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2017/№12

24‑Hour Arterial Pressure Variability: Prognostic Significance, Methods of Evaluation, Effect of Antihypertensive Therapy

Ostroumova O. D.1, 2, Borisova E. V.3, Ostroumova T. M.2, Kochetkov A. I.1
1 A. I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
2 I. M. Sechenov First Moscow State Medical University, Moscow, Russia
3 City Clinical Hospital named after E. O. Mukhina, Moscow, Russia

Keywords: arterial hypertension; ambulatory blood pressure monitoring; ambulatory blood pressure variability; target-organ damage; antihypertensive treatment; perindopril/amlodipine fixed-dose combination

DOI: 10.18087/cardio.2017.12.10068

We discuss in this article problems of prognostic significance of 24‑hour arterial pressure variability (24hAPV), as well as the role of 24hAPV in development and progression of various target organs damage by arterial hypertension. We also present literature data on impact of various regimens of antihypertensive therapy on 24hAPV, and on ability of fixed-dose perindopril/amlodipine to lower 24‑hAPV.
  1. Gorbunov V. M. Modern views on the variability of blood pressure. Rational Pharmacother Card 2012;8 (6):810–818. Russian (Горбунов ВМ. Современные представления о вариабельности артериального давления. Рациональная фармакотерапия в кардиологии 2012;8 (6): 810–818).
  2. Ostroumova O. D. The variability of blood pressure and the risk of complications in arterial hypertension. Terapevticheskii arkhiv 2012;10:91–97. Russian (Остроумова О. Д. Вариабельность артериального давления и риск развития осложнений при артериальной гипертонии. Терапевтический архив 2012;10:91–97).
  3. O’Brien E., Parati G., Stergiou G. Ambulatory Blood Pressure Measurement: What Is the International Consensus? Hypertension 2013;62:988–994.
  4. Parati G., Stergiou G., O’Brien E. et al., on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014;32:1359–1366.
  5. Arabidze G. G., editor. Daily monitoring of blood pressure in hypertension (methodological issues). Moscow: RKNPK; 1996. Russian (Арабидзе Г. Г., редактор. Суточное мониторирование артериального давления при гипертонии (методические вопросы). М.: РКНПК; 1996).
  6. Bilo G., Giglio A., Styczkiewicz K. et al. A new method for assessing 24‑h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J Hypertens 2007;25:2058–2066.
  7. Mena L., Pintos S., Queipo N. V. A reliable index for the prognostic significance of blood pressure variability. J Hypertens 2003;23:505–511.
  8. Verdecchia P., Angeli F., Gattobigio R. et al. Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension. Am J Hypertens 2007;20:154–161.
  9. Mancia G., Bombelli M., Facchetti R. et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007;49:1265–1270.
  10. Rogoza A. N., Nikol’skij V. P., Oshchepkova E. V. et al. Edited by the head of the department of arterial hypertension Arabidze G. G. and the head of the Department of New Methods of Diagnostics and Research At’kova O. Yu. Ambulatory blood pressure monitoring in arterial hypertension. (Methodological issues). Moscow, 2005). Russian (Рогоза А. Н., Никольский В. П., Ощепкова Е. В. и др. Под ред. руководителя отдела артериальных гипертоний Арабидзе Г. Г. и руководителя отдела новых методов диагностики и исследований Атькова О. Ю. Суточное мониторирование артериального давления при гипертонии. (Методические вопросы). М., 2005).
  11. Stolarz-Skrzypek K., Thijs L., Richart T. et al. Blood Pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Hypertension Res 2010;33:757–766.
  12. Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281–1357. DOI: 10.1093/eurheartj/eht151
  13. Gorbunov V. M., Oganov R. G., Deev A. D. Comparative information value of different ways of analyzing the results of ambulatory blood pressure monitoring to assess the effectiveness of antihypertensive therapy. Kardiovaskulyarnaya Terapiya i Profilaktika 2003;1:17–25. Russian (Горбунов В. М., Оганов Р. Г., Деев А. Д. Сравнительная информативность различных способов анализа результатов суточного мониторирования артериального давления в оценке эффективности антигипертензивной терапии. Кардиоваскулярная терапия и профилактика 2003;1:17–25).
  14. Rothwell P. M., Howard S. C., Dolan E. et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure and episodic hypertension. Lancet 2010;375:895–905.
  15. Rothwell P. M., Howard S. C., Dolan E. et al. Effects of betablockers and calcium channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol 2010;9:469–480.
  16. Eguchi К., Hoshide S., Schwartz J. E. et al. Visit-to-visit and Ambulatory Blood Pressure Variability as Predictors of Incident Cardiovascular Events in Patients with Hypertension. Am J Hypertens 2012;25 (9):962-8. doi: 10.1038/ajh.2012.75
  17. Pringle E., Phillips C., Thijs L. et al., Syst-Eur investigators. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens 2003;21:2251–2257.
  18. Verdecchia P., Angeli.F, Gattobigio R. et al. Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am J Hypertens 2007;20:154–161.
  19. Mena L. J., Maestre G. E., Hansen T. W. et al. on behalf of the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators How Many Measurements Are Needed to Estimate Blood Pressure Variability Without Loss of Prognostic Information? Am J Hypertens 2014;27 (1):46–55.
  20. Stevens S. L., Wood S., Koshiaris C. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 2016;354:9;354: i4098. doi: 10.1136/bmj.i4098.
  21. Sehestedt T., Jeppesen J., Hansen T. W. et al. Risk prediction is improved by adding markers of subclinical organ damage to SCORE. Eur Heart J 2010;31:883–891.
  22. Sehestedt T., Jeppesen J., Hansen T. W. et al. Thresholds for pulse wave velocity, urine albumin creatinine ratio and left ventricular mass index using SCORE, Framingham and ESH/ESC risk charts. J Hypertens 2012;30:1928–1936.
  23. Volpe M., Battistoni A., Tocci G. et al. Cardiovascular risk assessment beyond systemic coronary risk estimation: a role for organ damage markers. J Hypertens 2012;30:1056–1064.
  24. Zhang Q. Q., Zhang X. J., Chang B. B. et al. [Blood pressure variability correlates with target-organ damage in elderly patients with hypertension]. [Article in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban 2011;42 (2):252–255.
  25. Tatasciore А., Renda G., Zimarino M. et al. Awake Systolic Blood Pressure Variability Correlates With Target-Organ Damage in Hypertensive Subjects. Hypertension 2007;50:325–332.
  26. Ozawa M., Tamura K., Okano Y. et al. Blood pressure variability as well as blood pressure level is important for left ventricular hypertrophy and brachial-ankle pulse wave velocity in hypertensives. Clin Exp Hypertens 2009;31 (8):669–679. doi: 10.3109/10641960903407033.
  27. Kastanayan A. A., Zheleznyak E. I., Hagush A. K. et al. Interrelation of blood pressure variability and cardiovascular remodeling with development of arterial hypertension in old age. Arterial’naya gipertenziya 2016;22 (4):389–400. Russian (Кастанаян А. А., Железняк Е. И., Хагуш А. К. и др. Взаимосвязь вариабельности артериального давления и сердечно-сосудистого ремоделирования при развитии артериальной гипертензии в пожилом возрасте. Артериальная гипертензия 2016;22 (4):389–400). doi: 10.18705/1607-419X-2016‑22‑4‑389‑400.
  28. Juhanoja E. P., Niiranen T. J., Johansson J. K. et al. Agreement between ambulatory, home, and office blood pressure variability. J Hypertens 2016;34 (1):61–67. doi: 10.1097/HJH.0000000000000772.
  29. Madden J. M., O’Flynn A. M., Fitzgerald A. P., Kearney P. M. Correlation between short-term blood pressure variability and left-ventricular mass index: a meta-analysis. Hypertens Res 2015. doi: 10.1038/hr.2015.126.
  30. Ishizu T., Seo Y., Kameda Y. et al. Left ventricular strain and transmural distribution of structural remodeling in hypertensive heart disease. Hypertension 2014;63:500–506.
  31. Borlaug B. A., Redfield M. M., Melenovsky V. et al. Longitudinal changes in left ventricular stiffness: a community-based study. Circ Heart Fail 2013;6:944–952.
  32. de Simone G., Devereux R. B., Koren M. J. et al. Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation 1996;93:259–265.
  33. Borlaug B. A., Lam C. S., Roger V. L. et al. Contractility and ventricular systolic stiffening in hypertensive heart disease. Insights into the pathogenesis of heart failure with preserved ejection fraction. J Am Coll Cardiol 2009;54:410–418.
  34. Shin S. M., Shim W. J., Park S. M. Early changes of left ventricular function in young adults with never-treated hypertension and no left ventricular hypertrophy:relationships to ambulatory blood pressure monitoring. Clin Exp Hypertens 2014;36 (7):517–523. doi: 10.3109/10641963.2013.863326.
  35. Tsai W. C., Lee W. H., Liu Y. W. P1270Effects of blood pressure variability on layer-specific longitudinal strain in hypertension. Eur Heart J Cardiovasc Imaging 2016;17 (suppl_2):ii270 – ii276. doi: 10.1093/ehjci/jew266.002.
