Progression of beat-to-beat blood pressure variability despite best medical management

Journal article

Beat-to-beat variability in blood pressure is associated with recurrent stroke despite good control of hypertension. However, no study has identified rates of progression of beat-to-beat BP variability, its determinants, or which patient groups are particularly affected, limiting understanding of its potential as a treatment target. In consecutive patients one month after a TIA or non-disabling stroke (Oxford Vascular Study), continuous non-invasive BP was measured beat-to-beat over 5 minutes (Finometer). Arterial stiffness was measured by carotid-femoral pulse wave velocity (Sphygmocor). Repeat assessments were performed at the 5 year follow-up visit and agreement determined by intraclass correlation coefficient (ICC). Rates of progression of systolic and diastolic BPV and their determinants were estimated by mixed-effect linear models, adjusted for age, sex and cardiovascular risk factors. 188 of 310 surviving, eligible patients had repeat assessments after a median of 5.8 years. Pulse wave velocity was highly reproducible but systolic BP variability and diastolic BP variability were not (ICC 0.71, 0.10 and 0.16 respectively), however, all three progressed significantly (PWV 2.39%, p<0.0001; SBPV 8.36%, p<0.0001; DBPV 9.7, p<0.0001). Rate of progression of pulse wave velocity, SBPV and DBPV all increased significantly with age (p<0.0001), with an increasingly positive skew, and were particularly associated with female sex (PWV p=0.00035; SBPV p<0.0001; DBPV p<0.0001) and aortic mean SBP (SBPV p=0.037, DBPV p<0.0001). Beat-to-beat BP variability progresses significantly in high-risk patients, particularly in older individuals with elevated aortic systolic pressure. Beat-to-beat BPV and its progression represent potential new therapeutic targets to reduce cardiovascular risk.

Authors: Webb, A; Lawson, A; Wartolowska, K; Mazzucco, S; Rothwell, P

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Lippincott, Williams & Wilkins
• Journal: Hypertension
• Volume: 77
• Issue: 1
• Pages: 193–201
• Publication date: 2020-11-30
• Acceptance date: 2020-10-25
• DOI: 10.1161/HYPERTENSIONAHA.120.16290
• EISSN: 1524-4563
• ISSN: 0194-911X
• Language: English
• Keywords: FFR