Background:Blood pressure variability (BPV) in hypertensive patients is implicated as a remarkable feature leading to additional cardiovascular complications.The aim of the study was to identify the determinants influencing BPV among patients with essential hypertension seen at the Cardiology department of the faculty of medicine, University of Alexandria, Egypt. Methods: This was a descriptive cross-sectional hospital-based study conducted from August 2019 to November 2019. All the eligible patients were made to fill out a standard questionnaire to obtain family and personal clinical history and undergo routine physical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring. BPV was summarized as the standard deviation (SD) of all-day systolic and diastolic BP in both normal patients (with SD < 11) and abnormal patients (with SD ≥11). Results: Out of a total of 114 patients, 18 (15.8%) non-hypertensive patients were included in the control group and the remaining96 (84.3%) were classified based on the degree of hypertension. BPV in all these patients was found to be significantly related to the male gender, a mild or moderate degree of hypertension, high prevalence of non-dipping, diabetes, use of beta-blockers as antihypertensive？medication, heart rate variability, BMI, and increased day-time variability. Conclusion: Variability in blood pressure influenced by different intrinsic and extrinsic factors plays an important role in the management of hypertension. In order to reduce the burden of disease and for a better quality of life for hypertensive patients, it is important that physicians start considering lowering BPV in addition to reducing physiological BP levels.
References
[1]
Stevens, S.L., Wood, S., Koshiaris, C., et al. (2016) Blood Pressure Variability and Cardiovascular Disease: Systematic Review and Meta-Analysis. British Medical Journal, 354, i4098. https://doi.org/10.1136/bmj.i4098
[2]
Hocht, C. (2013) Blood Pressure Variability: Prognostic Value and Therapeutic Implications. International Scholarly Research Notices, 2013, Article ID: 398485.
https://doi.org/10.5402/2013/398485
[3]
Leoncini, G., Viazzi, F., Storace, G., et al. (2013) Blood Pressure Variability and Multiple Organ Damage in Primary Hypertension. Journal of Human Hypertension, 27, 663-670. https://doi.org/10.1038/jhh.2013.45
[4]
Li, C.L., Liu, R., Wang, J.R., et al. (2017) Relationship between Blood Pressure Variability and Target Organ Damage in Elderly Patients. European Review for Medical and Pharmacological Sciences, 21, 5451-5455.
[5]
Su, D.F. and Miao, C.Y. (2001) Blood Pressure Variability and Organ Damage. Clinical and Experimental Pharmacology and Physiology, 28, 709-715.
https://doi.org/10.1046/j.1440-1681.2001.03508.x
[6]
Hano, T. and Koike, Y. (2022) Visit-to-Visit Blood Pressure Variability Are Associated with an Imbalance between Sympathetic and Parasympathetic Tone in Hypertensive Patients. Health, 14, 246-253. https://doi.org/10.4236/health.2022.142019
[7]
Parati, G., Ochoa, J.E., Lombardi, C., et al. (2015) Blood Pressure Variability: Assessment, Predictive Value, and Potential as Therapeutic Target. Current Hypertension Reports, 17, 537. https://doi.org/10.1007/s11906-015-0537-1
[8]
Amoussou-Guenou, D., Wanvoegbe, A., Agbodande, A., et al. (2015) Prevalence and Risk Factors of Hypertension in Type 2 Diabetics in Benin. Journal of Diabetes Mellitus, 5, 227-232. https://doi.org/10.4236/jdm.2015.54027
[9]
Rothwell, P.M. (2010) Limitations of the Usual Blood-Pressure Hypothesis and Importance of Variability, Instability, and Episodic Hypertension. The Lancet, 375, 938-948. https://doi.org/10.1016/S0140-6736(10)60309-1
[10]
Abellán-Huerta, J., Prieto-Valiente, L., Montoro-García, S., et al. (2018) Correlation of Blood Pressure Variability as Measured By Clinic, Self-Measurement at Home, and Ambulatory Blood Pressure Monitoring. American Journal of Hypertension, 31, 305-312. https://doi.org/10.1093/ajh/hpx183
[11]
Nobre, F. and Mion, J.D. (2016) Ambulatory Blood Pressure Monitoring: Five Decades of MoreLight and Less Shadows. Arquivos Brasileiros de Cardiologia, 106, 528-537. https://doi.org/10.5935/abc.20160065
[12]
O’Brien, E., Parati, G. and Stergiou, G. (2013) Ambulatory Blood Pressure Measurement. Hypertension, 62, 988-994.
https://doi.org/10.1161/HYPERTENSIONAHA.113.02148
[13]
James, P.A., Oparil, S., Carter, B.L., et al. (2014) 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association, 311, 507-520. https://doi.org/10.1001/jama.2013.284427
[14]
Mancia, G., Fagard, R., Narkiewicz, K., et al. (2013) 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). European Heart Journal, 34, 2159-2219.
https://doi.org/10.1093/eurheartj/eht151
[15]
Khalil, H. and Zeltser, R. (2020) Antihypertensive Medications. StatPearls Publishing, Treasure Island, FL.
[16]
Mancia, G., De Backer, G., Dominiczak, A., et al. (2007) 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension, 25, 1105-1187.
https://doi.org/10.1097/HJH.0b013e3281fc975a
[17]
O’Brien, E., Asmar, R., Beilin, L., et al. (2003) European Society of Hypertension Recommendations for Conventional, Ambulatory and Home Blood Pressure Measurement. Journal of Hypertension, 21, 821-848.
https://doi.org/10.1097/00004872-200305000-00001
[18]
Head, G.A., Mihailidou, A.S., Duggan, K.A., et al. (2010) Definition of Ambulatory Blood Pressure Targets for Diagnosis and Treatment of Hypertension in Relation to clinic Blood Pressure: Prospective Cohort Study. British Medical Journal, 340, c1104.
https://doi.org/10.1136/bmj.c1104
[19]
Pickering, T.G., Miller, N.H., Ogedegbe, G., et al. (2008) Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary: A Joint Scientific Statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension, 52, 1-9. https://doi.org/10.1161/HYPERTENSIONAHA.107.189011
[20]
O’Brien, E., Beevers, G. and Lip, G.H.Y. (2001) ABC of Hypertension. Part III. Automated Sphygmomanometry, Ambulatory Blood Pressure Measurement. British Medical Journal, 322, 1110-1114. https://doi.org/10.1136/bmj.322.7294.1110
[21]
Fan, H.Q., Li, Y., Thijs, L., et al. (2010) Prognostic Value of Isolated Nocturnal Hypertension on Ambulatory Measurement in 8711 Individuals from 10 Populations. Journal of Hypertension, 28, 2036-2045.
https://doi.org/10.1097/HJH.0b013e32833b49fe
[22]
Minh, H.V., Byass, P., Chuc, N.T., et al. (2006) Gender Differences in Prevalence and Socioeconomic Determinants of Hypertension. Journal of Human Hypertension, 20, 109-115. https://doi.org/10.1038/sj.jhh.1001942
[23]
Wang, X., Poole, J.C., Treiber, F.A., et al. (2006) Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories. Circulation, 114, 2780-2787.
https://doi.org/10.1161/CIRCULATIONAHA.106.643940
[24]
Ninios, I., Ninios, V., Lazaridou, F., et al. (2008) Gender-Specific Differences in Hypertension Prevalence, Treatment, Control, and Associated Conditions among the Elderly: Data from a Greek Population. Clinical and Experimental Hypertension, 30, 327-337. https://doi.org/10.1080/10641960802269943
[25]
Mancia, G., Ferrari, A., Gregorini, L., et al. (2000) Blood Pressure Variability in Man: Its Relation to High Blood Pressure, Age and Baroreflex Sensitivity. Clinical Science, 59, 401s-404s. https://doi.org/10.1042/cs059401s
[26]
McDonald, C., Pearce, M.S., Wincenciak, J., et al. (2016) Ambulatory Blood Pressure Variability Increases over a 10-Year Follow-Up in Community-Dwelling Older People. American Journal of Hypertension, 29, 560-567.
https://doi.org/10.1093/ajh/hpv150
[27]
Dupont, A.G., Vanderniepen, P., Volckaert, A., et al. (2000) Noninvasive Ambulatory Monitoring of Blood Pressure in Essential Hypertension. Effect of Age on Variability and Disparity. The Journal of Clinical Hypertension, 2, 278-284.