  36. Ciobanu A. O., Gherghinescu C. L., Dulgheru R. et al. The Impact of Blood Pressure Variability on Subclinical Ventricular, Renal and Vascular Dysfunction, in Patients with Hypertension and Diabetes. MAEDICA 2013;8 (2):129–136.
  37. Eshoo S., Ross D. L., Thomas L. Impact of mild hypertension on left atrial size and function. Circ Cardiovasc Imaging 2009;2:93–99.
  38. Benjamin E. J., D’Agostino R. B., Belanger A. J. et al. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 1995;92:835–841.
  39. Cipollini F., Arcangeli E., Seghieri G. Left atrial dimension is related to blood pressure variability in newly diagnosed untreated hypertensive patients. Hypertens Res 2016;39 (8):583–587. doi: 10.1038/hr.2016.29.
  40. Tadic M., Cuspidi C., Ilic I. et al. The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population. Int J Cardiovasc Imaging 2016;32 (4):603–612. doi: 10.1007/s10554‑015‑0822‑8.
  41. Irigoyen M.‑C., De Angelis K., dos Santos F. et al. Hypertension, Blood Pressure Variability, and Target Organ Lesion. Curr Hypertens Rep 2016;18 (4):31. doi: 10.1007/s11906‑016‑0642‑9.
  42. Parati G., Ochoa J. E., Bilo G. Blood pressure variability, cardiovascular risk, and risk for renal disease progression. Curr Hypertens Rep 2012;14 (5):421–431. doi: 10.1007/s11906‑012‑0290‑7.
  43. Manios E., Tsagalis G., Tsivgoulis G. et al. Time rate of blood pressure variation is associated with impaired renal function in hypertensive patients. J Hypertens 2009;27 (11):2244–2248. doi: 10.1097/HJH.0b013e328330a94f.
  44. Zakopoulos N. A., Tsivgoulis G., Barlas G. et al. Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness. Hypertension 2005;45 (4):505–512. doi: 10.1161/01.HYP.0000158306.87582.43.
  45. Mancia G., Parati G., HennigM. et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001;19 (11):1981–1989.
  46. Chen Y., Xiong H., Wu D. et al. Relationship of short-term blood pressure variability with carotid intima-media thickness in hypertensive patients. Biomed Eng Online 2015;14:71. doi: 10.1186/s12938‑015‑0059‑8.
  47. Shintani Y., Kikuya M., Hara A. et al. Ambulatory blood pressure, blood pressure variability and the prevalence of carotid artery alteration: the Ohasama study. J Hypertens 2007;25 (8):1704–1710.
  48. Kawai T., Ohishi M., Kamide K. et al. Differences between daytime and nighttime blood pressure variability regarding systemic atherosclerotic change and renal function. Hypertens Res 2013;36 (3):232–239. doi: 10.1038/hr.2012.162. Epub 2012 Oct 18.
  49. Chen Y., Xiong H., Wu D. et al. Relationship of short‑term blood pressure variability with carotid intima‑media thickness in hypertensive patients. BioMed Eng OnLine 2015;14:71. DOI: 10.1186/s12938‑015‑0059‑8
  50. Ichihara A., Kaneshiro Y., Takemitsu T. et al. Ambulatory blood pressure variability and brachial-ankle pulse wave velocity in untreated hypertensive patients. J Hum Hypertens 2006;20:529–536. doi: 10.1038/sj.jhh.1002023
  51. Laurent S., Cockcroft J., Van Bortel L. et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588–2605.
  52. Laurent S., Boutouyrie P., Asmar R. et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236–1241.
  53. Vlachopoulos C., Aznaouridis K., Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010;55:1318–1327.
  54. Schillaci G., Bilo G., Pucci G. et al. Relationship Between Short-Term Blood Pressure Variability and Large-Artery Stiffness in Human Hypertension: Findings From 2 Large Databases. Hypertension 2012;60:369–377. doi: 10.1161/HYPERTENSIONAHA.112.197491
  55. Longstreth W. T. Jr, Manolio T. A., Arnold A. et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke 1996;27:1274–1282.
  56. de Leeuw F. E., de Groot J. C., Oudkerk M. et al. Hypertension and cerebral white matter lesions in a prospective cohort study. Brain 2002;125:765–772.
  57. Vermeer S. E., Longstreth W. T. Jr, Koudstaal P. J. Silent brain infarcts: a systematic review. Lancet Neurol 2007;6:611–619.
  58. Wong T. Y., Klein R., Sharrett A. R. et al. Cerebral white matter lesions, retinopathy and incident clinical stroke. JAMA 2002;288:67–74.
  59. Buyck J. F., Dufouil C., Mazoyer B. et al. Cerebral white matter lesions are associated with the risk of stroke but not with other vascular events: the 3‑City Dijon Study. Stroke 2009;40:2327–2331.
