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Background and purpose: Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. Patients and methods: INTERSTROKE is an international case–control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1-month follow-up, and logistic regression was used to identify risk factors for blood pressure variability. Results: Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03–1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04–1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. Conclusion: Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinar

Background and purpose: Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. Patients and methods: INTERSTROKE is an international case–control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1-month follow-up, and logistic regression was used to identify risk factors for blood pressure variability. Results: Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03–1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04–1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. Conclusion: Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinar

Blood pressure variability (BPV) is emerging as an important risk factor across numerous disease states, including cerebrovascular and neurodegenerative disease in older adults. However, there is no current consensus regarding specific use cases for the numerous available BPV metrics. There is also little published data supporting the ability to reliably measure BPV across metrics in older adults. The present study derived BPV metrics from continuous beat-to-beat blood pressure monitoring data. Two sequential 7 min waveforms were analyzed. Absolute and relative reliability testing was performed. Differences between antihypertensive medication users and non-users on BPV metric reliability was also assessed. All sequence and dispersion based BPV metrics displayed good test-retest reliability. A measure of BP instability displayed only moderate reliability. Systolic and diastolic average real variability displayed the highest levels of reliability at ICC = 0.87 and 0.82 respectively. Additionally, systolic average real variability was the most reliable metric in both the antihypertensive use group, and the no antihypertensive use group. In conclusion, beat-to-beat dispersion and sequence-based metrics of BPV can be reliably obtained in older adults using noninvasive continuous blood pressure monitoring. Average real variability may be the most reliable and specific beat-to-beat blood pressure variability metric due to its decreased susceptibility to outliers and low frequency blood pressure oscillations.

This proposal encompasses a comprehensive investigation into non-invasive cardiovascular monitoring techniques, which involved developing and integrating novel signal processing algorithms and machine learning (ML) architectures. We introduced a unique algorithm employing a novel intra-beat biomarker, designed for correcting raw BP data from various sensor sources. Our diastolic transit time (DTT)-based approach successfully eliminated stochastic baseline wander, enabling accurate, single-sensor beat-to-beat blood pressure (BP) measurements. This method not only maintained the spatiotemporal integrity of signals but also mitigated motion artifacts, paving the way for its application in continuous non-invasive BP technologies for acute, outpatient, and home settings. Our investigations into beat-to-beat heart rate and BP variability revealed significant physiological insights, particularly in stroke and sickle cell disease (SCD) patients. We observed increased systolic BP variability in stroke patients compared to healthy controls, a finding that underscores the potential of BP variability as a marker for long-term monitoring and management. In SCD patients, our study highlighted the impact of mental and psychological stressors on BP variability and vascular tone, revealing a complex interplay between autonomic nervous system dysregulation, endothelial dysfunction, and vascular tone alterations. These insights suggest the need for holistic management strategies that address both physiological and psychosocial aspects of disease. The application of ML in predictive health analytics marks a significant advancement in non-invasive monitoring of cardiac output (CO) and intracranial pressure (ICP). We developed a model for real-time, accurate CO monitoring using arterial line BP data, demonstrating the potential of ML to revolutionize acute care patient management. Additionally, our work in developing a non-invasive sensing system for continuous ICP measurement through be

Objectives:Heterogeneous are the results of the published studies aimed at determining the long-term effects of habitual coffee consumption on blood pressure (BP). Specifically, no data are available on the longitudinal association between habitual coffee consumption and office, home and 24 h BP profile and variability.Methods:In 1408 subjects recruited in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, followed for a 10 year follow-up period and classified as coffee consumers and nonconsumers (self-reporting), we prospectically investigated the association between habitual coffee consumption and office, home and 24-h ambulatory BP; 24-h BP variability; and development of a new hypertensive state. Data were also analysed according to gender.Results:When data were adjusted for confounders habitual coffee nonconsumers and consumers displayed similar long-term BP changes during the follow-up in office, home, and ambulatory BP. No difference was found between heavy and moderate coffee consumers. Furthermore, also new-onset hypertension and patterns of BP variability were superimposable in coffee nonconsumers and consumers, independently on confounders including gender, number, and characteristics of the antihypertensive drug treatment.Conclusion:The present study, which is the first longitudinal investigation never performed examining in a prospective fashion the long-term (10 year) effects of coffee consumption on office, home, and ambulatory BP, provides conclusive evidence that habitual coffee consumption is associated with neutral effects on in-office and out-of-office BP values and related variabilities. This is the also the case for the new-onset hypertensive state.

BACKGROUND: Sodium glucose cotransporter-2 inhibitors reduce systolic blood pressure (SBP), but whether they affect SBP variability is unknown. There also remains uncertainty regarding the prognostic value of SBP variability for different clinical outcomes. METHODS AND RESULTS: Using individual participant data from the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program and CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial, we assessed the effect of canagliflozin on SBP variability in people with type 2 diabetes across 4 study visits over 1.5 years as measured by standard deviation, coefficient of variation, and variability independent of the mean. We used multivariable Cox regression models to estimate associations of SBP variability with cardiovascular, kidney, and mortality outcomes. In 11 551 trial participants, canagliflozin modestly lowered the standard deviation of SBP variability (−0.25 mm Hg [95% CI, –0.44 to −0.06]), but there was no effect on coefficient of variation (0.02% [95% CI, –0.12 to 0.16]) or variability independent of the mean (0.08 U [95% CI, –0.11 to 0.26]) when adjusting for correlation with mean SBP. Each 1 standard deviation increase in standard deviation of SBP variability was independently associated with higher risk of hospitalization for heart failure (hazard ratio [HR], 1.19 [95% CI, 1.02–1.38]) and all-cause mortality (HR, 1.12 [95% CI, 1.01–1.25]), with consistent results observed for coefficient of variation and variability independent of the mean. Increases in SBP variability were not associated with kidney outcomes. CONCLUSIONS: In people with type 2 diabetes at high cardiovascular risk or with chronic kidney disease, higher visit-to-visit SBP variability is independently associated with risks of hospitalization for heart failure and all-cause mortality. Canagliflozin has little to no effect on SBP variability, independent of its established SBP-lowering effect

BACKGROUND: Elevated blood pressure (BP) variability is predictive of increased risk for stroke, cerebrovascular disease, and other vascular brain injuries, independent of traditionally studied average BP levels. However, no studies to date have evaluated whether BP variability is related to diminished cerebrovascular reactivity, which may represent an early marker of cerebrovascular dysfunction presaging vascular brain injury. METHODS: The present study investigated BP variability and cerebrovascular reactivity in a sample of 41 community-dwelling older adults (mean age 69.6 [SD 8.7] years) without a history of dementia or stroke. Short-term BP variability was determined from BP measurements collected continuously during a 5-minute resting period followed by cerebrovascular reactivity during 5-minute hypocapnia and hypercapnia challenge induced by visually guided breathing conditions. Cerebrovascular reactivity was quantified as percent change in cerebral perfusion by pseudo-continuous arterial spin labeling (pCASL)-MRI per unit change in end-tidal CO2. RESULTS: Elevated systolic BP variability was related to lower whole brain cerebrovascular reactivity during hypocapnia (ß = -0.43 [95% CI -0.73, -0.12]; P = 0.008; adjusted R2 =.11) and hypercapnia (ß = -0.42 [95% CI -0.77, -0.06]; P = 0.02; adjusted R2 = 0.19). CONCLUSIONS: Findings add to prior work linking BP variability and cerebrovascular disease burden and suggest BP variability may also be related to prodromal markers of cerebrovascular dysfunction and disease, with potential therapeutic implications.

