title: Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness.
abstract: The extent of target-organ damage has been positively associated with the magnitude of blood pressure (BP) variability in essential hypertension. However, the clinical implications of the rate of BP changes have never been investigated. We evaluated the association between the rate of systolic BP (SBP) variation derived from ambulatory BP monitoring (ABPM) data analysis and the extent of common carotid artery (CCA) intima-media thickness (IMT) in normotensive (n=280) and in uncomplicated hypertensive subjects (n=234). The 24-hour rate of SBP variation was significantly (P<0.001) higher in hypertensive (0.608 mm Hg/min; 95% confidence interval [CI], 0.595 to 0.622) than in normotensive individuals (0.567 mm Hg/min; 95% CI, 0.555 to 0.578), even after adjusting for baseline characteristics, day-night BP changes, 24-hour heart rate (HR), SBP, and HR variability. In the entire group of patients, multiple linear regression models revealed independent determinants of CCA-IMT in the following rank order: age (P<0.001), 24-hour rate of SBP variation (P<0.001), male gender (P=0.004), cholesterol (P=0.009), and smoking (P=0.014). A 0.1 mm Hg/min increase in the 24-hour rate of SBP variation was associated to an increment of 0.029 mm (95% CI, 0.018 to 0.040) in CCA-IMT independent of BP and HR levels, BP and HR variability, and dipping status. The rate of SBP variation during the morning BP surge correlated independently (P<0.001) to larger CCA-IMT values after adjustment for baseline characteristics and other ABPM parameters. Thus, the rate of BP fluctuations is greater in hypertensive patients and correlates to increased CCA-IMT. This finding indicates that steeper BP variations may produce a greater stress on the vessel wall and consequently result in medial hypertrophy of the large arteries.
authors.affiliation: Department of Clinical Therapeutics Alexandra Hospital, University of Athens, Greece. nzakop@med.uoa.gr
authors.forename: Nikos A
authors.initials: NA
authors.lastname: Zakopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Gerassimos
authors.initials: G
authors.lastname: Barlas
authors.forename: Christos
authors.initials: C
authors.lastname: Papamichael
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
authors.forename: Efstathios
authors.initials: E
authors.lastname: Manios
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Vassilios
authors.initials: V
authors.lastname: Kotsis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Spiliopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vemmos
authors.forename: Myron
authors.initials: M
authors.lastname: Mavrikakis
authors.forename: Spyridon D
authors.initials: SD
authors.lastname: Moulopoulos
mesh_terms: D000375:Aging; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D012907:Smoking; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D002784:Cholesterol