Prognostic Value of Blood Pressure Variability and Average Blood Pressure Levels in Patients With Hypertension and Diabetes
TLDR
The available evidence on the prognostic importance of BP mean levels and of BP variability (BPV) estimates is reviewed to critically evaluate whether antihypertensive treatment strategies should be targeted at reducing not only average BP levels but also the degree of BPV in order to optimize CV protection in diabetic patients.Abstract:
Elevated blood pressure (BP) is a major risk factor for cardiovascular (CV) events and mortality (1) and a leading contributor to the global disease burden (2). Overwhelming evidence is now available showing that BP measured in the office shows a linear relationship with a number of CV and renal outcomes as well as with overall mortality and that lowering of office BP (OBP) with treatment is effective in reducing morbidity and mortality (3,4). However, application over the last 40 years of techniques for out-of-office BP monitoring including home BP monitoring (HBPM) and 24-h ambulatory BP monitoring (ABPM) has led to further important findings. In particular, 1 ) average BP measured in everyday life conditions may be an even better predictor of CV outcomes than isolated OBP readings and 2 ) the extent of fluctuations of BP over time may provide additional, independent prognostic information compared with both isolated office readings and average ambulatory BP (ABP) levels, respectively. These findings are of upmost relevance in the case of diabetic patients who are characterized by a significantly higher risk of CV events compared with nondiabetic individuals, with diabetes itself currently considered a CV disease equivalent (5,6). The aim of the present article is to review the available evidence on the prognostic importance of BP mean levels and of BP variability (BPV) estimates and to critically evaluate whether antihypertensive treatment strategies should be targeted at reducing not only average BP levels but also the degree of BPV in order to optimize CV protection in diabetic patients.
### Prognostic value of OBP values
Consistent evidence from observational studies has indicated that the risk of CV morbidity and mortality has a strong and continuous relationship with OBP levels (3), without any evidence of a threshold down to at least 115/75 mmHg (4). Furthermore, large meta-analyses of major interventional trials …read more
Citations
More filters
Journal ArticleDOI
Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension
Jaakko Tuomilehto,Daiva Rastenyte,W. H. Birkenhäger,Lutgarde Thijs,Riitta Antikainen,Christopher J. Bulpitt,Astrid E. Fletcher,Françoise Forette,Adiv Goldhaber,Paolo Palatini,Cinzia Sarti,Robert Fagard +11 more
TL;DR: In this paper, the authors compared the outcome of treatment with nitrendipine in diabetic and nondiabetic patients, and reported that antihypertensive treatment with the calcium-channel blocker reduced the risk of cardiovascular events.
Journal ArticleDOI
Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease
Elvira O. Gosmanova,Margit K. Mikkelsen,Miklos Z. Molnar,Jun L. Lu,Lenar Yessayan,Kamyar Kalantar-Zadeh,Csaba P. Kovesdy,Csaba P. Kovesdy +7 more
TL;DR: Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD, and further studies are needed to determine interventions that can lowerSBPV and their impact on adverse health outcomes.
Journal ArticleDOI
Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index With Mortality and Cardiovascular Outcomes in the General Population.
Mee Kyoung Kim,Kyungdo Han,Yong-Moon Park,Hyuk-Sang Kwon,Gunseog Kang,Kun-Ho Yoon,Seung-Hwan Lee +6 more
TL;DR: High variability in each metabolic parameter was associated with a higher risk for all-cause mortality, myocardial infarction, and stroke, and the risk of outcomes increased significantly with the number of high-variability metabolic parameters.
Journal ArticleDOI
Association of Assisted Reproductive Technologies With Arterial Hypertension During Adolescence
Théo A. Meister,Stefano F. Rimoldi,Rodrigo Soria,Robert von Arx,Franz H. Messerli,Claudio Sartori,Urs Scherrer,Emrush Rexhaj +7 more
TL;DR: Premature vascular aging persisted in ART-conceived subjects, as evidenced by a roughly 25% impairment of flow-mediated dilation of the brachial artery and increased pulse-wave velocity and carotid intima-media thickness.
