;38:427–37.PubMedCrossRef
94.
go back to reference Su DF. Treatment of hypertension based on measurement of blood pressure variability: lessons from animal studies. Curr Opin Cardiol. 2006;21:486–91.PubMedCrossRef Su DF. Treatment of hypertension based on measurement of blood pressure variability: lessons from animal studies. Curr Opin Cardiol. 2006;21:486–91.PubMedCrossRef
95.
go back to reference Tatasciore A, Zimarino M, Renda G, et al. Awake blood pressure variability, inflammatory markers and target organ damage in newly diagnosed hypertension. Hypertens Res. 2008;31:2137–46.PubMedCrossRef Tatasciore A, Zimarino M, Renda G, et al. Awake blood pressure variability, inflammatory markers and target organ damage in newly diagnosed hypertension. Hypertens Res. 2008;31:2137–46.PubMedCrossRef
96.
go back to reference Desjardins F, Sekkali B, Verreth W, et al. Rosuvastatin increases vascular endothelial PPARgamma expression and corrects blood pressure variability in obese dyslipidaemic mice. Eur Heart J. 2008;29:128–37.PubMedCrossRef Desjardins F, Sekkali B, Verreth W, et al. Rosuvastatin increases vascular endothelial PPARgamma expression and corrects blood pressure variability in obese dyslipidaemic mice. Eur Heart J. 2008;29:128–37.PubMedCrossRef
97.
go back to reference Sorond FA, Khavari R, Serrador JM, Lipsitz LA. Regional cerebral autoregulation during orthostatic stress: age-related differences. J Gerontol A Biol Sci Med Sci. 2005;60:1484–7.PubMed Sorond FA, Khavari R, Serrador JM, Lipsitz LA. Regional cerebral autoregulation during orthostatic stress: age-related differences. J Gerontol A Biol Sci Med Sci. 2005;60:1484–7.PubMed
98.
go back to reference Zhang R, Witkowski S, Fu Q, Claassen JA, Levine BD. Cerebral hemodynamics after short- and long-term reduction in blood pressure in mild and moderate hypertension. Hypertension. 2007;49:1149–55.PubMedCrossRef Zhang R, Witkowski S, Fu Q, Claassen JA, Levine BD. Cerebral hemodynamics after short- and long-term reduction in blood pressure in mild and moderate hypertension. Hypertension. 2007;49:1149–55.PubMedCrossRef
99.
go back to reference Rothwell PM, Howard SC, Spence D. Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease. Stroke. 2003;34:2583–90.PubMedCrossRef Rothwell PM, Howard SC, Spence D. Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease. Stroke. 2003;34:2583–90.PubMedCrossRef
100.
go back to reference Lammie GA, Lindley R, Keir S, Wiggam MI. Stress-related primary intracerebral hemorrhage: autopsy clues to underlying mechanism. Stroke. 2000;31:1426–8.PubMed Lammie GA, Lindley R, Keir S, Wiggam MI. Stress-related primary intracerebral hemorrhage: autopsy clues to underlying mechanism. Stroke. 2000;31:1426–8.PubMed
101.
go back to reference Moody DM, Brown WR, Challa VR, Ghazi-Birry HS, Reboussin DM. Cerebral microvascular alterations in aging, leukoaraiosis, and Alzheimer's disease. Ann NY Acad Sci. 1997;826:103–16.PubMedCrossRef Moody DM, Brown WR, Challa VR, Ghazi-Birry HS, Reboussin DM. Cerebral microvascular alterations in aging, leukoaraiosis, and Alzheimer's disease. Ann NY Acad Sci. 1997;826:103–16.PubMedCrossRef
102.
go back to reference Meyer JS, Waltz AG, Gotoh F. Pathogenesis of cerebral vasospasm in hypertensive encephalopathy. I. Effects of acute increases in intraluminal blood pressure on pial blood flow. Neurology. 1960;10:735–44. Meyer JS, Waltz AG, Gotoh F. Pathogenesis of cerebral vasospasm in hypertensive encephalopathy. I. Effects of acute increases in intraluminal blood pressure on pial blood flow. Neurology. 1960;10:735–44.
103.
go back to reference Thom S, Stettler C, Stanton A, et al. Differential effects of antihypertensive treatment on the retinal microcirculation: an Anglo-Scandinavian Cardiac Outcomes Trial substudy. Hypertension. 2009;54:405–8.PubMedCrossRef Thom S, Stettler C, Stanton A, et al. Differential effects of antihypertensive treatment on the retinal microcirculation: an Anglo-Scandinavian Cardiac Outcomes Trial substudy. Hypertension. 2009;54:405–8.PubMedCrossRef
Metadata
Title
Does Blood Pressure Variability Modulate Cardiovascular Risk?
Author
Peter M. Rothwell
Publication date
01-06-2011
Publisher
Current Science Inc.
Published in
Current Hypertension Reports / Issue 3/2011
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-011-0201-3

Other articles of this Issue 3/2011

Current Hypertension Reports 3/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine