Blood Pressure Variability: Mechanisms, Measurement, Subtypes, and Clinical Implications
Main Article Content
Abstract
The complex topic of short- and long-term blood pressure (BP) variability confounds the diagnosis, classification, and management of hypertension. True pathophysiologic BP variation (systematic and non-systematic deviations between- and within-individuals) is related to heart rate, respiration, complex responses of the sympathetic nervous system, vascular reactivity, and arterial stiffness. Measurement errors (systematic biases and random error) further compound the analysis. Most studies use serial clinic BP values, 24-hour ambulatory BP recordings, or home BP values with standard statistical indicators (standard deviation, variance, or coefficient of variation) or absolute real variability (mean difference of successive values). Clinical impact in retrospective secondary analyses includes a modest increase in cardiovascular disease (CVD) risk (equivalent to a few mmHg in mean systolic BP) yet questions remain whether adjustment for mean BP is needed. BP variability is reduced to a small degree by calcium antagonists and increased by ACE inhibitors, beta-blockers, and alpha-blockers but no interventional trial has addressed the question of whether reducing BP variability confers CVD risk protection. BP variability is not specifically discussed in practice guidelines but it is tacitly acknowledged by recommendations to repeat BP measurements, standardize technique, and confirm the hypertension diagnosis by home or ambulatory BP measurements to account for the “white coat effect.” There is no formal consensus on how to quantitate or manage BP variability despite a real-world need for better diagnostic and therapeutic guidance. Practitioners should thus focus on control of (mean) BP using combinations of agents that improve CVD outcomes. Future consensus guidance should directly address BP variability and should include educational materials for physicians, patient-contact staff, and patients.
Keywords:
blood pressure, blood pressure variability, hypertension
Article Details
How to Cite
IZZO, Joseph L..
Blood Pressure Variability: Mechanisms, Measurement, Subtypes, and Clinical Implications.
Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3174>. Date accessed: 03 july 2024.
doi: https://doi.org/10.18103/mra.v10i10.3174.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Gunstad J, Cohen RA, Tate DF, et al. Blood pressure variability and white matter hyperintensities in older adults with cardiovascular disease. Research Support, N.I.H., Extramural. Blood pressure. 2005;14(6):353-8.
4. Webb AJ, Rothwell PM. Physiological correlates of beat-to-beat, ambulatory, and day-to-day home blood pressure variability after transient ischemic attack or minor stroke. Stroke. Feb 2014;45(2):533-8. doi:10.1161/strokeaha.113.003321
5. Asayama K, Wei FF, Liu YP, et al. Does blood pressure variability contribute to risk stratification? Methodological issues and a review of outcome studies based on home blood pressure. Hypertension research : official journal of the Japanese Society of Hypertension. Feb 2015;38(2):97-101. doi:10.1038/hr.2014.153
6. Del Giorno R, Balestra L, Heiniger PS, Gabutti L. Blood pressure variability with different measurement methods: Reliability and predictors. A proof of concept cross sectional study in elderly hypertensive hospitalized patients. Medicine. 2019;98(28):e16347.
7. Parati G, Torlasco C, Pengo M, et al. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertension Research. 2020/07/01 2020;43(7):609-620. doi:10.1038/s41440-020-0421-5
8. Izzo J, Nagpal S, Mukhopadhyay D, et al. Variation in mean arterial pressure and its hemodynamic components during 24-hour ambulatory pulse wave analysis: impact of age, race, and gender. Journal of hypertension. 2022;40(Suppl 1):e116-e117.
9. Parati G, Izzo JL, Jr., Gavish B. Respiration and blood pressure. In: Izzo JL, Jr, Sica DA, Black HR, eds. Hypertension Primer. American Heart Association; 2008:136-8:chap A43.
10. Teboul JL, Monnet X, Chemla D, Michard F. Arterial Pulse Pressure Variation with Mechanical Ventilation. Am J Respir Crit Care Med. 2019;199(1):22-31. doi:10.1164/rccm.201801-0088CI
11. Izzo JL, Jr. The sympathetic nervous system in acute and chronic blood pressure elevation. In: Oparil S, Weber MA, eds. Hypertension: Companion to Brenner and Rector's The Kidney. Second ed. Elsevier-Saunders; 2005:60-76:chap 6.
12. Izzo JL, Jr., Sander E, Larrabee PS. Effect of postural stimulation on systemic hemodynamics and sympathetic nervous activity in systemic hypertension. Am J Cardiol. 1990 1990;65:339-342.
13. Izzo JL, Anwar MA, Elango K, et al. Decoupling of Heart Rate and Blood Pressure: Hemodynamic Counter-regulatory Mechanisms and their Implications. Artery Research. 2019/12/24 2019;25(3-4):87-94. doi:https://doi.org/10.2991/artres.k.191210.001
14. Izzo JL, Jr., Smith RJ, Larrabee PS, Kallay MC. Plasma norepinephrine and age as determinants of systemic hemodynamics in men with established essential hypertension. Hypertension (Dallas, Tex : 1979). 1987 1987;9:415-419.
15. Izzo JL, Taylor AA. The sympathetic nervous system and baroreflexes in hypertension and hypotension. journal article. Curr Hypertens Rep. 1999;1(3):254-263. doi:10.1007/s11906-999-0030-9
16. Folkow B. Structural factors: the vascular wall. Consequences of treatment. Hypertension (Dallas, Tex : 1979). Sep-Oct 1983;5(5 Pt 2):Iii58-62. doi:10.1161/01.hyp.5.5_pt_2.iii58
17. Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: testing and clinical relevance. Circulation. Mar 13 2007;115(10):1285-95. doi:10.1161/circulationaha.106.652859
18. Harrison DG. Endothelial function and oxidant stress. Clin Cardiol. Nov 1997;20(11 Suppl 2):Ii-11-7.
19. Mitra S, Goyal T, Mehta JL. Oxidized LDL, LOX-1 and atherosclerosis. Cardiovasc Drugs Ther. Oct 2011;25(5):419-29. doi:10.1007/s10557-011-6341-5
20. Sung BH, Izzo JL, Jr., Wilson MF. Effects of cholesterol reduction on BP response to mental stress in patients with high cholesterol. AmJHypertens. 1997 1997;10(6):592-599.
21. Sung BH, Izzo JL, Jr., Dandona P, Wilson MF. Vasodilatory effects of troglitazone improve blood pressure at rest and during mental stress in type 2 diabetes mellitus. Hypertension (Dallas, Tex : 1979). 1999;34(1):83-8.
22. Maseli A, Aeschbacher S, Schoen T, et al. Healthy Lifestyle and Blood Pressure Variability in Young Adults. American journal of hypertension. Jul 1 2017;30(7):690-699. doi:10.1093/ajh/hpx034
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