References
More filters
Journal ArticleDOI
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
Aram V. Chobanian,George L. Bakris,Henry R. Black,William C. Cushman,Lee A. Green,Joseph L. Izzo,Daniel W. Jones,Barry J. Materson,Suzanne Oparil,Jackson T. Wright,Edward J. Roccella +10 more
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
Journal Article
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
R C Turner,Rury R. Holman,Carole A. Cull,Irene M Stratton,David R Matthews,V Frighi,Susan E. Manley,Andrew Neil,K McElroy,D Wright,E. M. Kohner,Caroline S. Fox,D R Hadden,Z Mehta,Albert V. Smith,Z Nugent,Richard Peto,A I Adlel,Jim Mann,P A Bassett,S. Oakes,Tim Dornan,Stephen J Aldington,H Lipinski,R Collum,K Harrison,C MacIntyre,S Skinner,A Mortemore,D Nelson,S Cockley,S Levien,L Bodsworth,R Willox,T Biggs,S Dove,E Beattie,M Gradwell,S Staples,R Lam,F Taylor,L Leung,R D Carter,S M Brownlee,K E Fisher,K Islam,R. Jelfs,P A Williams,F A Williams,P J Sutton,A Ayres,Lisa Logie,C Lovatt,M A Evans,L A Stowell,I Ross,I A Kennedy,D. J. Croft,A H Keen,C Rose,M Raikou,A E Fletcher,Christopher J. Bulpitt,Clare Battersby,J S Yudkin,Richard Stevens,M R Stearn,S L Palmer,M S Hammersley,S L Franklin,R S Spivey,Jonathan C. Levy,C R Tidy,N J Bell,J Steemson,B A Barrow,R Coster,K Waring,L Nolan,E Truscott,N Walravens,L Cook,H Lampard,C Merle,P Parker,J McVittie,I Draisey,L E Murchison,Brunt Ahe.,M J Williams,D W Pearson,Petrie Xmp.,Lean Mej.,D Walmsley,F Lyall,E Christie,J Church,E Thomson,A Farrow,J M Stowers,M Stowers,K McHardy,N Patterson,Alex D. Wright,N A Levi,Shearer Aci.,Thompson Rjw.,G Taylor,S Rayton,M Bradbury,A Glover,A Smyth-Osbourne,C Parkes,J Graham,P England,S Gyde,C Eagle,B Chakrabarti,Josh Smith,J Sherwell,N. W. Oakley,M. Whitehead,G P Hollier,T. Pilkington,J Simpson,Michael W. Anderson,S Martin,J Kean,B Rice,A Rolland,J Nisbet,E M Kohner,A Dornhorst,M C Doddridge,M Dumskyij,S Walji,P Sharp,M Sleightholm,G Vanterpool,G Frost,M Roseblade,S Elliott,S Forrester,Meredith C. Foster,K Myers,R Chapman,J R Hayes,R W Henry,M S Featherston,Archbold Gpr.,M Copeland,R Harper,I Richardson,H A Davison,L Alexander,Scarpello Jhb.,D E Shiers,R J Tucker,Worthington Jrh.,S Angris,A Bates,J Walton,M Teasdale,J Browne,S Stanley,B A Davis,R C Strange,Hadden,L Kennedy,A B Atkinson,P M Bell,D R McCance,J Rutherford,A M Culbert,C Hegan,H Tennet,N Webb,I Robinson,J Holmes,S Nesbitt,A S Spathis,S Hyer,M E Nanson,L M James,J M Tyrell,C Davis,P Strugnell,M Booth,H Petrie,D Clark,S Hulland,J L Barron,B C Gould,J Singer,A Badenoch,M McGregor,L Isenberg,M Eckert,K Alibhai,E Marriot,Christopher E. Cox,R Price,M Fernandez,A Ryle,S Clarke,G Wallace,E Mehmed,J A Lankester,E Howard,A Waite,S MacFarlane,R H Greenwood,J Wilson,M J Denholm,R C Temple,K Whitfield,F Johnson,C Munroe,S Gorick,E Duckworth,M Fatman,S Rainbow,L J Borthwick,D J Wheatcroft,R J Seaman,R A Christie,W Wheatcroft,P Musk,Jennifer White,S McDougal,M Bond,P Raniga,J L Day,M J Doshi,James G. Wilson,J. Howard-Williams,H Humphreys,A Graham,K Hicks,S Hexman,P Bayliss,D Pledger,R W Newton,R T Jung,C Roxburgh,B Kilgallon,L Dick,N Waugh,S Kilby,A Ellingford,J Burns,C Fox,M C Holloway,H M Coghill,N Hein,A J Fox,W Cowan,M Richard,K Quested,S J Evans,Richard B Paisey,Brown Npr.,A J Tucker,R Paisey,F Garrett,J Hogg,P Park,K Williams,P Harvey,R Wilcocks,S Mason,J. C. Frost,C Warren,P Rocket,L Bower,J M Roland,D J Brown,J Youens,K Stanton-King,H Mungall,V Ball,W Maddison,D Donnelly,S King,P Griffin,Sidney C. Smith,S Church,Graham Dunn,Andrew D. Wilson,K Palmer,P M Brown,D Humphriss,Davidson Ajm.,Richard Rose,L Armistead,S Townsend,P Poon,Peacock Ida.,Culverwell Njc.,M H Charlton,Connolly Bps.,J Peacock,J Barrett,J Wain,W Beeston,George L. King,P G Hill,Boulton Ajm.,A M Robertson,V Katoulis,A Olukoga,H McDonald,S Kumar,F Abouaesha,B Abuaisha,E A Knowles,S Higgins,J Booker,J Sunter,K Breislin,R Parker,P Raval,J Curwell,H Davenport,G Shawcross,A Prest,J Grey,H Cole,C Sereviratne,R J Young,J R Clyne,M Gibson,I O'Connell,L M Wong,S J Wilson,K L Wright,Chris Wallace,D McDowell,A C Burden,E M Sellen,R Gregory,M Roshan,N Vaghela,M Burden,C Sherriff,S Mansingh,J Clarke,J Grenfell,Je Tooke,K. M. MacLeod,C Seamark,M Rammell,C Pym,J Stockman,C Yeo,J Piper,L Leighton,Ellen Green,M Hoyle,K Jones,A Hudson,A J James,Angela C. Shore,A Higham,B Martin,Neil Haw.,Butterfield Wjh.,Doll Wrs.,R Eastman,F R Ferris,N Kurinij,K McPherson,R F Mahler,Tom W. Meade,G Shafer,P J Watkins,H Keen,D Siegel,D J Betteridge,R D Cohen,D Currie,Julie L Darbyshire,J V Forrester,T Guppy,D G Johnston,Alistair McGuire,Mike Murphy,A M el-Nahas,B Pentecost,D Spiegelhalter,Alberti Kgmm.,R Denton,Philip Home,S Howell,Jarrett,V Marks,Michael Marmot,J D Ward,Grp Ukpds. +398 more
TL;DR: In this article, the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial were compared.