  60. Filomena J., Riba-Llena I., Vinyoles E. et al. Short-term blood pressure variability relates to the presence of subclinical brain small vessel disease in primary hypertension. Hypertension 2015;66 (3):634–640. doi: 10.1161/HYPERTENSIONAHA.115.05440. discussion 445.
  61. Yamaguchi Y., Wada M., Sato H. et al. Impact of Ambulatory Blood Pressure Variability on Cerebral Small Vessel Disease Progression and Cognitive Decline in Community-Based Elderly Japanese. Am J Hypertens 2014;27 (10):1257–1267. doi: 10.1093/ajh/hpu045
  62. Kanemary A., Kanemary K., Kuwajima I. The effects of Short-Term blood pressure variability and nighttime blood pressure levels on cognitive function. Hypertens Res 2001;24:19–24.
  63. Sakakura K., Ishikawa J., Okuno M. et al. Exaggerated Ambulatory Blood Pressure Variability Is Associated with Cognitive Dysfunction in the Very Elderly and Quality of Life in the Younger Elderly. AJH 2007;20:720–727.
  64. Leoncini G., Viazzi F., Storace G. et al. Blood pressure variability and multiple organ damage in primary hypertension. J Hum Hypertens 2013;27 (11):663–670. doi: 10.1038/jhh.2013.45. Epub 2013 Jun 6.
  65. Tolstov S. N., Mychka V. B., Salov I. A. Blood pressure variability and the state of target organs in menopausal women. Rossijskij kardiologicheskij zhurnal 2014;6 (110):62–70. Russian (Толстов С. Н., Мычка В. Б., Салов И. А. Вариабельность артериального давления и состояние органов-мишеней у женщин климактерического периода. Российский кардиологический журнал 2014;6(110):62–70).
  66. Höcht Ch. Blood Pressure Variability: Prognostic Value and Therapeutic Implications. Hindawi Publishing Corporation ISRN Hypertension Volume 2013, Article ID 398485, 16 pages http://dx.doi.org/10.5402/2013/398485
  67. London G., Schmieder R., Calvo C., Asmar R. Indapamide SR versus candesartan and amlodipine in hypertension: the X–CELLENT Study. Am J Hypertens 2006;19 (1):113–121.
  68. Zhang Н., Agnoletti В., Safar M. E., Blacher J. Effect of antihypertensive agents on blood pressure variability: the natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X–CELLENT) study. Hypertension 2011;58 (2):155–160.
  69. Ichihara A., Kaneshiro Y., Takemitsu T., Sakoda M. Effects of amlodipine and valsartan on vascular damage and ambulatory blood pressure in untreated hypertensive patients. J Hum Hypertens 2006;20:787–794.
  70. Levi-Marpillat N., Macquin-Mavier I., Tropeano A. I. et al. Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension. Hypertens Res 2014;37 (6):585–590. doi: 10.1038/hr.2014.33. Epub 2014 Mar 27.
  71. Nedogoda S. V., Konradi A. O., Zvartau N. E. et al. Optimization of blood pressure control and angioprotection with a fixed combination of perindopril and amlodipine in patients with arterial hypertension and a high speed pulse wave. Kardiologiya 2017;57 (3):31–38. Russian (Недогода С. В., Конради А. О., Звартау Н. Э. и др. Оптимизация контроля артериального давления и ангиопротекции с помощью фиксированной комбинации периндоприла и амлодипина у пациентов с артериальной гипертензией и высокой скоростью распространения пульсовой волны. Кардиология 2017;57 (3):31–38). DOI: https://doi.org/10.18565/cardio.2017.3.31–38
  72. Gorbunov V. M., Karpov Yu.A., Deev A. D. on behalf of the participants of the research PRORYV 2. Study PRORYV 2: Part II. The effect of a fixed combination of perindopril arginine/amlodipine on the variability of blood pressure and the quality of life of patients with initially uncontrolled arterial hypertension. Atmosfera. Novosti kardiologii 2014;2:3–10. Russian (Горбунов В. М., Карпов Ю. А., Деев А. Д. от имени участников исследования ПРОРЫВ 2. Исследование ПРОРЫВ 2: Часть II. Влияние фиксированной комбинации периндоприла аргинин/амлодипин на вариабельность артериального давления и качество жизни больных с исходно неконтролируемой артериальной гипертонией. Атмосфера. Новости кардиологии 2014;2:3–10).
Ostroumova O. D., Borisova E. V., Ostroumova T. M., Kochetkov A. I. 24-Hour Arterial Pressure Variability: Prognostic Significance, Methods of Evaluation, Effect of Antihypertensive Therapy. Kardiologiia. 2017;57(12):62–72.

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