Background and aims: Chronic coffee consuption has been reported to be associated with a modest but significant increase in blood pressure (BP), although some recent studies have shown the opposite. These data, however, largely refer to clinic BP and virtually no study evaluated cross-sectionally the association between chronic coffee consuption, out-of-office BP and BP variability. Methods and results: In 2045 subjects belonging to the population of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, we analyzed cross-sectionally the association between clinic, 24-hour, home BP and BP variability and level of chronic coffee consumption. Results show that when adjusted for confounders (age, gender, body mass index, cigarette smoking, physical activity and alcohol drinking) chronic coffee consumption does not appear to have any major lowering effect on BP values, particulary when they are assessed via 24-hour ambulatory (0 Cup/day: 118.5 ± 0.7/72.8 ± 0.4 mmHg vs 3 cups/day: 120.2 ± 0.4/74.8 ± 0.3 mmHg, PNS) or home BP monitoring (0 cup/day: 124.1 ± 1.2/75.4 ± 0.7 mmHg vs 3 cups/day: 123.3 ± 0.6/76.4 ± 0.36 mmHg, PNS). However, daytime BP was significantly higher in coffee consumers (about 2 mmHg), suggesting some pressor effects of coffee which vanish during nighttime. Both BP and HR 24-hour HR variability were unaffected. Conclusion: Thus chronic coffee consumption does not appear to have any major lowering effect either on absolute BP values, particulary when they are assessed via 24-hour ambulatory or home BP monitoring, or on 24-hour BP variability.

In patients receiving surgery, increased blood pressure variability may contribute to the onset of acute kidney injury (AKI). However, the extent and significance of blood pressure variability in patients undergoing aortic dissection surgery have yet to be determined. The authors analyzed all patients operated for aortic dissection at Peking University Shenzhen Hospital from January 1, 2011 to December 31, 2021. Preoperative blood pressure variability was expressed as standard deviation, coefficient of variation (CV), and range. The primary outcome was postoperative AKI. After multivariate analysis, systolic blood pressure variability was found to be independently associated with AKI after aortic dissection surgery. The odds ratios and 95% confidence intervals for standard deviation, CV, and systolic blood pressure range were 1.232 (1.011–1.500), 1.451 (1.058–1.991), and 1.138 (0.986–1.288) for postoperative AKI, respectively. However, there was no significant relationship between diastolic blood pressure variability and AKI after aortic dissection surgery. Finally, in patients undergoing surgery for aortic dissection, the variability of systolic blood pressure is actually an important factor in the development of AKI.

Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment.The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.

BACKGROUND: The causal relationship between blood pressure variability (BPV) and arterial stiffness remains debated. OBJECTIVE: This study aimed to explore the temporal and bidirectional associations between long-term BPV and arterial stiffness using a cohort design with multiple surveys. METHODS: Participants from the Beijing Health Management Cohort who underwent health examinations from visit 1 (2010-2011) to visit 5 (2018-2019) were enrolled in this study. Long-term BPV was defined as intraindividual variation using the coefficient of variation (CV) and SD. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). The bidirectional relationship between BPV and arterial stiffness was explored using cross-lagged analysis and linear regression models, with records before and after visit 3 categorized as phase 1 and phase 2, respectively. RESULTS: Of the 1506 participants, who were a mean of 56.11 (SD 8.57) years old, 1148 (76.2%) were male. The cross-lagged analysis indicated that the standardized coefficients of BPV at phase 1 directing to the baPWV level at phase 2 were statistically significant but not vice-versa. The adjusted regression coefficients of the CV were 4.708 (95% CI 0.946-8.470) for systolic blood pressure, 3.119 (95% 0.166-6.073) for diastolic pressure, and 2.205 (95% CI 0.300-4.110) for pulse pressure. The coefficients of the SD were 4.208 (95% CI 0.177-8.239) for diastolic pressure and 4.247 (95% CI 0.448-8.046) for pulse pressure. The associations were predominant in the subgroup with hypertension, but we did not observe any significant association of baPWV level with subsequent BPV indices. CONCLUSIONS: The findings supported a temporal relationship between long-term BPV and arterial stiffness level, especially among people with hypertension.

Understanding the complex mechanisms associated with systemic arterial hypertension represents a global health challenge, especially in secondary forms of hypertension. These occur in >10% of cases, mostly in younger people, and are often associated with poor blood pressure control and higher cardiovascular risk. This doctoral thesis highlights that, besides blood pressure values, multiple aspects of arterial hypertension, such as blood pressure variability and sleep disorders, should be taken into consideration as additional tools in clinical management and cardiovascular risk stratification of hypertensive patients with secondary forms, e.g., pheochromocytoma, renal artery fibromuscular dysplasia, and chronic kidney disease. Furthermore, most common sleep disorders (i.e., obstructive sleep apnoea) are frequently linked to increases in blood pressure variability, which represents an additional cardiovascular risk factor. Moreover, the analysis of pathogenic mechanisms that link sleep disorders to arterial hypertension represents an unmet research need. Results obtained in the second part of this thesis open new perspectives on potential pathogenic systems involved in obstructive sleep apnoea, hypertension, and cardiovascular diseases.

Purpose of Review: To examine published and unpublished data collected in the context of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study on the relationships between serum uric acid (SUA), office and out-of-office blood pressure (BP), and organ damage. Recent Findings: SUA values were directly and significantly related to a large number of covariates that participate at cardiovascular risk determination, such as blood glucose, total serum cholesterol, serum triglycerides, body mass index, and serum creatinine. Additional variables included echocardiographically-determined left ventricular mass index and BP values, the latter not just when measured in the office but also when evaluated at home or over the 24-h period. White-coat hypertension and masked hypertension were characterized, as sustained hypertension, by a significant increase in SUA levels, which were also directly related to different indices of 24-h BP variability. No substantial difference in SUA levels was found when data were analyzed according to the dipping or non-dipping nocturnal BP profile. Summary: Data collected in the frame of the PAMELA study document the presence of a close relationship between SUA levels and BP values independently on the hypertensive phenotype patterns of BP increase (office, 24 h, or both) and nighttime BP profile. They also document the increase in SUA as a potential factor favoring the occurrence of new hypertension and new left ventricular hypertrophy.

Introduction: Patients with tIPH (used here to refer to traumatic intraparenchymal hemorrhagic contusion) or intraparenchymal hemorrhage face high rates of mortality and persistent functional deficits. Prior studies have found an association between blood pressure variability (BPV) and neurologic outcomes in patients with spontaneous IPH. Our study investigated the association between BPV and discharge destination (a proxy for functional outcome) in patients with tIPH. Methods: We retrospectively reviewed the charts of patients admitted to a Level I trauma center for ≥ 24 hours with tIPH. We examined variability in hourly BP measurements over the first 24 hours of hospitalization. Our outcome of interest was discharge destination (home vs facility). We performed 1:1 propensity score matching and multivariate regressions to identify demographic and clinical factors predictive of discharge home. Results: We included 354 patients; 91 were discharged home and 263 to a location other than home. The mean age was 56 (SD 21), 260 (73%) were male, 22 (6%) were on anticoagulation, and 54 (15%) on antiplatelet therapy. Our propensity-matched cohorts included 76 patients who were discharged home and 76 who were discharged to a location other than home. One measure of BPV (successive variation in systolic BP) was identified as an independent predictor of discharge location in our propensity-matched cohorts (odds ratio 0.89, 95% confidence interval 0.8-0.98; P = 0.02). Our model demonstrated good goodness of fit (P-value for Hosmer-Lemeshow test = 0.88) and very good discriminatory capability (AUROC = 0.81). High Glasgow Coma Scale score at 24 hours and treatment with fresh frozen plasma were also associated with discharge home.Conclusion: Our study suggests that increased BPV is associated with lower rates of discharge home after initial hospitalization among patients with tIPH. Additional research is needed to evaluate the impact of BP control on patient outcomes.

ObjectivesDepression is related to increased risk for dementia, possibly through links with cerebrovascular disease. Blood pressure variability is an emerging risk factor for cerebrovascular disease and dementia, but relationships with affective symptoms remain understudied.DesignRetrospective analysis of prospective cohort study.SettingAlzheimer's Disease Neuroimaging Initiative.Participants505 older adults without history of dementia or recent depression underwent three to four blood pressure measurements over 12 months and completed a self-report measure of depressive symptoms (Geriatric Depression Scale - 15 Item) at study baseline and 24-months follow-up.MeasurementsBlood pressure variability was calculated as variability independent of mean and maximum minus minimum. Regression models investigated relationships between blood pressure variability and severity of self-reported depressive symptoms at 24-months follow-up after controlling for several variables, including average blood pressure, antihypertensive use, antidepressant use, and baseline depressive symptom severity.ResultsElevated diastolic blood pressure variability was related to greater total depressive symptom score at follow-up (ß = .16 [95% CI 0.02, .30]; p = 0.03), with specific contribution from increased severity of symptoms of dysphoria (odds ratio = 1.35 [95% CI 1.07, 1.75]; p = 0.02). Blood pressure variability was not significantly related to other symptom subscales, including those reflecting life satisfaction or withdrawal.ConclusionsFindings suggest that elevated diastolic blood pressure variability is related to subthreshold depressive symptomatology in older adults without history of dementia or recent depression, independent of average blood pressure. Blood pressure variability may be an understudied vascular risk factor linked with depression and cognitive impairment, with potential therapeutic implications.

Introduction: Chronic mountain sickness (CMS) is a condition characterized by excessive erythrocytosis in response to chronic hypobaric hypoxia. CMS frequently triggers cardiorespiratory diseases such as pulmonary hypertension and right or left heart failure. Ambient hypoxia might be further amplified night-time by intermittent hypoxia related to sleep-disordered breathing (SDB) so that sleep disturbance may be an important feature of CMS. Our aim was to characterize in a cross-sectional study nocturnal hypoxaemia, SDB, blood pressure (BP), arterial stiffness and carotid intima-media thickness (CIMT) in highlanders living at extreme altitude. Methods: Men aged 18 to 55 years were prospectively recruited. Home sleep apnoea test, questionnaires (short-form health survey; Montreal cognitive assessment; Pittsburgh Sleep Questionnaire Index and the Insomnia severity index), 24-h ambulatory BP monitoring, CIMT and arterial stiffness were evaluated in 3 groups: i) Andean lowlanders (sea-level); ii) highlanders living at 3,800 m and iii) highlanders living at 5,100 m. Analyses were conducted in sub-groups according to 1) CMS severity 2) healthy subjects living at the three different altitude. Results: Ninety-two males were evaluated at their living altitudes. Among the 54 highlanders living at 5,100 m, subjects with CMS showed lower mean nocturnal oxygen saturation (SpO2), SpO2 nadir, lower pulse wave velocity and higher nocturnal BP variability than those with no-CMS. Lower nocturnal SpO2 nadir was associated with higher CMS severity (ß= −0.14, p=.009). Among the 55 healthy subjects, healthy highlanders at 5,100 m were characterized by lower scores on quality of life and sleep quality scales and lower mean SpO2 compared to lowlanders. Conclusions: Lower nocturnal SpO2 and higher nocturnal BP variability are associated with CMS severity in individuals living permanently at high altitude. The role of lower SpO2 and higher nocturnal BP variability in the cardiovascular progre

Introduction: Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients’ hospital stay.Methods: We retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes.Results: We analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 (14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBPSD), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005-1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15-0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients’ likelihood to be discharged home.Conclusion: Our study suggests that greater SBPSD during patients’ ED stay is associated with higher likelihood of AKI, while starting ni

La hipertensió arterial és un factor de risc de deteriorament cognitiu (DC). Tradicionalment, aquest risc s'ha atribuït a les xifres mitjanes de pressió arterial (PA). No obstant, la PA està sotmesa a una gran variabilitat que pot ser estudiada a curt plaç (en 24 hores) mitjançant la monitorització ambulatòria de la pressió arterial (MAPA) o a llarg plaç amb les PA de diferents visites separades en el temps. Recentment, la variabilidad de la PA (VPA) s'ha associat, independentment de les xifres mitjanes de PA, a un major risc de DC i d'atròfia cerebral. Per determinar la VPA existeixen diferents índexs, com la desviació estàndard (DS), el coeficient de variació (CV) i l' Average Real Variability (ARV). Mentre que la relació entre la VPA a llarg plaç i el DC està ben establerta, els estudis sobre VPA a curt plaç i cognició mostren resultats discordants. A més, l'associació entre ambdós tipus de VPA i el deteriorament cognitiu lleu (DCL), estat cognitiu que precedeix a la demència, ha estat poc estudiada i no s'ha fet de forma prospectiva. L'objectiu d'aquesta tesi és estudiar la VPA a curt i llarg plaç en una cohort de pacients hipertensos i determinar prospectivament la seva associació amb el decliu cognitiu i amb les transicions entre els estats de normalitat cognitiva i DCL després de quatre anys de seguiment. També s'investiga l'associació de la VPA amb el grau d'atròfia cerebral temporal medial (ATM) a la RMN cranial. Es van avaluar 361 pacients hipertensos mitjançant dues visites separades quatre anys. A cada visita es va realitzar una avaluació cognitiva, una RMN cranial i una MAPA (utilitzada per a calcular la VPA a curt plaç). Es recolliren, també, les determinacions de PA realitzades en Atenció Primària entre ambdues visites per calcular la VPA a llarg plaç. A cada visita es va passar la Rating Scale-second edition (DRS-2) i cada subjecte es va clasificar en normalitat cognitiva o DCL. Entre ambdues visites es recolliren els casos de DCL incident. L'ATM va, La hipertensión arterial es un factor de riesgo para el deterioro cognitivo (DC). Tradicionalmente, este riesgo se ha atribuido a las cifras medias de presión arterial (PA). Sin embargo, la PA está sujeta a una gran variabilidad que puede ser estudiada a corto plazo (en 24 horas) mediante la monitorización ambulatoria de la presión arterial (MAPA) o a largo plazo con las PA de diferentes visitas separadas en el tiempo. Recientemente la variabilidad de la PA (VPA) se ha asociado, independientemente de las cifras medias de PA, a un mayor riesgo de DC y de atrofia cerebral. Para determinar la VPA existen diferentes índices, como la desviación estándar (DS), el coeficiente de variación (CV) y la Average Real Variability (ARV). Mientras que la relación entre la VPA a largo plazo y el DC está bien establecida, los estudios sobre VPA a corto plazo y cognición muestran resultados discordantes. Además, la asociación entre ambos tipos de VPA y el deterioro cognitivo leve (DCL), estado cognitivo que precede a la demencia, ha sido poco estudiada y no se ha hecho de forma prospectiva. El objetivo de esta tesis es estudiar la VPA a corto y largo plazo en una cohorte de pacientes hipertensos y determinar prospectivamente su asociación con el declive cognitivo y con las transiciones entre los estados de normalidad cognitiva y DCL tras cuatro años de seguimiento. También se investiga la asociación de la VPA con el grado de atrofia cerebral temporal medial (ATM) en la RMN craneal. Se evaluaron 361 pacientes hipertensos mediante dos visitas separadas cuatro años. En cada visita se realizó una evaluación cognitiva, una RMN craneal y una MAPA (usada para calcular la VPA a corto plazo). Se recogieron también las determinaciones de PA que se realizaron en Atención Primaria entre ambas visitas para calcular la VPA a largo plazo. En cada visita se pasó la Dementia Rating Scale-second edition (DRS-2) y cada sujeto fue clasificado en normalidad cognitiva o DCL. Entre ambas visitas se recogier, Hypertension is a risk factor for cognitive impairment (CI). Traditionally, this risk has been attributed to mean blood pressure (BP). However, BP blood pressure levels exhibit a great variability over time. Blood pressure variability (BPV) can be assessed in the short term (within 24 hours) using ambulatory blood pressure monitoring (ABPM) or in the long term through BP measurements blood pressure measurements from different visits separated in time. Recently, BPV has been associated with a higher risk of CI and cerebral atrophy, regardless of the mean arterial pressure levels. Several indices have been proposed to measure BPV, such as the standard deviation (SD), the coefficient of variation (CV) and the Average Real Variability (ARV). The relationship between long-term BPV and CI is well established; however, studies assessing short-term BPV and cognition show conflicting results. Furthermore, the association between both types of VPA and mild cognitive impairment (MCI), a cognitive state that precedes dementia, has been assessed in few studies and has not been performed prospectively. The aim of this Thesis was to evaluate short-term and long-term BPV in a cohort of hypertensive patients and prospectively determine its association with cognitive decline and with cognitive changes between normal cognition states and MCI after four years of follow-up. The association of BPV with medial temporal cerebral atrophy (MTA) on cranial MRI was also investigated. 361 hypertensive patients were evaluated in two visits separated four years between them. A cognitive assessment, cranial MRI, and ABPM (used to calculate short-term VPA) were performed at each visit. BP determinations measured in Primary Care between both visits were also collected to calculate long-term BPV. In both visits, the Dementia Rating Scale-second edition (DRS-2) was performed and each subject was classified in cognitive normal state or MCI. Incident MCI patients between both visits were collected. The, Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina

Blood pressure variability (BPV) is linked to dementia risk, possibly through cerebral hypoperfusion. We investigated BPV over 1 year and concurrent regional cerebral perfusion decline in older adults without dementia. Participants underwent 4 blood pressure measurements across 12 months, ASL-MRI at baseline and 12-months, and baseline FDG-PET. Regional perfusion was normalized to precentral gyrus. A subset had cerebral spinal fluid Alzheimer's disease biomarker abnormalities. For every SD increase in BPV, perfusion decreased in medial orbitofrontal cortex (ß = -.36; p = 0.008), hippocampus (ß = -.37; p = 0.005), entorhinal cortex (ß = -.48; p < 0.001), precuneus (ß = -.31; p = 0.02), inferior parietal cortex (ß = -.44; p < 0.001), and inferior temporal cortex (ß = -.46; p < 0.001). Similar patterns emerged in subsets with biomarker abnormalities. Older adults with elevated BPV exhibit concurrent regional perfusion decline in areas vulnerable to Alzheimer's disease, independent of cerebral hypometabolism. BPV may be an early marker of vascular dysfunction in aging.

The study by Triantafyllidi et al. supports the view that regression of subclinical cardiac damage requires an effective 24‐hour blood pressure (BP) control along with a reduction in BP variability and suggests that the assessment of BPV and its modifications during the course of therapy may be an useful approach in predicting the beneficial effects of treatment on cardiac structure. However, some aspects and limitations of this study require caution in drawing firm conclusions. So, further investigation is needed to determine if reduction of BPV is actually associated with a regression in cardiac and extracardiac organ damage to identify which which classes of antihypertensive drugs are most effective in reducing BPV, and to elucidate whether those treatments provide additional clinical benefit, independent of the conventional BP targets.

[Purpose]The purpose of our study was to predict blood pressure variability from time-series data of blood pressure measured at home and data obtained through medical examination at a hospital. Previous studies have reported the blood pressure variability is a significant independent risk factor for cardiovascular disease. [Methods]We adopted standard deviation for a certain period and predicted variabilities and mean values of blood pressure for 4 weeks using multi-input multi-output deep neural networks. In designing the prediction model, we prepared a dataset from a clinical study. The dataset included past time-series data for blood pressure and medical examination data such as gender, age, and others. As evaluation metrics, we used the standard deviation ratio (SR) and the root-mean-square error (RMSE). Moreover, we used cross-validation as the evaluation method. [Results]The prediction performances of blood pressure variability and mean value after 1–4 weeks showed the SRs were “0.67” to “0.70”, the RMSEs were “5.04” to “6.65” mmHg, respectively. Additionally, our models were able to work for a participant with high variability in blood pressure values due to its multi-output nature. [Conclusion]The results of this study show that our models can predict blood pressure over 4 weeks. Our models work for an individual with high variability of blood pressure. Therefore, we consider that our prediction models are valuable for blood pressure management., Kojima, Ryosuke, Kario, Kazuomi, Okuno, Yasushi

BACKGROUND: Optimal cerebral perfusion pressure (CPPopt) is an autoregulatory-oriented target in the neurointensive care (NIC) of patients with traumatic brain injury (TBI), and deviation from CPPopt is associated with poor outcome. We recently found that blood pressure variability (BPV) is associated with deviation from CPPopt. OBJECTIVE: To evaluate BPV and other variables related to deviation from CPPopt and to evaluate challenges and strategies for autoregulatory-oriented treatment in TBI. METHODS: Data including arterial blood pressure and intracranial pressure (ICP) from 362 TBI patients treated at the NIC unit, Uppsala University Hospital, Sweden, between 2008 and 2016, were retrospectively analyzed day 2 to 5. RESULTS: Higher BPV was a strong predictor of both CPP deviation below and above CPPopt after multiple regression analyses. There was no other explanatory variable for CPP deviation above CPPopt, whereas also higher ICP and worse autoregulation (higher pressure reactivity index) were associated with CPP deviation below CPPopt. A higher BPV was, in turn, explained by older age, lower ICP, higher mean arterial blood pressure, and higher slow arterial blood pressure amplitude (0.018-0.067 Hz). CONCLUSION: BPV was strongly associated with deviation from CPPopt. High age is a risk factor for high BPV and hence CPP insults. Our treatment protocol is focused on avoiding CPP below 60 mm Hg. It is possible that a more restrictive upper level could generate more stable blood pressure and less deviation from CPPopt.

Background: Research links blood pressure variability (BPV) with stroke; however, the association with cerebral small-vessel disease (CSVD) remains unclear. As BPV and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding cerebrovascular morphological characteristics. Methods and Results: A systematic review was performed from inception until March 3, 2019. Eligibility criteria included population, adults without stroke (<4 weeks); exposure, BPV quantified by any metric over any duration; comparison, (1) low versus high or mean BPV and (2) people with versus without CSVD; and outcomes, (1) CSVD as subcortical infarct, lacunae, white matter hyperintensities, cerebral microbleeds, or enlarged perivascular spaces; and (2) standardized mean difference in BPV. A total of 27 articles were meta-analyzed, comprising 12 309 unique brain scans. A total of 31 odds ratios (ORs) were pooled, indicating that higher systolic BPV was associated with higher odds for CSVD (OR, 1.27; 95% CI, 1.14–1.42; I2=85%) independent of mean systolic pressure. Likewise, higher diastolic BPV was associated with higher odds for CSVD (OR, 1.30; 95% CI, 1.14–1.48; I2=53%) independent of mean diastolic pressure. There was no evidence of a pairwise interaction between systolic/diastolic and BPV/mean ORs (P=0.47), nor a difference between BPV versus mean pressure ORs (P=0.58). Fifty-four standardized mean differences were pooled and provided similar results for pairwise interaction (P=0.38) and difference between standardized mean differences (P=0.70). Conclusions: On the basis of the available studies, BPV was associated with CSVD independent of mean blood pressure. However, more high-quality longitudinal data are required to elucidate whether BPV contributes unique variance to CSVD morphological characteristics.

Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints.Copyright © 2020 International Society of Nephrology

Objective: Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure-matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end-organ damage. However, PA is currently substantially under-diagnosed. The standard screening test for PA, the aldosterone-to-renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening. Study design: Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM. Result(s): In this study, PA patients were younger and had higher 24-h, day, and night-time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day-night blood pressure variability between the two groups. Conclusion(s): An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.Copyright © 2020 John Wiley & Sons Ltd

Spontaneous baroreflex sensitivity (BRS) is a widely used tool for the quantification of the cardiovascular regulation. Numerous groups use the xBRS method, which calculates the cross-correlation between the systolic beat-to-beat blood pressure and the R-R interval (resampled at 1 Hz) in a 10 s sliding window, with 0–5 s delays for the interval. The delay with the highest correlation is selected and, if significant, the quotient of the standard deviations of the R-R intervals and the systolic blood pressures is recorded as the corresponding xBRS value. In this paper we test the hypothesis that the xBRS method quantifies the causal interactions of spontaneous BRS from non-invasive measurements at rest. We use the term spontaneous BRS in the sense of the sensitivity curve is calculated from non-interventional, i.e., spontaneous, baroreceptor activity. This study includes retrospective analysis of 1828 measurements containing ECG as well as continues blood pressure under resting conditions. Our results show a high correlation between the heart rate – systolic blood pressure variability (HRV/BPV) quotient and the xBRS (r = 0.94, p < 0.001). For a deeper understanding we conducted two surrogate analyses by substituting the systolic blood pressure by its reversed time series. These showed that the xBRS method was not able to quantify causal relationships between the two signals. It was not possible to distinguish between random and baroreflex controlled sequences. It appears xBRS rather determines the HRV/BPV quotient. We conclude that the xBRS method has a potentially large bias in characterizing the capacity of the arterial baroreflex under resting conditions. During slow breathing, estimates for xBRS are significantly increased, which clearly shows that measurements at rest only involve limited baroreflex activity, but does neither challenge, nor show the full range of the arterial baroreflex regulatory capacity. We show that xBRS is exclusively dominated by the heart, Peer Reviewed

Objective: In order to quantify spontaneous baroreflex sensitivity (BRS) many groups use the sequence method (SME). In this paper we test the hypothesis that SME is quantifying causal interactions of pontaneous BRS at rest rather than, alternatively, being solely dominated by heart rate variability (HRV) and/or systolic blood pressure variability (BPV). Approach: Therefore, we retrospectively analyzed 1828 beat-to-beat time series and their corresponding systolic blood pressure during resting conditions. Main results: We found a high correlation between short-term HRV and the SME of baroreflex sensitivity of r = 0.85 (p < 0.001). The correlation is even higher between SME and the root mean square ratio of HRV and BPV (r = 0.93, p < 0.001). Surrogate analyses revealed that SME is not able to quantify causal relationships between both signals, it cannot differentiate between random and baroreflex driven sequences, and rather determines the HRV-BPV variability ratio. Significance: We conclude that SME has a potentially large methodological bias in the characterization of the capacity of the arterial baroreflex during resting conditions., Peer Reviewed

