title: Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects.
abstract: Growing evidence associates blood pressure (BP) variability with cardiovascular events in hypertensive patients. Here we tested the existence of a relationship between awake BP variability and target-organ damage in subjects referred for suspected hypertension. Systolic and diastolic BP variability were assessed as the standard deviation of the mean out of 24-hour, awake and asleep BP recordings in 180 untreated subjects, referred for suspected hypertension. Measurements were done at 15-minute intervals during daytime and 30-minute intervals during nighttime. Left ventricular mass index (by echo), intima-media thickness (by carotid ultrasonography), and microalbuminuria were assessed as indices of cardiac, vascular and renal damage, respectively. Intima-media thickness and left ventricular mass index progressively increased across tertiles of awake systolic BP variability (P for trend=0.001 and 0.003, respectively). Conversely, microalbuminuria was similar in the 3 tertiles (P=NS). Multivariable analysis identified age (P=0.0001), awake systolic BP (P=0.001), awake systolic BP variability (P=0.015) and diastolic BP load (P=0.01) as independent predictors of intima-media thickness; age (P=0.0001), male sex (P=0.012), awake systolic (P=0.0001) and diastolic BP (P=0.035), and awake systolic BP variability (P=0.028) as independent predictors of left ventricular mass index; awake systolic BP variability (P=0.01) and diastolic BP load (P=0.01) as independent predictors of microalbuminuria. Therefore, awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels. Such relationship, found in subjects referred for recently suspected hypertension, likely appears early in the natural history of hypertension.
authors.affiliation: Institute of Cardiology, Center of Excellence on Aging, G. d'Annunzio University, Chieti, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Tatasciore
authors.forename: Giulia
authors.initials: G
authors.lastname: Renda
authors.forename: Marco
authors.initials: M
authors.lastname: Zimarino
authors.forename: Manola
authors.initials: M
authors.lastname: Soccio
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Bilo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D017677:Age Distribution; D000704:Analysis of Variance; D018660:Blood Pressure Monitoring, Ambulatory; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002940:Circadian Rhythm; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography