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Background: Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes.Methods: We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression.Results: Among 153 patients (mean age 49 ± 20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBPSV) and standard deviation in systolic blood pressure (SBPSD), was not significantly associated with hospital disposition. SBPSV and SBPSD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS.Conclusion: Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes.

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.

BackgroundBlood pressure variability is increasingly linked with cerebrovascular disease and Alzheimer's disease, independent of mean blood pressure levels. Elevated blood pressure variability is also associated with attenuated cerebrovascular reactivity, which may have implications for functional hyperemia underpinning brain network connectivity. It remains unclear whether blood pressure variability is related to functional network connectivity. We examined relationships between beat-to-beat blood pressure variability and functional connectivity in brain networks vulnerable to aging and Alzheimer's disease.Methods53 community-dwelling older adults (mean [SD] age = 69.9 [7.5] years, 62.3% female) without history of dementia or clinical stroke underwent continuous blood pressure monitoring and resting state fMRI scan. Blood pressure variability was calculated as variability independent of mean. Functional connectivity was determined by resting state fMRI for several brain networks: default, salience, dorsal attention, fronto-parietal, and language. Multiple linear regression examined relationships between short-term blood pressure variability and functional network connectivity.ResultsElevated short-term blood pressure variability was associated with lower functional connectivity in the default network (systolic: standardized ß = -0.30 [95% CI -0.59, -0.01], p = .04). There were no significant associations between blood pressure variability and connectivity in other functional networks or between mean blood pressure and functional connectivity in any network.DiscussionOlder adults with elevated short-term blood pressure variability exhibit lower resting state functional connectivity in the default network. Findings support the role of blood pressure variability in neurovascular dysfunction and Alzheimer's disease. Blood pressure variability may represent an understudied early vascular risk factor for neurovascular dysfunction relevant to Alzheimer's disease, with potential therapeutic implications.

Background: Blood pressure (BP) variability (BPV) and time in target range (TTR) are emerging vascular risk factors for dementia, independent of traditionally targeted mean BP. Objective: Determine whether BPV or TTR is most strongly associated with cognitive risk. Methods: In this post hoc analysis of the SPRINT trial, 8034 participants underwent repeated BP measurement and cognitive testing at baseline and follow-up. Visit-to-visit BPV was calculated as average real variability. TTR was the percent of time in desired treatment arm target range (standard: 120–140 mmHg systolic BP; intensive: 110–130 mmHg systolic BP). Adjudicated clinical outcomes were no cognitive impairment, mild cognitive impairment (MCI), and probable dementia. We investigated a direct comparison of BPV and TTR in predicting cognitive risk, stratified by BP treatment group. Results: Elevated BPV was associated with increased risk for MCI (adjusted HR: 1.21 [95% CI 1.10, 1.33], p < 0.001) and MCI/dementia (HR: 1.17 [95% CI 1.07, 1.27], p < 0.001) in the standard group, and dementia (HR: 1.17 [95% CI 1.01, 1.36], p = 0.039) in the intensive group. Higher TTR was related to lower dementia risk (HR: 0.72 [95% CI 0.60, 0.86], p < 0.001) in the intensive group only. Conclusions: Visit-to-visit BPV outperformed TTR in predicting risk for MCI and MCI/dementia. TTR was more strongly associated with dementia risk under intensive treatment. Findings were independent of mean BP in a cohort with rigorously controlled BP and suggest newer aspects of BP control may be harnessed to further reduce cognitive risk. Clinical trial information: ClinicalTrials.gov; NCT01206062. [ABSTRACT FROM AUTHOR]

Background: The overall effect of long-term variability in physiological measures on cardiovascular health of older adults and the underlying mechanic pathway remain uncertain. Methods: We constructed a composite score (0 ~ 3) of variability in physiological measures, including blood pressure, pulse rate, and body mass index, in older adults from the China Health and Retirement Longitudinal Study (CHARLS) 2011 ~ 2015, the Health and Retirement Study (HRS) 2006/2008 ~ 2014/2016, and the UK Biobank 2006 ~ 2019. The associations of the composite score with incident risks of heart disease and stroke were assessed. The mediation roles of several biomarkers were explored. Results: A higher composite score was related to increased incident risk of heart disease in older adults from the US and the UK and increased incident risk of stroke in all three cohorts. Upon pooling the results, each 1-point increment in the composite score was associated with a 19% (hazard ratio: 1.19; 95% confidence interval: 1.14, 1.30) and a 23% (1.23; 1.12, 1.35) increments in incident risks of heart disease and stroke, respectively. The composite score also exhibited an inverse relationship with grip strength while displaying positive associations with C-reactive protein, glycosylated hemoglobin Alc (HbAlc), and cystatin C. Reduced grip strength, elevated HbAlc, and elevated cystatin C significantly mediated the composite score-associated elevated risks of heart disease and stroke. Conclusions: Long-term variability in physiological measures was associated with increased incident risks of heart disease and stroke, and the associations were partially mediated through deteriorated biomarkers of muscle strength, hyperglycemia, and kidney function. [ABSTRACT FROM AUTHOR]

ABSTRACT In hemodialysis patients, blood pressure variability (BPV) is associated with cardiovascular events and all‐cause mortality. However, previous research has predominantly concentrated on the predialysis BPV. In contrast, intradialytic BPV, reflecting the cardiovascular regulatory function during the process of rapid clearance of volume overload, holds greater relevance to the prognosis of patients. In this study, a latent category trajectory model was used to identify the patterns of intradialytic BPV and analyze the association between intradialytic BPV and the cardio‐cerebrovascular events and other clinical outcomes. We found the variation of intradialytic systolic blood pressure (SBP) was associated with the risk of cardio‐cerebrovascular events in hemodialysis patients. Patients in “SBP Class 4” and “SBP Class 3” subgroups were associated with the occurrence of cardio‐cerebrovascular events and the number of cardio‐cerebrovascular event hospitalizations during the follow‐up period. This indicates that the variation pattern of intradialytic SBP results from the comprehensive action of various BP regulatory mechanisms in the body, which can reflect the level of cardiovascular regulatory function in hemodialysis patients and serve as a predictor of recent adverse cardio‐cerebrovascular events. [ABSTRACT FROM AUTHOR]

To determine the relationship of hemodialysis access with vital sign variability and hemodialysis-related headache (HRH). Adult outpatients receiving maintenance hemodialysis (MHD) were prospectively recruited, and 12 consecutive dialysis sessions were monitored. Intradialysis (hour-to-hour) and interdialysis (dialysis day-to-day) vital sign variabilities were assessed via three metrics: the difference between the maximum and minimum values, average real variability (ARV), and residuals. Multivariate logistic regression analysis was used to explore the factors triggering HRH. A total of 91 Chinese MHD patients (60.4% male) aged 58.5 ± 17.2 years were included, with 59 patients using radiocephalic arteriovenous fistulas (RCAVFs) and 32 patients using tunneled cuffed catheters (TCCs) for dialysis. The median dialysis vintage was 26.8 (12.0–44.7) months. Compared with the RCAVF group, the TCC group had significantly greater urea reduction (71.1 ± 9.3% vs. 61.7 ± 10.5%, p < 0.001) and clearance (1.5 (1.2–1.8) vs. 1.1 (1.0–1.4), p < 0.001) rates, higher intradialysis pulse variability and lower intradialysis diastolic blood pressure variability. Some of interdialysis variability indexes in pulse, systolic blood pressure (SBP), and SpO2 were significantly greater in the TCC group than that in the RCAVF group. Age (OR = 0.880, 95% CI = 0.785–0.986, p = 0.028), TCC use (OR = 22.257, 95% CI = 1.190–416.399, p = 0.038), intradialysis SBP-ARV (OR = 2.768, 95% CI = 1.069–7.171, p = 0.036), and blood sodium level (OR = 0.400, 95% CI = 0.192–0.832, p = 0.014) were shown to be independent risk factors for HRH. In conclusion, the use of TCCs has multifaceted effects on intradialysis and interdialysis vital sign variabilities and is independently associated with an increased risk of HRH. [ABSTRACT FROM AUTHOR]

Background/Objectives: The complications of hypertension depend not only on the mean blood pressure (BP) but also on its variability (BPV). Recent studies suggest that the choroid may serve as an indicator of systemic vascular damage. These studies have been made possible by the increased availability of optical coherence tomography (OCT). The aim of our study was to analyze the relationship between short-term BP variability (STBPV) and choroid–retinal thickness in hypertensive patients. Methods: A total of 98 patients with a mean age of 49 ± 12 years were enrolled in the study. All participants underwent 24 h blood pressure (BP) monitoring to measure 24 h mean systolic (SBP) and diastolic blood pressure (DBP), along with their respective standard deviations (SD), the weighted SD of 24 h SBP and DBP, and the average real variability (ARV) of 24 h SBP and DBP. The choroid–retinal region was assessed using Swept-Source OCT, with choroidal thickness (ChT) and retinal thickness divided into three concentric rings, and their mean choroidal thickness (ChT-or) was calculated. Results: The choroidal thickness of the concentric rings was found to be inversely correlated with all ARV values of the monitored blood pressure means. In particular, a correlation was observed between the ARV of daytime DBP and ChT-or. This correlation remained statistically significant (β = −0.34; p = 0.02) even after adjustment for various confounding factors. The ARV of daytime DBP was the only STBPV index to maintain a significant association, in the multivariate analysis, with the central ring mean thickness (β = −0.314; p = 0.001) and the inner choroidal ring mean thickness (β = −0.262; p = 0.003). Conclusions: Our study demonstrated an independent negative association between short-term BP variability (STBPV), when expressed as ARV of daytime DBP, and choroidal thickness. This finding confirms the value of choroidal thickness as a marker of cardiovascular risk. [ABSTRACT FROM AUTHOR]

Background: High variations in serially measured blood pressures (BPs) portend a variety of adverse clinical events including dementia, cardiovascular sequelae and frailty. In this study, systolic blood pressure variability (BPV) was examined for its association with fall frequency and time to next fall among older adults living in nursing homes. Methods: BP values and falls over time were extracted from medical records of nursing home residents aged ≥65 years over a 10‐month period. BPV was measured as the standard deviation of 17 to 20 systolic values, and its correlation with falls and time to next fall were evaluated according to quartile values. Results: One hundred patient charts were analyzed with nearly 2000 BP data points. All older adults had at least one fall incident. Higher BPV was related to more falls, shorter time between the first and second fall and fewer average days between falls. Subgroups of high BP and different diagnoses affected this association between BPV and falls. Conclusions: People who fall often show a high variability in BP; as the number of falls increases, the BPV also increases. This study suggests that BPV may be marker for patients who might benefit from more aggressive application of fall reduction strategies. Geriatr Gerontol Int 2024; 24: 1315–1319. [ABSTRACT FROM AUTHOR]

Background & Objective: There is insufficient research on the use of population data to construct a predictive model of blood pressure variability (BPV) after thrombolysis to estimate the subsequent development of acute ischemic stroke (AIS) patients. The aim of this study is to construct and validate a model that uses BPV 24 hours after thrombolytic therapy to predict outcome in patients with AIS. Methods: To construct and validate a model that uses BPV 24 hours after thrombolytic therapy to predict outcome in patients with AIS. Results: A total of 503 patients with acute ischemic stroke who received intravenous thrombolytic therapy were enrolled in the study. The multivariate analysis outcomes have delineated several pivotal factors that are significantly prognostic of adverse outcomes in AIS patients post-thrombolysis: The initial National Institutes of Health Stroke Scale score, a recorded history of hypertension, the variability in systolic and diastolic blood pressure as indicated by their standard deviation, and the blood pressure measurements recorded 24 hours subsequent to thrombolytic therapy. These determinants have emerged as substantial predictors, shedding light on the complex interplay of clinical parameters that influence patient prognosis following AIS treatment. Within the development and validation cohorts, the area under the curve for the nomogram, which estimates the probability of an unfavorable prognosis, was determined to be 0.876 (95%CI: 0.84-0.913) and 0.849 (95%CI: 0.784-0.913), respectively. The calibration curve revealed a striking congruence between the predicted probabilities by the nomogram and the actual outcomes observed in the validation set. Furthermore, the decision curve analysis underscored the significant clinical utility and robust applicability of the prognostic model, illustrating its potential to guide clinical decision-making effectively. Conclusion: Because of its superior predictive accuracy, discriminative power, and clinical utility, the nomogram is an important adjunct tool for the assessment of possible adverse outcomes in patients with AIS following thrombolytic therapy. [ABSTRACT FROM AUTHOR]

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Higher blood pressure (BP) variability (BPV) was shown to be strong predictors of poor cardiovascular outcomes in heart failure (HF). It is currently unknown if low-level tragus stimulation (LLTS) would lead to improvement in BPV in acute HF (AHF). The 22 patients with AHF (median 80 yrs, males 60%) were randomly assigned to active or sham group using an ear clip attached to the tragus (active group) or the earlobe (sham group) for 1 h daily over 5 days. In the active group, standard deviation (SD), coefficient of variation (CV) and δ in SBP were significantly decreased after LLTS (all p < 0.05). All the changes in SD, CV and δ in SBP before and after stimulation were also significantly different between active and sham groups (all p < 0.05). This proof-of-concept study demonstrates the beneficial effects of LLTS on BPV in AHF. [ABSTRACT FROM AUTHOR]

Background: Short-term blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, but its impact on left atrium (LA) function and structure remains unclear. This study aims to explore the relationship between short-term BPV and LA function in patients with controlled and uncontrolled hypertension, using speckle-tracking echocardiography (STE). Methods: In this cross-sectional study, 150 hypertensive patients were recruited and categorized into controlled and uncontrolled hypertension groups based on ambulatory blood pressure (BP) monitoring. BPV was calculated from 24-h ambulatory BP recordings, and LA function was assessed using STE to measure LA volume, strain, and strain rate parameters. Univariate and multivariate analyses were performed to investigate associations between BPV and LA functions. Results: Higher short-term BPV was significantly associated with impaired LA function, including reduced LA strain and increased LA volume index, in both hypertensive groups. After adjusting for confounding factors such as age, body mass index, and duration of hypertension, BPV remained an independent predictor of LA dysfunction (P < 0.01). The relationship was more pronounced in the uncontrolled hypertension group. Conclusion: Short-term BPV is independently associated with left atrial dysfunction in hypertensive patients, particularly in those with uncontrolled hypertension. These findings suggest that BPV could serve as a potential marker for early left atrial remodeling in hypertensive populations, providing insights for better risk stratification and management.

Abstract Background Delirium is one of the most common neurological complications after cardiac surgery. The purpose of our study was to assess the relationship between perioperative blood pressure variability (BPV) and postoperative delirium (POD) in the patients undergoing cardiac surgery. Methods Adult patients received cardiac surgery and stayed in Cardiovascular Intensive Care Unit (ICU) for more than 24 h after surgery during the study period between June 2019 and December 2022 were included in this study. Baseline characteristics, perioperative hemodynamic variables and postoperative laboratory results of the cardiac patients were collected and analyzed. Perioperative BPV was quantified by calculating the standard deviation (SD) and average real variability (ARV) of blood pressure. Assessment of delirium was based on the mental status of the patients and CAM-positive. The relationship between perioperative BPV and POD was analyzed by LASSO and logistic regression using R (R package, 4.3.2). Results The incidence of POD was 15.0% (324/2164) in the patients receiving cardiac surgery, and the average day for POD occurred at day 3 after surgery. Patients with POD had statistically lower levels of intraoperative mean blood pressure (P = 0.015) and blood pressure ARV (P

Abstract Although hypertension is highly prevalent among the elderly and significantly contributes to cardiovascular disease risk, studies focusing on male elderly individuals over 85 years old are relatively scarce. This study aimed to investigate ambulatory blood pressure monitoring (ABPM) characteristics in male hypertensive patients aged over 85 years. These included demographic characteristics, antihypertensive drug use, 24‐h ABPM values, diabetes, coronary heart disease, sleep disorders, smoking history, and drinking history, and the differences in ABPM between the age groups over and under 85 years old were analyzed. A total of 585 elderly hypertensive patients were included. The mean systolic blood pressure in individuals aged over 85 years was significantly greater throughout the day (131.57 ± 12.52 mmHg vs. 123.75 ± 2.74 mmHg, p

Haifan Xu,1,2,&ast; Xiaoshuang Wang,1,3,&ast; Miao Feng,1 Liqun Chen1 1Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Nephrology, The People’s Hospital of Kaizhou District, Chongqing, People’s Republic of China; 3Department of Nephrology, Yubei District People’s Hospital, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Liqun Chen, Email cqll1970@163.comObjective: To investigate the correlation between background factors and blood pressure variability (BPV), and the prognostic value of intra-dialytic BPV metrics for cardiovascular death and all-cause mortality in hemodialysis (HD) patients.Methods: A retrospective study of 264 hD patients was followed up for 36 months. The intra-dialytic BP during the 3-month period for each patient was used to calculate BPV metrics, including standard deviation (SD), coefficient of variation (CV), average real variability (ARV), blood pressure change (ΔBP), and percent change in blood pressure (ΔBP/pre-BP). The primary outcomes were CVD death and all-cause mortality.Results: Age, body mass index (BMI), predialysis blood pressure, inter-dialytic weight gain rate (IDWG%), α- blockers, and cholesterol levels were positively correlated with intra-dialytic BPV. Hemoglobin and albumin are negatively associated with intra-dialytic BPV. In Cox regression analysis, SBP-ARV, ΔSBP, and ΔSBP/pre-SBP were independent risk factors for CVD death (HR: 1.087, 95% CI: 1.001– 1.181, p = 0.047; HR: 1.072, 95% CI: 1.016– 1.131, p = 0.011; HR: 1.107, 95% CI: 1.011– 1.211, p = 0.028). SBP-ARV showed the largest AUC of 0.593 (p = 0.022) in predicting all-cause death. SBP-ARV, ΔSBP, and ΔSBP/pre-SBP showed relatively large area (AUC = 0.631, 0.639, and 0.620; p = 0.007, 0.004, and 0.013 respectively) in predicting CVD death.Conclusion: Age, BMI, IDWG%, predialysis blood pressure, albumin, hemoglobin, α- blockers, and total cholesterol were significantly correlated with intra-dialytic BPV. SBP-ARV, ΔSBP, and ΔSBP/pre-SBP were independent risk factors for CVD mortality, and there were no differences in prognostic value among various BPV metrics.Keywords: hemodialysis, blood pressure variability, influencing factors, all-cause mortality, cardiovascular death

Objective: Blood pressure variability (BPV) and its potential association with early hematoma expansion (HE) in intracerebral hemorrhage (ICH) remains to be fully elucidated. Our study explores the potential link between BPV within the first 24 h after admission and HE in ICH. Methods: In a prospective cohort single-center study, we analyzed consecutive patients with spontaneous ICH. Continuous BP data via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) were analyzed over 0–2, 0–8, 0–12, and 0–24 h intervals post-admission. BPV was assessed through successive variability (SV), standard deviation (SD), and coefficient of variation (CV) using all available BP measurements. Early HE was defined as an absolute [≥ 6 ml] or relative [≥ 33 %] increase in ICH volume on 24-hours follow-up brain imaging. Secondary endpoints were the influence of BP on admission and other potential risk factors for HE. Results: Among 305 ICH-patients (mean age ± SD 70.1 ± 14.9 years, 47.9 % female, median NIHSS 6 (3, 13), median ICH score 1 (1, 2)), 41 (13.4 %) experienced HE. HE-patients had higher NIHSS (p = 0.015), ICH-score (p = 0.005), ICH volume (p 30 cm3) experienced lower absolute BP and BPV indices and worse clinical outcomes. These findings suggest a nuanced relationship between BP dynamics and ICH severity, underscoring the need for individualized BP management in acute ICH care. Further research is necessary to explore these relationships and optimize treatment strategies.

Abstract Background To investigate if intraoperative very short-term variability in blood pressure measured by sample entropy improves discrimination of postoperative acute kidney injury after noncardiac surgery. Methods Adult surgical patients undergoing general, thoracic, urological, or gynecological surgery between August 2016 to June 2017 at Seoul National University Hospital were included. The primary outcome was acute kidney injury stage 1, defined by the Kidney Disease: Improving Global Outcomes guidelines. Exploratory and explanatory variables included sample entropy of the mean arterial pressure and standard demographic, surgical, anesthesia and hypotension over time indices known to be associated with acute kidney injury respectively. Random forest classification and L1 logistic regression were used to assess four models for discriminating acute kidney injury: (1) Standard risk factors which included demographic, anesthetic, and surgical variables (2) Standard risk factors and cumulative hypotension over time (3) Standard risk factors and sample entropy (4) Standard risk factors, cumulative hypotension over time and sample entropy. Results Two hundred and thirteen (7.4%) cases developed postoperative acute kidney injury. The median and interquartile range for sample entropy of mean arterial pressure was 0.34 and [0.26, 0.42] respectively. C-statistics were identical between the random forest and L1 logistic regression models. Results demonstrated no improvement in discrimination of postoperative acute kidney injury with the addition of the sample entropy of mean arterial pressure: Standard risk factors: 0.81 [0.76, 0.85], Standard risk factors and hypotension over time indices: 0.80 [0.75, 0.85], Standard risk factors and sample entropy of mean arterial pressure: 0.81 [0.76, 0.85] and Standard risk factors, sample entropy of mean arterial pressure and hypotension over time indices: 0.81 [0.76, 0.86]. Conclusion Assessment of very short-term blood pressure variability does not improve the discrimination of postoperative acute kidney injury in patients undergoing non-cardiac surgery in this sample.

Background: Delirium is one of the most common neurological complications after cardiac surgery. The purpose of our study was to assess the relationship between perioperative blood pressure variability (BPV) and postoperative delirium (POD) in the patients undergoing cardiac surgery. Methods: Adult patients received cardiac surgery and stayed in Cardiovascular Intensive Care Unit (ICU) for more than 24 h after surgery during the study period between June 2019 and December 2022 were included in this study. Baseline characteristics, perioperative hemodynamic variables and postoperative laboratory results of the cardiac patients were collected and analyzed. Perioperative BPV was quantified by calculating the standard deviation (SD) and average real variability (ARV) of blood pressure. Assessment of delirium was based on the mental status of the patients and CAM-positive. The relationship between perioperative BPV and POD was analyzed by LASSO and logistic regression using R (R package, 4.3.2). Results: The incidence of POD was 15.0% (324/2164) in the patients receiving cardiac surgery, and the average day for POD occurred at day 3 after surgery. Patients with POD had statistically lower levels of intraoperative mean blood pressure (P = 0.015) and blood pressure ARV (P < 0.001) as well as mean blood pressure at 24 h postoperatively (P = 0.003) when compared to those without. Whereas, ARV for systolic blood pressure (8.64 vs. 7.91 mmHg, P < 0.001), diastolic blood pressure (4.00 vs. 3.77 mmHg, P = 0.014) and mean blood pressure (5.23 vs. 4.94 mmHg, P = 0.001) at 24 h postoperatively was significantly higher in the patients with POD than those without. LASSO regression and further logistic regression revealed that intraoperative blood pressure ARV (OR:0.92, P < 0.001), mean central venous pressure (OR:1.05, P = 0.048) and ARV of systolic blood pressure (OR:1.17, P = 0.002) at 24 h postoperatively were independent risk factors for POD. Conclusions: Perioperative ARV, especially postoperative high ARV exposure, was associated with POD in the patients receiving cardiac surgery. Maintaining a relatively stable blood pressure after cardiac surgery might be beneficial to avoid POD in those patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Erectile dysfunction (ED) and cardiovascular diseases (CVD) share common pathophysiological mechanisms. This study aimed to assess the relationship between ED and its severity with the risk of developing CVD by analyzing changes in the circadian blood pressure (BP) rhythm. In the study, 24‐h BP levels of 192 (94 with ED and 98 controls) participants with no history of CVD were evaluated using an ambulatory blood pressure monitoring (ABPM) device. The International Index of Erectile Function (IIEF) questionnaire was used to assess the ED severity in the study group. ABPM measurements revealed higher BP values among the ED group. The nondipper pattern was significantly more frequent in the ED group compared to the controls (56.2% vs. 77.1%, p < 0.01). Blood pressure variability parameters, including systolic standard deviation (SD) and average real variability (ARV), were notably higher in the ED group (16.3 ± 3.9 vs. 14.6 ± 4.3, p < 0.01 and 13.39 ± 7.24 vs. 11.5 ± 2.1, p < 0.01, respectively). Furthermore, parameters reflecting arterial stiffness including pulse pressure index (PPI) and ambulatory arterial stiffness index (AASI) were higher in the ED group (0.81 ± 0.33 vs. 0.73 ± 0.18, p = 0.03 and 0.71 ± 0.09 vs. 0.59 ± 0.17, p = 0.014, respectively). Both AASI and ARV were significantly correlated with the severity of ED. This study suggests a significant association between ED severity and altered blood pressure patterns which in part explains the increased risk of CVD among individuals with ED. [ABSTRACT FROM AUTHOR]

ABSTRACT Long‐term visit‐to‐visit blood pressure (BP) variability is linked to various diseases, but its impact on cerebral small vessel disease (cSVD) burden, and its features remains uncertain. We analyzed 1284 participants from the Kailuan cohort (2006–2022). Visit‐to‐visit systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) variability were categorized into tertiles (low, middle, high). Magnetic resonance imaging identified white matter hyperintensities (WMH), lacunae of presumed vascular origin (LA), cerebral microbleeds (CMBs), and visible perivascular spaces (PVS). Total cSVD burden was classified as none (0), mild (1), moderate (2), or severe (3–4) based on the presence of these features. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). High SBP variability was associated with moderate cSVD burden (OR = 1.89, 95% CI: 1.09–3.29) and PVS (OR = 1.62, 95% CI: 1.10–2.39). High DBP variability was associated with LA (OR = 1.74, 95% CI: 1.06–2.84). High PP variability showed a significant risk for severe cSVD burden (OR = 2.49, 95% CI: 1.34–4.63). These associations were modified by age and hypertension status. Among young adults (age < 60 years), high PP variability was associated with severe cSVD burden (OR = 3.33, 95% CI: 1.31–8.44), LA (OR = 3.02, 95% CI: 1.31–6.93), and PVS (OR = 1.86, 95% CI: 1.20–2.88). The risk effects of SBP and PP variability on cSVD burden were significant only in participants with hypertension. High long‐term visit‐to‐visit BP variability (BPV), particularly in combination with hypertension, is a significant risk factor for total cSVD. Special attention should be given to PP variability in younger adults. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of this study was to evaluate the efficacy of olmesartan/amlodipine (OLM/AML) single‐pill combination (SPC) therapy using ambulatory blood pressure monitoring (ABPM) in non‐responders to valsartan or candesartan monotherapy. Isolated systolic hypertension (ISH) is the most prevalent form of hypertension in middle‐aged and elderly individuals. Patients aged over 55 years who did not achieve the target systolic blood pressure (SBP < 140 mmHg) with valsartan 80 mg or candesartan 8 mg for at least 4 weeks were included. Doses were escalated from 20/5 mg to 40/5 mg and finally to 40/10 mg of OLM/AML SPC until patients reached the target SBP. Efficacy was assessed via ABPM by comparing baseline values with those in the 12th week. Office blood pressure (OBP) and brachial‐ankle pulse wave velocity (baPWV) were assessed at baseline, weeks 4, 8, and 12. Fifty‐four patients (average age 64 ± 6 years; 33 males) participated. The 24‐h mean BPs decreased significantly from an average of 146.2 ± 12.7/93.3 ± 9.2 mmHg to 129.7 ± 14.3/83.4 ± 10.7 mmHg (p < 0.001), and pulse pressures (PPs) from ABPM were reduced (p < 0.001). Additionally, significant reductions in night‐time SBP standard deviations (SDs) (14.7 ± 4.7 vs. 12.5 ± 3.9, p = 0.029) were observed at 12 weeks compared to baseline. OBPs significantly dropped from 151.1 ± 9.7/89.3 ± 8.3 mmHg to 125.5 ± 13.8/77.8 ± 8.8 mmHg after 12 weeks of SPC therapy (p < 0.001). Reductions in PPs of OBP and baPWVs were also observed. OLM/AML SPC therapy effectively reduced the 24‐h mean BP, as measured by ABPM, in hypertensive patients over 55 years old who failed to achieve a target SBP (< 140 mmHg) with angiotensin receptor blocker (ARB) monotherapy using valsartan 80 mg or candesartan 8 mg.Trial Registration: ClinicalTrials.gov identifier: NCT01713920 [ABSTRACT FROM AUTHOR]

• Investigated the impact of forced awakening on morning BP surge (MBPS). • Measured MBPS and sleep under free-living conditions. • MBPS increased by 74 % during forced awakening compared with natural awakening. • Forced awakening related to greater MBPS, regardless of sleep quality. Poor sleep quality can cause an increase in morning blood pressure surge (MBPS), an independent risk factor of cardiovascular disease (CVD) events. Awakening induced by external factors such as alarm clocks, may also contribute to increased MBPS. To (1) compare the MBPS and sleep quality parameters between natural and forced awakenings and (2) examine the potential impact of forced awakening on MBPS, independent of sleep quality. Thirty-two healthy adults participated in this pilot study, which included one night of natural awakening and one night of forced awakening (i.e., sleep was interrupted by an alarm after five hours). Objective and self-reported sleep quality parameters were measured using a multisensory wristband and sleep diaries, respectively, and beat-to-beat blood pressure variability was assessed using a continuous blood pressure monitor. Analyses included a paired t -test (objective 1) and linear mixed models (objective 2). Participants predominantly consisted of young, healthy, and highly educated Asian adults. During the night of sleep with forced awakening, significantly higher MBPS, lower objective wakefulness after sleep onset, and lower self-reported sleep latency were observed, compared to the night with natural awakening. Forced awakening was significantly associated with increased MBPS after controlling for age, sex, mean arterial pressure, and sleep quality. Forced awakening may significantly increase MBPS, consequently heightening the risk of CVD events. Study findings should be validated in a larger sample. Further research is also warranted to examine the impact of forced awakening on MBPS in individuals with CVD. [ABSTRACT FROM AUTHOR]

Although hypertension is highly prevalent among the elderly and significantly contributes to cardiovascular disease risk, studies focusing on male elderly individuals over 85 years old are relatively scarce. This study aimed to investigate ambulatory blood pressure monitoring (ABPM) characteristics in male hypertensive patients aged over 85 years. These included demographic characteristics, antihypertensive drug use, 24‐h ABPM values, diabetes, coronary heart disease, sleep disorders, smoking history, and drinking history, and the differences in ABPM between the age groups over and under 85 years old were analyzed. A total of 585 elderly hypertensive patients were included. The mean systolic blood pressure in individuals aged over 85 years was significantly greater throughout the day (131.57 ± 12.52 mmHg vs. 123.75 ± 2.74 mmHg, p <.001). In the 85 years older age group, the nighttime variability coefficient of SBP was lower at 7.84 ± 2.9 than the under 85 years age group 8.92 ± 3.13 (p <.001). The 85 years older age group age group presented a significantly greater whole‐day systolic blood pressure standard deviation of ABPM (13.2 ± 3.19 vs. 12.47 ± 3.05, p =.005) compared with those under the age of 85 years. In the 85 years older age group, the proportion of individuals with the reverse dipper pattern was higher (48.15% vs. 38.31%, p =.017) than under 85 years age group. This study revealed that elderly male hypertensive patients aged over 85 years presented elevated average blood pressure levels. The research investigated ABPM characteristics. Older hypertensive individuals are more likely to have a reverse‐dipper blood pressure pattern. [ABSTRACT FROM AUTHOR]