[28]
Yusoff, S.S.M., Juwita, S., Harmy, M.Y., et al. (2013) Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers. IMJ Malaysia, 2, 23-31.
[29]
Tartan, Z., Uyarel, H., Kasikcioglu, H., et al. (2006) Metabolic Syndrome as a Predictor of Non-Dipping Hypertension. The Tohoku Journal of Experimental Medicine, 210, 57-66.
[30]
Ikeda, T., Matsubara, T., Sato, Y., et al. (1993) Circadian Blood Pressure Variation in Diabetic Patients with Autonomic Neuropathy. Journal of Hypertension, 11, 581-588.
https://doi.org/10.1097/00004872-199305000-00015
[31]
Mokhtar, R.H., Ayob, A. and Noor, N.M. (2010) Blood Pressure Variability in Patients with Diabetes Mellitus. Asian Cardiovascular and Thoracic Annals, 18, 344-348.
https://doi.org/10.1177/0218492310375723
[32]
Suzuki, M., Kimura, Y., Tsushima, M., et al. (2000) Association of Insulin Resistance with Salt Sensitivity and Nocturnal Fall of Blood Pressure. Hypertension, 35, 864-868. https://doi.org/10.1161/01.HYP.35.4.864
[33]
Nardin, C., Rattazzi, M. and Pauletto, P. (2019) Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases. High Blood Pressure & Cardiovascular Prevention, 26, 353-359.
https://doi.org/10.1007/s40292-019-00339-z
[34]
Widimsky, J. (2011) Variability in Blood Pressure and Arterial Hypertension. Vnitrní Lékarství, 57, 320-324.
[35]
Zhang, Y., Agnoletti, D., Safar, M.E., et al. (2011) Effect of Antihypertensive Agents on Blood Pressure Variability. Hypertension, 58, 155-160.
https://doi.org/10.1161/HYPERTENSIONAHA.111.174383
[36]
Muntner, P. and Oparil, S. (2011) Response to Inter Visit Blood Pressure Variability and Outcome: Is Heart Rate a Missing Confounder. Hypertension, 58, e2.
https://doi.org/10.1161/HYPERTENSIONAHA.111.173765
[37]
Schroeder, E.B., Liao, D., Chambless, L.E., et al. (2003) Hypertension, Blood Pressure, and Heart Rate Variability: The Atherosclerosis Risk in Communities (ARIC) Study. Hypertension, 42, 1106-1111.
https://doi.org/10.1161/01.HYP.0000100444.71069.73
[38]
Kotsis, V., Stabouli, S., Bouldin, M., et al. (2005) Adolescent Obesity Is Associated with High Ambulatory Blood Pressure and Increased Carotid Intimal-Medial Thickness. Hypertension, 45, 602-607.
https://doi.org/10.1161/01.HYP.0000158261.86674.8e
[39]
Abramson, J.L., Lewis, C., Murrah, N.V. (2011) Body Mass Index, Leptin, and Ambulatory Blood Pressure Variability in Healthy Adults. Atherosclerosis, 214, 456-461.
https://doi.org/10.1016/j.atherosclerosis.2010.11.003
[40]
Palatini, P., Penzo, M., Racioppa, A., et al. (1992) Clinical Relevance of Night-Time Blood Pressure and of Day-Time Blood Pressure Variability. Archives of Internal Medicine, 152, 1855-1860. https://doi.org/10.1001/archinte.1992.00400210081013