Journal ArticleDOI
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Aram V. Chobanian,George L. Bakris,Henry R. Black,William C. Cushman,Lee A. Green,Joseph L. Izzo,Daniel W. Jones,Barry J. Materson,Suzanne Oparil,Jackson T. Wright,Edward J. Roccella +10 more
TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
Journal ArticleDOI
2013 ESH/ESC 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).
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna F. Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stéphane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad,Michel Burnier,Ettore Ambrosioni,Mark Caufield,Antonio Coca,Michael H. Olsen,Costas Tsioufis,Philippe van de Borne,José Luis Zamorano,Stephan Achenbach,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Roberto Ferrari,David Hasdai,Arno W. Hoes,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Denis Clement,Thierry C. Gillebert,Enrico Agabiti Rosei,Stefan D. Anker,Johann Bauersachs,Jana Brguljan Hitij,Mark J. Caulfield,Marc De Buyzere,Sabina De Geest,Geneviève Derumeaux,Serap Erdine,Csaba Farsang,Christian Funck-Brentano,Vjekoslav Gerc,Giuseppe Germanò,Stephan Gielen,Herman Haller,Jens Jordan,Thomas Kahan,Michel Komajda,Dragan Lovic,Heiko Mahrholdt,Jan Östergren,Gianfranco Parati,Joep Perk,Jorge Polónia,Bogdan A. Popescu,Zeljko Reiner,Lars Rydén,Yuriy Sirenko,Alice Stanton,Harry A.J. Struijker-Boudier,Charalambos Vlachopoulos,Massimo Volpe,David A. Wood +89 more
TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
Journal ArticleDOI
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).
Giuseppe Mancia,Guy De Backer,Anna F. Dominiczak,Renata Cifkova,Robert Fagard,Giuseppe Germanò,Guido Grassi,Anthony M. Heagerty,Sverre E. Kjeldsen,Stéphane Laurent,Krzysztof Narkiewicz,Luis M. Ruilope,Andrzej Rynkiewicz,Roland E. Schmieder,Harry A.J. Struijker Boudier,Alberto Zanchetti +15 more
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Related Papers (5)
2013 ESH/ESC 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).
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna F. Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stéphane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad,Michel Burnier,Ettore Ambrosioni,Mark Caufield,Antonio Coca,Michael H. Olsen,Costas Tsioufis,Philippe van de Borne,José Luis Zamorano,Stephan Achenbach,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Roberto Ferrari,David Hasdai,Arno W. Hoes,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Denis Clement,Thierry C. Gillebert,Enrico Agabiti Rosei,Stefan D. Anker,Johann Bauersachs,Jana Brguljan Hitij,Mark J. Caulfield,Marc De Buyzere,Sabina De Geest,Geneviève Derumeaux,Serap Erdine,Csaba Farsang,Christian Funck-Brentano,Vjekoslav Gerc,Giuseppe Germanò,Stephan Gielen,Herman Haller,Jens Jordan,Thomas Kahan,Michel Komajda,Dragan Lovic,Heiko Mahrholdt,Jan Östergren,Gianfranco Parati,Joep Perk,Jorge Polónia,Bogdan A. Popescu,Zeljko Reiner,Lars Rydén,Yuriy Sirenko,Alice Stanton,Harry A.J. Struijker-Boudier,Charalambos Vlachopoulos,Massimo Volpe,David A. Wood +89 more
Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations
Tine W. Hansen,Lutgarde Thijs,Yan Li,Yan Li,Yan Li,José Boggia,Masahiro Kikuya,Kristina Björklund-Bodegård,Tom Richart,Tom Richart,Takayoshi Ohkubo,Jørgen Jeppesen,C Torp-Pedersen,Eamon Dolan,Tatiana Kuznetsova,Katarzyna Stolarz-Skrzypek,Valérie Tikhonoff,Sofia Malyutina,Edoardo Casiglia,Yuri Nikitin,Lars Lind,E Sandoya,Kalina Kawecka-Jaszcz,Yutaka Imai,Ji-Guang Wang,H. Ibsen,Eoin O'Brien,Jan A. Staessen,Jan A. Staessen +28 more