The purpose of this study was to determine whether there is a difference in hemodynamic responses to head-up tilt (HUT) in subjects who do, and do not, experience acute mountain sickness (AMS) during exposure to hypobaric hypoxia. Secondarily, we aimed to determine if those hemodynamic variables altered during HUT correlated with AMS severity. Fifteen participants completed three testing sessions: 1) VO2max test to determine workload at 50% VO2max for hypoxia exposure; 2) HUT test consisting of supine rest for 20 min followed by 70° upright tilting for ≤ 40 min; and 3) six hours of hypobaric hypoxic exposure simulating 4572 m where participants performed two, 30 min cycling bouts and rested when not exercising. During HUT, continuous blood pressure monitoring was used to assess systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), variability in SBP, DBP, and MAP, and heart rate. AMS scores were determined before and after six hours of hypoxic exposure. Statistical analysis included mixed effects ANOVA to determine changes between supine rest and end of HUT and between selected AMS positive (AMS+) and AMS negative (AMS-) groups. Correlations by linear regression determined associations between HUT hemodynamic responses and AMS scores. Statistical significance was set to p < 0.05. Those with higher AMS scores tended to have a greater magnitude of change in SBP, DBP, and MAP variability during the HUT test (r = 0.65, 0.64, & 0.60, respectively). Increased blood pressure variability (BPV) indicated a disruption in blood pressure regulation, suggesting that AMS+ individuals may have a disruption in their blood pressure regulation. This increases their susceptibility which could be observed during a postural change prior to hypoxic exposure. In conclusion, BPV during HUT may be a promising predictive variable for AMS but further research is needed. In the future, researchers should consider using sea-l

Blood pressure-lowering drugs have different blood pressure-lowering profiles. We studied if differences in blood pressure mean and variability can explain the differences in risks of cardiovascular events and death among 15 245 high-risk hypertensive patients randomized to valsartan or amlodipine and followed for 4.2 years in the VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation). We selected patients with ≥3 visits and performed Cox regression analyses, defining mean blood pressure as a time-dependent covariate and visit-to-visit and within-visit blood pressure variability as the SD. Of 14 996 eligible patients, participants in the valsartan group had higher systolic mean blood pressure by 2.2 mm Hg, higher visit-to-visit systolic variability by 1.4 mm Hg, and higher within-visit systolic variability by 0.2 mm Hg (P values <0.0001). The higher risks of myocardial infarction and stroke in the valsartan group was attenuated after adjustment for mean and variability of systolic blood pressure, from HR 1.19 (95% CI, 1.02-1.39) to 1.11 (0.96-1.30) and from HR 1.13 (0.96-1.33) to 1.00 (0.85-1.18), respectively. The lower risk of congestive heart failure in the valsartan group was accentuated after adjustment, from HR 0.86 (0.74-1.00) to 0.76 (0.65-0.89). A smaller effect was seen on risk of death, from 1.01 (0.92-1.12) to 0.94 (0.85-1.04). In conclusion, the higher risks of myocardial infarction and stroke in patients randomized to valsartan versus amlodipine were related to the drugs' different blood pressure modulating profiles. The risk of congestive heart failure with valsartan was lower, independent of the less favorable blood pressure modulating profile.

Blood pressure (BP) is one of the most dynamic physiologic variables that is routinely measured in clinical practice and is characterized by continuous and significant changes beat-to-beat, over 24 h, day-to-day, and visit-to-visit. Under physiological conditions, these BP variations largely represent a response to environmental stimulations and challenges of daily life aimed at maintaining so-called cardiovascular “homeostasis”. However, sustained increases in blood pressure variability (BPV) may also reflect alterations in cardiovascular regulatory mechanisms or underlying pathological conditions and may represent a source of damage to the cardiovascular system. The clinical significance and prognostic implications of these BP variations have been demonstrated by a series of clinical and population studies conducted in recent years, in which increasing BPV has been associated with a higher risk of subclinical organ damage, cardiovascular events, and cardiovascular and all-cause mortality, independent of elevated average BP values. This paper will review the available evidence on the current definitions, classification, and mechanisms responsible for different types of BPV by focusing on their relevance to cardiovascular homeostasis and cardiovascular disease.

Background Twenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importance of systolic and diastolic BPV. The aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 h with cardiovascular mortality in untreated subjects is affected by age. Design and methods The study included 9154 untreated individuals assessed for hypertension between 1982 and 2002 in the frame of the Dublin Outcome Study, in which 24 h ambulatory blood pressure monitoring was obtained (age 54.1 +/- 14.3 years, 47% males). The association of short-term systolic and diastolic blood pressure variability with cardiovascular and all-cause mortality in the entire sample and separately in younger and older age subgroups was assessed over a median follow-up period of 6.3 years. Results Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for daytime standard deviation 1.16 (95% confidence interval 1.08-1.26)) with no significant differences among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for daytime standard deviation 1.72 (95% confidence interval 1.33-2.23)), superseding the predictive value of diastolic BPV in this group. Conclusions Diastolic short-term BPV independently predicts CARDiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application

Svi živi organizmi na zemlji stalno su izloženi magnetnom polju za koje je pokazano da, zavisno od intenziteta i dužine ekspozicije, može značajno da menja brojne fiziološke funkcije. U ovom radu ispitivali smo antihipertenzivni potencijal stalnog magnetnog polja srednjeg intenziteta i pratli moguće štetno dejstvo na hematopoezne organe. Eksperimenti su izvedeni na odraslim mužijacima spontano hipertenzivnih pacova randomizovanim u 3 eksperimentalne grupe: GRUPA I (n=17) izložena 30 dana kontinuirano dejstvu severnog pola stalnog magnetnog polja; GRUPA II (n=17) 30 dana kontinuirano izložena južnom polu stalnog magnetnog polja i treća, KONTROLNA GRUPA (n=17) koja nije bila izložena stalnom magnetnom polju. Nakon ekspozicije, pacovima je ugrađen kateter u femoralnu arteriju za registraciju arterisjkog krvnog pritiska i srčane frekvencije. Kratkoročni varijabilitet arterisjkog krvnog pritiska i srčane frekvencije evaluiran je spektralnom analizom (brzom Furijeovom transformacijom), a senzitivnost baroreceptorskog refleksa metodom sekvenci. Genska ekspresija receptora angiotenzina II u jedru solitarnog trakta određena je RT-qPCR metodom. Stepen hipertenzivne kardiomiopatije i glomeruloskleroze procenjivan je post mortem patohistološkim pregledom. Krvna slika, celularnost slezine i koštane srži određivana je u specijalnoj komori za brojanje ćelija. Kontinuirano izlaganje spontano hipertenzivnih pacova južnom polu stalnog magnetnog polja povećalo je gensku ekspresiju AT1b receptora a smanjilo ekspresiju AT2 receptora u jedru solitarnog trakta. Ekspozicija spontano hipertenzivnih pacova stalnom magnetnom polju obe orijentacije dovela je do smanjenja arterisjkog krvnog pritiska i njegovog kratkoročnog varijabiliteta kao i do povećanja senzitivnost baroreceptorskog refleksa, ali bez efekta na razvoj hipertenzivne kardiomiopatije i glomeruloskleroze. Istovremeno primećeno je smanjenje broja trombocita u krvi, granulocita u slezini i koštanoj srži i porast broja eritrocita u