Background: Blood pressure variability (BPV) is a critical risk factor for cardiovascular outcomes and is associated with atherosclerotic renal artery stenosis (ARAS), which is diagnosed using digital subtraction angiography (DSA). However, the relationship between the degree of renal artery stenosis (d-RAS), diagnosed using renal artery contrast-enhanced ultrasound (CEUS), and 24-hour ambulatory BPV in hospitalized patients with ARAS remains unclear. Methods: Hospitalized hypertensive patients were divided into ARAS and non-ARAS groups based RAS diagnoses using CEUS. The ARAS patients were further classified into unilateral and bilateral categories. Quantification of BPV over 24 hours, daytime, and nighttime utilized standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Percentage stenosis was used to evaluate d-RAS. Pearson's and multivariate beta regression analyses were used to assess correlations between BPV and d-RAS. Results: We found that 24-hour systolic BPV (SBPV), presented as SD, CV, and ARV indices, was positively correlated with unilateral d-RAS (R¹ = 0.460, p = 0.001; R¹ = 0.509, p < 0.001; R¹ = 0.677, p < 0.001, respectively). This correlation was consistent with the daytime SBPV (R¹ = 0.512, p < 0.001; R¹ = 0.539, p < 0.001; R¹ = 0.678, p < 0.001, respectively) and daytime diastolic BPV (DBPV) (R¹ = 0.379, p = 0.010; R¹ = 0.397, p = 0.007; R¹ = 0.319, p = 0.033, respectively). Similarly, 24-hour DBPV assessed by SD and CV also correlated positively with unilateral d-RAS (R¹ = 0.347, p = 0.019; R¹ = 0.340, p = 0.022, respectively), as did nighttime SBPV assessed by ARV indices (R¹ = 0.415, p = 0.005). No significant correlations were found between BPV and bilateral d-RAS (p > 0.05). Multivariate beta regression analysis indicated that 24-hour SBPV (odds ratio [OR] = 1.035, 95% confidence interval [CI]: 1.054-1.607, p = 0.035) and daytime SBPV (OR = 1.033, 95% CI: 1.004-1.061, p = 0.023; both evaluated via AVR) were independent risk factors for d-RAS. Conclusions: SBPV is positively correlated with unilateral d-RAS at all time points. Both 24-hour and daytime SBPV (evaluated using ARV indices) were identified as independent d-RAS risk factors. [ABSTRACT FROM AUTHOR]

Background: To investigate if intraoperative very short-term variability in blood pressure measured by sample entropy improves discrimination of postoperative acute kidney injury after noncardiac surgery. Methods: Adult surgical patients undergoing general, thoracic, urological, or gynecological surgery between August 2016 to June 2017 at Seoul National University Hospital were included. The primary outcome was acute kidney injury stage 1, defined by the Kidney Disease: Improving Global Outcomes guidelines. Exploratory and explanatory variables included sample entropy of the mean arterial pressure and standard demographic, surgical, anesthesia and hypotension over time indices known to be associated with acute kidney injury respectively. Random forest classification and L1 logistic regression were used to assess four models for discriminating acute kidney injury: (1) Standard risk factors which included demographic, anesthetic, and surgical variables (2) Standard risk factors and cumulative hypotension over time (3) Standard risk factors and sample entropy (4) Standard risk factors, cumulative hypotension over time and sample entropy. Results: Two hundred and thirteen (7.4%) cases developed postoperative acute kidney injury. The median and interquartile range for sample entropy of mean arterial pressure was 0.34 and [0.26, 0.42] respectively. C-statistics were identical between the random forest and L1 logistic regression models. Results demonstrated no improvement in discrimination of postoperative acute kidney injury with the addition of the sample entropy of mean arterial pressure: Standard risk factors: 0.81 [0.76, 0.85], Standard risk factors and hypotension over time indices: 0.80 [0.75, 0.85], Standard risk factors and sample entropy of mean arterial pressure: 0.81 [0.76, 0.85] and Standard risk factors, sample entropy of mean arterial pressure and hypotension over time indices: 0.81 [0.76, 0.86]. Conclusion: Assessment of very short-term blood pressure variability does not improve the discrimination of postoperative acute kidney injury in patients undergoing non-cardiac surgery in this sample. [ABSTRACT FROM AUTHOR]

Background: We aimed to explore the association between visit‐to‐visit systolic blood pressure variability (BPV) and cognitive function in individuals with type 2 diabetes. Methods: We performed a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD‐MIND) substudy. A total of 2867 diabetes patients with ≥3 BP measurements between the 4‐ and 20‐month visits were included. Visit‐to‐visit systolic BPV was calculated. Cognitive decline was defined as a Mini‐Mental State Exam (MMSE), Digit Symbol Substitution Test (DSST), or Rey Auditory Verbal Learning Test (RAVLT) score greater than 1 standard deviation (SD) below the baseline mean, or a Stroop test score more than 1 SD above the baseline mean. The associations of systolic BPV with risks of cognitive decline were examined using Cox proportional hazards models, and with changes in brain magnetic resonance imaging parameters were evaluated using mixed models. Results: The risk of cognitive decline defined by the DSST score (but not by other scores) increased significantly with systolic BPV quartiles (p for trend = 0.008), and there was a 55% increased risk for BPV quartile 4 versus quartile 1 (hazard ratio = 1.55, 95% confidence interval 1.10–2.19). Furthermore, a positive correlation was observed between systolic BPV and change in white matter lesion volume (β = 0.07, 95% CI 0.01–0.13). Conclusions: A greater visit‐to‐visit systolic BPV was significantly associated with an increased risk of cognitive decline measured by DSST and an increase in white matter lesion volume in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims/Background Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. Methods This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. Results The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis (p < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. Conclusion A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures. [ABSTRACT FROM AUTHOR]

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is recognized as a reference tool for accurately diagnosing hypertension. Until a few years ago, this technique was restricted to use by specialists. Recently, however, due to the need for wider availability and thanks to technological innovation, simplification of analysis processes, and increasing recognition of the importance of this tool for the diagnosis of hypertension, ABPM is now also being used in non-specialist settings. In such settings, ABPM is used with a two-pronged approach: (i) independently by a general practitioner with the possibility of specialist supervision for particular and complex cases; (ii) in the non-medical setting (community pharmacies, home care services, etc.) where the healthcare provider is trained in the proper use of the technique, with the understanding a physician must be responsible for the final clinical reporting. Unfortunately, due to the increasingly wide diffusion of ABPM, there has been considerable confusion about management roles and responsibilities in recent years. To clarify competencies and roles and standardize the processes related to the technique's implementation and proper management, experts of the Blood Pressure Monitoring Working Group of the Italian Society of Hypertension have drafted this document with the aim of providing a quick and easy reference guide for training healthcare professionals in the field. [ABSTRACT FROM AUTHOR]

BACKGROUND More habitual time spent engaging in prolonged sedentary behaviors increases the risk of developing hypertension. Beat-by-beat systolic (SBPV) and diastolic blood pressure variability (DBPV) are more pronounced in persons with hypertension and may be an early manifestation of blood pressure dysregulation. We tested the hypothesis that a single bout of prolonged sitting augments very short-term SBPV and DBPV. The secondary aim was to explore sex differences in prolonged sitting-induced increases in SBPV and DBPV. METHODS Thirty-three adults (22.9 ± 1.9 years; 17 females) completed a single, 3-hour bout of prolonged sitting with beat-by-beat arterial pressure determined at baseline, 1.5-hour, and 3-hour via finger photoplethysmography. RESULTS There were no sex differences observed for baseline brachial SBP (males: 122 ± 10 mm Hg; females: 111 ± 9 mm Hg), SBPV (males: 1.87 ± 0.63 mm Hg; females: 1.51 ± 0.38 mm Hg), DBP (males: 68 ± 6 mm Hg; females: 66 ± 8 mm Hg), or DBPV (males: 1.40 ± 0.41 mm Hg; females: 1.27 ± 0.32 mm Hg) (all, P  > 0.41). In the pooled sample, baseline SBPV (1.68 ± 0.54 mm Hg) remained unchanged after 1.5 hours (1.80 ± 0.60 mm Hg; P  = 0.59) but increased after 3.0 hours (1.84 ± 0.52 mm Hg; P  = 0.01). This post-sitting increase was driven by males (P  = 0.009), with no difference observed in females (P  = 1.00). Similarly, baseline DBPV (1.33 ± 0.36 mm Hg) was similar after 1.5 hours (1.42 ± 0.41 mm Hg; P  = 0.72) but was increased at 3 hours (1.50 ± 0.34 mm Hg; P  = 0.02). However, no sex differences in DBPV (all, P  > 0.07) were observed across the time points. CONCLUSIONS In young, normotensive adults, a single bout of prolonged sitting augmented beat-by-beat blood pressure variability, which may provide a link between uninterrupted sitting and the development of blood pressure dysregulation. [ABSTRACT FROM AUTHOR]

ABSTRACT Early neurological deterioration (END) following endovascular treatment (EVT) in acute ischemic stroke (AIS) patients is associated with poor long‐term outcomes. Although unstable systolic blood pressure (SBP) after EVT is recognized as a risk factor for END, it remains unclear whether this association persists after excluding identifiable causes of END. In this prospective, observational cohort study, AIS patients who underwent EVT within 24 h of stroke onset were included. Invasive arterial blood pressure (BP) monitoring recorded hourly BP readings during the first 24 h post‐EVT. Unexplained END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale score 24 h after EVT without any identifiable cause. Two distinct SBP trajectories—high and low—were identified within 24 h post‐EVT. The high‐trajectory group, characterized by elevated mean SBP and increased SBP variability (SBPV), exhibited a significantly higher incidence of unexplained END (odds ratio [OR] = 3.28, p

Purpose Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population.Materials and methods This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of ‘high blood pressure’, an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint.Result During follow-up, ‘high blood pressure’ developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of ‘high blood pressure’. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of ‘high blood pressure’.Conclusion Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.

Purpose: There is evidence that blood pressure variability (BPV) is associated with cerebral small vessel disease (SVD) and may therefore increase the risk of stroke and dementia. It remains unclear if BPV is associated with SVD progression over years. We examined whether visit-to-visit BPV is associated with white matter hyperintensity (WMH) progression over 14 years and MRI markers after 14 years.Materials and methods: We included participants with SVD from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) who underwent baseline assessment in 2006 and follow-up in 2011, 2015 and 2020. BPV was calculated as coefficient of variation (CV) of BP at all visits. Association between WMH progression rates over 14 years and BPV was examined using linear-mixed effects (LME) model. Regression models were used to examine association between BPV and MRI markers at final visit in participants.Results: A total of 199 participants (60.5 SD 6.6 years) who underwent four MRI scans and BP measurements were included, with mean follow-up of 13.7 (SD 0.5) years. Systolic BPV was associated with higher progression of WMH (β = 0.013, 95% CI 0.005 − 0.022) and higher risk of incident lacunes (OR: 1.10, 95% CI 1.01–1.21). There was no association between systolic BPV and grey and white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD) or microbleed count after 13.7 years.Conclusions: Visit-to-visit systolic BPV is associated with increased progression of WMH volumes and higher risk of incident lacunes over 14 years in participants with SVD. Future studies are needed to examine causality of this association.

Objective This study investigates the relationship between hypertension, dysregulation of the autonomic nervous system, heart rate variability (HRV), and chronic inflammation.Methods We analysed a cohort of 50 hypertensive patients treated at the affiliated Hospital of Jianghan University. The average systolic and diastolic blood pressures (BPs) in this group were 155.26 and 95.32 mmHg, respectively. A control group of 50 healthy volunteers, undergoing routine physical examinations at the same hospital, was also analysed.Results The average systolic BP of the control group was 115.64 ± 10.27 mmHg, and the average diastolic BP was 75.33 ± 8.25 mmHg. In contrast, the experimental group exhibited an average systolic BP of 155.26 ± 20.13 mmHg and an average diastolic BP of 95.32 ± 12.16 mmHg. Both systolic and diastolic BPs were significantly higher in the hypertensive group (p

Abstract Extreme cold exposure has been widely considered as a cardiac stress and may result in cardiac function decompensation. This study was to examine the risk factors that contribute to changes in cardiovascular indicators of cardiac function following extreme cold exposure and to provide valuable insights into the preservation of cardiac function and the cardiac adaptation that occur in real‐world cold environment. Seventy subjects were exposed to cold outside (Mohe, mean temperature −17 to −34°C) for one day, and were monitored by a 24‐h ambulatory blood pressure device and underwent echocardiography examination before and after extreme cold exposure. After exposure to extreme cold, 41 subjects exhibited an increase in ejection fraction (EF), while 29 subjects experienced a decrease. Subjects with elevated EF had lower baseline coefficients of variation (CV) in blood pressure compared to those in the EF decrease group. Additionally, the average real variability (ARV) of blood pressure was also significantly lower in the EF increase group. Multivariate regression analysis indicated that both baseline CV and ARV of blood pressure were independent risk factors for EF decrease, and both indicators proved effective for prognostic evaluation. Correlation analysis revealed a correlation between baseline blood pressure CV and ARV, as well as EF variation after exposure to extreme cold environment. Our research clearly indicated that baseline cardiovascular indicators were closely associated with the changes in EF after extreme cold exposure. Furthermore, baseline blood pressure variability could effectively predict alterations in left cardiac functions when individuals were exposed to extreme cold environment.

