Journal ArticleDOI
Blood pressure variability: its measurement and significance in hypertension.
Reads0
Chats0
TLDR
In conclusion, the goals of antihypertensive treatment should consider the reduction of both 24-h mean blood pressure and its variability, and long-lasting drugs or drug combinations are preferable to ensure a homogeneous and smooth 24-H blood pressure profile.Abstract:
The occurrence of blood pressure fluctuations over time has been documented since the 18th century, but the clinical importance of this phenomenon is only now being recognized. The introduction of ambulatory blood pressure monitoring in the late 1960s represented a major step forward in the study of blood pressure behaviour and helped to characterize the relationship between blood pressure variability and cardiovascular disease. In hypertension, blood pressure variability increases with increasing blood pressure and correlates closely with target-organ damage, independently of absolute blood pressure values. This has important consequences for treatment, which in the past has focused on reducing mean blood pressure values as the main goal. Experimental evidence suggests that drugs capable of buffering or reducing blood pressure variability may confer additional benefits on target-organ protection. Effective target-organ protection could best be afforded by antihypertensive agents that provide efficient 24-h blood pressure control and also stabilize blood pressure variability. Mathematical indices, such as the trough:peak ratio and the smoothness index, provide useful measures of the homogeneity of the antihypertensive effect over 24 h; optimum control is provided by drugs with a trough:peak ratio close to 1 and a smoothness index > 1, as is observed with long-acting drugs such as telmisartan or amlodipine. Recently, a direct relationship was demonstrated between homogeneous blood pressure control and treatment-induced regression of left ventricular hypertrophy, emphasizing the importance of smooth 24-h blood pressure control. In conclusion, the goals of antihypertensive treatment should consider the reduction of both 24-h mean blood pressure and its variability. Long-lasting drugs or drug combinations are preferable to ensure a homogeneous and smooth 24-h blood pressure profile.read more
Citations
More filters
Journal ArticleDOI
European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring
Eoin O'Brien,Gianfranco Parati,George S. Stergiou,Roland Asmar,Laurie Beilin,Grzegorz Bilo,Denis Clement,Alejandro de la Sierra,Peter W. de Leeuw,Eamon Dolan,Robert Fagard,John W. Graves,Geoffrey A. Head,Yutaka Imai,Kazuomi Kario,Empar Lurbe,Jean-Michel Mallion,Giuseppe Mancia,Thomas Mengden,Martin G. Myers,Gbenga Ogedegbe,Takayoshi Ohkubo,Stefano Omboni,Paolo Palatini,Josep Redon,Luis M. Ruilope,Andrew Shennan,Jan A. Staessen,Gert vanMontfrans,Paolo Verdecchia,Bernard Waeber,Ji-Guang Wang,Alberto Zanchetti,Yuqing Zhang +33 more
TL;DR: The historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique are considered, while the role ofABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined.
Journal ArticleDOI
Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects
Alfonso Tatasciore,Giulia Renda,Marco Zimarino,Manola Soccio,Grzegorz Bilo,Gianfranco Parati,Giuseppe Schillaci,Raffaele De Caterina +7 more
TL;DR: O awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels, and likely appears early in the natural history of hypertension.
Journal ArticleDOI
Blood pressure variability: its measurement and significance in hypertension.
TL;DR: It has been suggested that drugs capable of providing smooth 24-hour BP control, reducing BPV, may confer additional target-organ protection and further studies are still needed to confirm that, in humans, interventions that can reduce BPV can also reduce the rate of cardiovascular events.
Journal ArticleDOI
Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage.
David Rodriguez-Luna,Socorro Piñeiro,Marta Rubiera,Marc Ribó,Pilar Coscojuela,Jorge Pagola,Alan Flores,Marian Muchada,B. Ibarra,Pilar Meler,Estela Sanjuan,Mar Hernández-Guillamon,José Alvarez-Sabín,Joan Montaner,Carlos A. Molina +14 more
TL;DR: The impact of BP changes and course on HG and clinical outcome in patients with acute ICH was determined and an association between high blood pressure in acute intracerebral hemorrhage and hematoma growth was not clearly demonstrated.
Journal ArticleDOI
Ambulatory blood pressure monitoring in the prediction of cardiovascular events and effects of chronotherapy: rationale and design of the MAPEC study.
TL;DR: The MAPEC study investigates the potential decrease in cardiovascular, cerebrovascular, and renal risk from the proper modeling of the circadian BP profile by the timed administration (chronotherapy) of antihypertensive medication, beyond the reduction of clinic‐determined daytime or ABPM‐d determined 24 h mean BP levels.
References
More filters
Journal ArticleDOI
Circadian variation in the frequency of onset of acute myocardial infarction
James E. Muller,Peter Stone,Zoltan G. Turi,John D. Rutherford,Charles A. Czeisler,Corette B. Parker,W. K. Poole,Eugene R. Passamani,Robert Roberts,Thomas L. Robertson +9 more
TL;DR: If coronary arteries become vulnerable to occlusion when the intima covering an atherosclerotic plaque is disrupted, the circadian timing of myocardial infarction may result from a variation in the tendency to thrombosis.
Journal ArticleDOI
Morning Surge in Blood Pressure as a Predictor of Silent and Clinical Cerebrovascular Disease in Elderly Hypertensives A Prospective Study
Kazuomi Kario,Thomas G. Pickering,Yuji Umeda,Satoshi Hoshide,Yoko Hoshide,Masato Morinari,Mitsunobu Murata,Toshio Kuroda,Joseph E. Schwartz,Kazuyuki Shimada +9 more
TL;DR: In older hypertensives, a higher morning BP surge is associated with stroke risk independently of ambulatory BP, nocturnal BP falls, and silent infarct, and reduction of the MS could be a new therapeutic target for preventing target organ damage and subsequent cardiovascular events in hypertensive patients.
Journal ArticleDOI
Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension.
TL;DR: The findings demonstrate that the severity of hypertension is more closely related to 24-h mean BP than to cuff BP values, and confirmed that 24-H BP may be variably different from cuff BP among subjects.
Journal ArticleDOI
Blood pressure and heart rate variabilities in normotensive and hypertensive human beings.
Giuseppe Mancia,Alberto U. Ferrari,Luisa Gregorini,Gianfranco Parati,Guido Pomidossi,Giovanni Bertinieri,Guido Grassi,M. Di Rienzo,Antonio Pedotti,Alberto Zanchetti +9 more
TL;DR: A number of factors that are associated with and responsible for blood pressure and heart rate variabilities in human beings are uncovered, suggesting a primary role of central nervous mechanisms in the production of these phenomena and in the overall cardiovascular modulation.
Journal ArticleDOI
Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population.
TL;DR: Investigation of physiologic changes occurring during the period of increased incidence of sudden cardiac death may provide increased insight into its causes and suggest possible means of prevention.