Arterial hypertension is a recognized modifiable risk factor for brain damage. To date, the hypertension has been proven to be one of the main causes of cognitive impairment. The article shows the relationship of blood pressure variability with cognitive impairment according to the data of pathophysiological and clinical studies. The increased blood pressure variability according to the results of daily monitoring of blood pressure contributes to the emergence and development of cognitive impairment and dementia. The role of blood pressure variability is emphasized as a target of antihypertensive therapy., Артериальная гипертензия относится к признанным модифицируемым факторам риска поражения головного мозга. На сегодняшний день доказано, что артериальная гипертензия является одной из основных причин развития когнитивных нарушений. В статье показана взаимосвязь вариабельности артериального давления с когнитивными нарушениями согласно данным патофизиологических и клинических исследований. Увеличение показателей вариабельности артериального давления по результатам суточного мониторирования артериального давления способствует возникновению и развитию нарушений когнитивных функций и деменции. Подчеркивается роль вариабельности артериального давления как мишени антигипертензивной терапии., Артеріальна гіпертензія належить до визнаних модифікованих факторів ризику ураження головного мозку. На сьогодні доведено, що артеріальна гіпертензія є однією з основних причин розвитку когнітивних порушень. У статті показано взаємозв’язок варіабельності артеріального тиску з когнітивними порушеннями згідно з даними патофізіологічних і клінічних досліджень. Збільшення показників варіабельності артеріального тиску за результатами добового моніторування артеріального тиску сприяє виникненню і розвитку порушень когнітивної функції та деменції. Підкреслюється роль варіабельності артеріального тиску як мішені антигіпертензивної терапії.

Using comprehensive analysis of heart rate (HRV) and blood pressure (BPV) short-term variability we estimated the time course of changes of autonomic nervous system remodeling in two stages of doxorubicin-induced cardiomyopathy (DCM). We also investigated the level of gene expression of cardiac beta-1 (beta-1AR) and beta-2 (beta-2AR) adrenoceptors. Experiments were performed in adult male Wistar rats equipped with indwelling catheters for BP recording and blood withdrawal. A 15 mg/kg total cumulative dose of doxorubicin was injected i.p. to rats to induce DCM or saline for control (n = 18). Rats were assessed for general toxicity, cardiovascular hemodynamic and echocardiography before treatment (n = 6), 35 days (DOX35; n = 6) and 70 days (DOX70; n = 6) post-treatment. HRV was evaluated by spectral analysis, Poincare plots, sample and approximate entropy. Expression of beta-1AR and beta-2AR mRNA was evaluated by RT-qPCR. Doxorubicin-treated rats exhibited poor general condition and lower survival than saline-treated rats. In DOX35 rats, there were no echocardiography signs of decompensation, no increase in serum cardiac troponins, but there was an increase of HRV and decrease of HR complexity. In these rats typical microscopic signs of cardiotoxicity were seen along with over-expression of beta-1AR mRNA. 70 days post-treatment echocardiography revealed signs of decompensation and serum cardiac troponin T was increased. At this stage BPV decreased. In conclusion, HRV increase matches transient over expression of cardiac beta-1AR mRNA in compensate stage of DCM while decompensate stage of DCM is characterized by a decrease of BPV and no changes in beta-1AR and beta-2AR gene expression.

Background. Long-term pre-dialysis blood pressure variability (BPV) in haemodialysis patients is associated with increased cardiovascular risk. The association of the main haemodynamic culprit in dialysis, that is, short-term BPV, with outcomes has not been investigated. We examine the prognostic role of short-term BPV for mortality and cardiovascular events in this population. Methods. A total of 227 haemodialysis patients underwent 44-h ambulatory monitoring during a standard interval and were followed-up for 30.17 ± 17.70 months. We calculated SD, weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP with validated formulas. The primary endpoint was first occurrence of all-cause death, non-fatal myocardial infarction or non-fatal stroke. Secondary endpoints were: (i) all-cause mortality, (ii) cardiovascular mortality and (iii) a combination of cardiovascular events. Results. Cumulative freedom from the primary endpoint was similar for quartiles of pre-dialysis and 44-h systolic BP (SBP), but was progressively longer for increasing quartiles of 44-h SBP-SD (P = 0.014), wSD (P = 0.007), CV (P = 0.031) and ARV (83.9, 71.9, 70.2 and 43.9% for quartiles 1-4; P < 0.001). Higher quartiles of 44-h SBP-ARV were associated with higher risk of all studied outcomes. Among diastolic BPV indices, 44-h diastolic BP (DBP)-CV and 44-h DBP-ARV were associated with increased risk for the composite cardiovascular outcome. In Cox regression analysis, SBP-BPV was related to the primary endpoint, independently of SBP levels and interdialytic weight gain [ARV: hazard ratio (HR) 1.115, 95% confidence interval (95% CI) 1.048-1.185]. This association become insignificant after adjustment for pulse wave velocity (PWV; HR 1.061, 95% CI 0.989-1.137), and further attenuated after additional adjustment for age, dialysis vintage, gender, comorbidities and prevalent cardiovascular disease (HR 1.031, 95% CI 0.946-1.122). Conclusions. Increased BPV during the

Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Studies on the effects of antihypertensive drugs on BPV in hemodialysis are scarce. This study examines the effects of nebivolol and irbesartan on short-term BPV in patients with intradialytic hypertension. This randomized-cross-over study included 38 patients (age: 60.4 ± 11.1 years, male: 65.8%) with intradialytic hypertension (intradialytic-SBP increase ≥ 10 mmHg at ≥4 over 6 consecutive sessions). After the baseline evaluation, participants were randomized to nebivolol 5 mg and subsequently irbesartan 150 mg, or vice versa, with a two-week wash-out period before initiation of the second drug. Patients underwent three respective 24 h-ABPM sessions starting before a midweek-session. We calculated the standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP with validated formulas. The post-hemodialysis and 24 h-SBP and DBP levels were significantly lower after treatment with both drugs. The systolic-BPV indices were marginally lower after nebivolol but not after irbesartan compared to baseline (SD: baseline 15.70 ± 4.69; nebivolol 14.45 ± 3.37, p = 0.090; irbesartan 15.39 ± 3.85, p = 0.706; wSD: 14.62 ± 4.36 vs 13.40 ± 3.07, p = 0.053 vs 14.36 ± 3.47, p = 0.805, respectively). The diastolic-BPV indices decreased with nebivolol and increased with irbesartan, resulting in significant differences between the two drugs (SD: baseline 10.56 ± 2.50; nebivolol 9.75 ± 2.12; irbesartan 10.84 ± 1.98, between-drug p = 0.014; wSD: baseline 9.86 ± 2.12; nebivolol 9.34 ± 2.01; irbesartan 10.25 ± 2.01, between-drug p = 0.029). The diastolic-BPV during intradialytic and day-time periods was marginally lower with nebivolol than with irbesartan. During nighttime, the BPV indices were unchanged with either drug. The short-term BPV was reduced after nebivolol but not after irbesartan treatment in patients with intradial