Abstract Background Preliminary evidence demonstrates that visit-to-visit systolic blood pressure (SBP) variability is a prognostic factor of TBI. However, literature regarding the impact of initial blood pressure management on the outcomes of TBI patients is limited. We aimed to further validate the clinical significance of BPV on the prognostic outcomes of patients with TBI. Methods We performed the analysis by using individual patient-level data acquired from the eICU-CRD, which collected 200,859 ICU admissions of 139,367 patients in 2014 and 2015 from 208 US hospitals. Adult patients with traumatic intraparenchymal hemorrhage or contusion were included. The primary outcome was in-hospital mortality and the secondary outcome was discharge-home rate. Blood pressure variability (BPV) was calculated according to standard criteria: at least six measurements were taken in the first 24 h (hyperacute group) and 36 over days 2–7 (acute group). We estimated the associations between BPV and outcomes with logistic and proportional odds regression models. The key parameter for BPV was standard deviation (SD) of SBP, categorized into quintiles. We also calculated the average real variability (ARV), as well as maximum, minimum, and mean SBP for comparison in our analysis. Results We studied 1486 patients in the hyperacute group and 857 in the acute group. SD of SBP had a significant association with the in-hospital mortality for both the hyperacute group (highest quintile adjusted OR 2.28 95% CI 1.18–4.42; ptrend

Abstract 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.

Abstract This research examines the association between blood pressure variability (BPV) and renal damage in a cohort of 129 primary aldosteronism (PA) patients, employing ambulatory blood pressure monitoring (ABPM) for comparative analysis with individuals diagnosed with essential hypertension (EH). The study reveals that PA patients exhibited significantly elevated levels of cystatin C and urine microalbumin/creatinine ratio (UACR). Additionally, a higher prevalence of non‐dipping blood pressure patterns in PA patients suggests an increased risk of circadian blood pressure regulation disturbances. Notably, while most BPV indices were comparable between the two groups, the standard deviation of 24‐h weighted diastolic blood pressure was markedly lower in the PA cohort, distinguishing it as a unique variable. Through multiple linear regression analysis, the duration of hypertension, angiotensin II concentrations, and daytime systolic blood pressure standard deviation emerged as significant determinants of estimated glomerular filtration rate (eGFR) in PA patients. Furthermore, UACR was significantly influenced by variables including the 24‐h weighted standard deviation (wSD) of systolic BP, glycosylated hemoglobin levels, nocturnal systolic BP peaks, aldosterone‐renin ratio (ARR), and total cholesterol, with the most pronounced association observed with the 24‐h wSD of systolic BP (β = 0.383).The study also found significant correlations between the 24‐h wSD of systolic BP, ARR, HbA1c, serum potassium levels, and 24‐h urinary microalbumin, underscoring the critical role of the 24‐h wSD of systolic BP (β = 0.267). These findings underscore the imperative of an integrated management strategy for PA, addressing the intricate interconnections among metabolic abnormalities, blood pressure variability, and renal health outcomes.

Abstract Background Risk factors for cardiovascular disease, including elevated blood pressure, are known to increase risk of Alzheimer’s disease. There has been increasing awareness of the relationship between long-term blood pressure (BP) patterns and their effects on the brain. We aimed to investigate the association of repeated BP measurements with Alzheimer’s and vascular disease markers. Methods We recruited 1,952 participants without dementia between August 2015 and February 2022. During serial clinic visits, we assessed both systolic BP (SBP) and diastolic BP (DBP), and visit-to-visit BP variability (BPV) was quantified from repeated measurements. In order to investigate the relationship of mean SBP (or DBP) with Alzheimer’s and vascular markers and cognition, we performed multiple linear and logistic regression analyses after controlling for potential confounders (Model 1). Next, we investigated the relationship of with variation of SBP (or DBP) with the aforementioned variables by adding it into Model 1 (Model 2). In addition, mediation analyses were conducted to determine mediation effects of Alzheimer’s and vascular makers on the relationship between BP parameters and cognitive impairment. Results High Aβ uptake was associated with greater mean SBP (β = 1.049, 95% confidence interval 1.016–1.083). High vascular burden was positively associated with mean SBP (odds ratio = 1.293, 95% CI 1.015–1.647) and mean DBP (1.390, 1.098–1.757). High tau uptake was related to greater systolic BPV (0.094, 0.001–0.187) and diastolic BPV (0.096, 0.007–0.184). High Aβ uptake partially mediated the relationship between mean SBP and the Mini-Mental State Examination (MMSE) scores. Hippocampal atrophy mediated the relationship between diastolic BPV and MMSE scores. Conclusions Each BP parameter affects Alzheimer’s and vascular disease markers differently, which in turn leads to cognitive impairment. Therefore, it is necessary to appropriately control specific BP parameters to prevent the development of dementia. Furthermore, a better understanding of pathways from specific BP parameters to cognitive impairments might enable us to select the managements targeting the specific BP parameters to prevent dementia effectively.

Objective: To observe the effects of cardiac rehabilitation guided by cardiopulmonary exercise testing (CPET) on cardiorespiratory reserve function, blood pressure, blood pressure variability, and lipid metabolism in patients with hypertension. Methods: A randomized trial enrolled 67 Grade 1 hypertensive patients on antihypertensive drugs, divided into conventional (n = 35) and CPET (n = 32) groups. Antihypertensive drugs were not adjusted in both groups during the study period. Blood pressure, cardiorespiratory indicators, lipid profile, and BMI were assessed pre/post 12 weeks. Results: Postintervention, the CPET group exhibited significantly lower blood pressure levels and improved cardiac indicators compared to the conventional group (p < 0.05). CPET group showed greater improvements in cardiorespiratory endurance indicators (p < 0.05). The cardiorespiratory endurance indicators showed significantly greater increases in the CPET group compared to the conventional group (p < 0.05). Low‐density lipoprotein cholesterol (LDL‐C), total cholesterol (TC), triglycerides (TG), and body mass index (BMI) were significantly lower in the CPET group (p < 0.05). Conclusion: In addition to drug treatment, cardiac rehabilitation guided by CPET can effectively improve blood pressure control, reduce blood pressure variability, improve cardiorespiratory function and lipid metabolism, and increase exercise endurance in patients with Grade 1 hypertension. Its efficacy is clear and safe, with clinical value for promotion. [ABSTRACT FROM AUTHOR]