Cardiovascular diseases are one of the most common causes of death; however, the early detection of patients at high risk of sudden cardiac death (SCD) remains an issue. The aim of this study was to analyze the cardio-vascular couplings based on heart rate variability (HRV) and blood pressure variability (BPV) analyses in order to introduce new indices for noninvasive risk stratification in idiopathic dilated cardiomyopathy patients (IDC). High-resolution electrocardiogram (ECG) and continuous noninvasive blood pressure (BP) signals were recorded in 91 IDC patients and 49 healthy subjects (CON). The patients were stratified by their SCD risk as high risk (IDCHR) when after two years the subject either died or suffered life-threatening complications, and as low risk (IDCLR) when the subject remained stable during this period. Values were extracted from ECG and BP signals, the beat-to-beat interval, and systolic and diastolic blood pressure, and analyzed using the segmented Poincaré plot analysis (SPPA), the high-resolution joint symbolic dynamics (HRJSD) and the normalized short time partial directed coherence methods. Support vector machine (SVM) models were built to classify these patients according to SCD risk. IDCHR patients presented lowered HRV and increased BPV compared to both IDCLR patients and the control subjects, suggesting a decrease in their vagal activity and a compensation of sympathetic activity. Both, the cardio -systolic and -diastolic coupling strength was stronger in high-risk patients when comparing with low-risk patients. The cardio-systolic coupling analysis revealed that the systolic influence on heart rate gets weaker as the risk increases. The SVM IDCLR vs. IDCHR model achieved 98.9% accuracy with an area under the curve (AUC) of 0.96. The IDC and the CON groups obtained 93.6% and 0.94 accuracy and AUC, respectively. To simulate a circumstance in which the original status of the subject is unknown, a cascade model was built fusing the afore, Postprint (published version)

[Purpose]To investigate acute blood pressure change during aortic angiography in aortic dissection endovascular repair, and analyse the potential risk of this incident.[Method]24 patients with aortic dissection underwent endovascular repair in department of vascular surgery of Changhai hospital between May 2016 and July 2016 were enrolled in this research. Patients were divided into two groups: patients underwent general anesthesia and patients underwent lumbar anesthesia. Blood pressure was monitored by intro-artery catheter. Blood pressure readings were recorded every 10 seconds during the procedure of angiography. Outcome of these patients were observed in hospital. [Result] All patients received endovascular aortic repair, with 19 underwent lumbar anesthesia and 5 underwent general anesthesia. Patients underwent lumbar anesthesia presented temporary blood pressure decrease with average of -11.2±13.4mmHg, while patients underwent general anesthesia presented temporary blood pressure elevation with average of 4.2±6.3mmHg. The Maximum time interval were 26.7±12.7s vs25.8±15.8s, and difference in blood pressure between pre- and post-angiography were 1.53±4.4mmHg vs. 4.6±3.4mmHg, both without significance (P>0.05).[Conclusion] Angiography is an effective factor influencing blood pressure during TEVAR, it’s a potential “trigger” of intra-operative cardiovascular events. Blood pressure should be kept on proper level to avoid cardiovascular events induced by blood pressure variability with angiography. Angiography with General anesthesia has less influence on blood pressure than with lumbar anesthesia.

Blood pressure (BP) is variable in children and this could affect BP assessment, but the magnitude of within-visit BP variability (BPV) over consecutive measurements has never been investigated. This study aimed to determine the direction and magnitude of, and factors affecting, within-visit BPV in children and adolescents. BP was recorded among 3047 children (aged 12 years [95%CI 12, 13], males 52%) from the 2011-2013 Australian Health Survey. BPV was defined as the absolute difference (SBPABS) between the first (SBP1) and second systolic BP (SBP2) and the overall variability in three measures when available (SBPV). On average, SBPABS was 6.7 mmHg (95%CI 6.3, 7.0) and SBPV was 8.2% (95%CI 7.8, 8.6). SBPABS was greater with higher BP levels but lower with older age. From first to second measurements, SBP decreased in 58% (95%CI 56, 60), did not change in 10% (95%CI 9, 12), and increased in 32% (95%CI 29, 34) of the population. Conclusion(s): BP is highly variable in children and adolescents, with the magnitude of variability being associated with both age and BP level. SBP increases on repeat measurement in a substantial proportion of the population. The optimal protocol of BP assessment to address this increased BPV needs to be determined.What is Known:* Diagnosis of elevated blood pressure (BP) is based on strict probabilistic criteria, the difference between the 90th (pre-hypertension) and 95th (hypertension) percentiles only being 3-4 mmHg.* BP variability could affect BP classification among children and adolescents.What is New:* The magnitude of BP change among children and adolescents is highly affected by BP level and age.* BP does not always drop on consecutive measurements, and evidence-based BP assessment protocols should be established to avoid misdiagnosis of hypertension.Copyright © 2017, Springer-Verlag GmbH Germany, part of Springer Nature.

Objectives: Based on anecdotal belief that blood pressure (BP) drops over consecutive measurements, guidelines recommend discarding the first BP reading (Canadian Hypertension Education Program guidelines) or take only one reading if SBP less than 140 mmHg (National Institute for Health and Care Excellence). However, the extent to which SBP fluctuations affect BP classification as well as the potential effect of age are unknown. We sought to assess the change in SBP classification over consecutive measurements following different guidelines, among younger (<50 years) and older individuals (>50 years). Furthermore, we aimed to investigate the direction of the change in SBP over consecutive measurements (increase or decrease) and the impact of age on SBP differences. Method(s): BP was measured among 20 716 adults from a general population. SBP was classified using the first reading (normal SBP or hypertension) and compared with the average SBP using different guideline protocols (reclassification). Result(s): Reclassification from normal SBP to hypertension was greatest with Canadian Hypertension Education Program guidelines (3% younger, 12% older individuals) and reclassification from hypertension to normal SBP was greatest with National Institute for Health and Care Excellence guidelines (70% younger, 44% older individuals). SBP increased between the first two measures in 37%, decreased in 56% and did not change in 7% of the population. Age had a strong interaction with SBP level (P< 0.0001) so that younger individuals exhibited greater SBP differences over repeated measures. Conclusion(s): This study highlights the need for an improvement in the evidence-base regarding the best way to assess office BP for correct hypertension diagnosis.Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Background: A body of empirical work demonstrates that wide fluctuations in a person's blood pressure across consecutive measures, known as blood pressure variability (BPV), hold prognostic value to predict stroke and transient ischemic attack. However, the magnitude of association between BPV and other neurological outcomes remains less clear. This systematic review aims to pool together data regarding BPV with respect to incident dementia, cognitive impairment, and cognitive function. Methods: Electronic databases (MEDLINE, EMBASE, and SCOPUS) will be searched for the key words blood pressure variability and outcomes of dementia, cognitive impairment, and cognitive function. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows: population - adult humans (over 18 years but with no upper age limit) without dementia at baseline, with or without elevated blood pressure, or from hypertensive populations (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or use of antihypertensive drug for hypertension) and from primary care, community cohort, electronic database registry, or randomized controlled trial (RCT); exposure - any metric of BPV (systolic, diastolic or both) over any duration; comparison - persons without dementia who do not have elevated BPV; and outcome - dementia, cognitive impairment, cognitive function at follow-up from standardized neurological assessment, or cognitive testing. Article screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, odds ratios, correlations, regression coefficients, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the neurological outc