title: Prognostic value of different indices of blood pressure variability in hypertensive patients.
abstract: BACKGROUND
  The independent prognostic significance of different indices of blood pressure (BP) variability is not clear. We investigated the prognostic value of BP variability estimated as s.d. or average real variability (ARV) of daytime and night time BP, in hypertensive patients.
  
  
  METHODS
  The occurrence of fatal and nonfatal cardiovascular events was evaluated in 1,280 sequential hypertensive patients (550 initially untreated and 730 initially treated) aged > or =40 years. Subjects with s.d. or ARV of daytime or night time systolic or diastolic BP below or above the median were classified as having low or high BP variability.
  
  
  RESULTS
  During the follow-up (4.75 +/- 1.8 years), 104 cardiovascular events occurred. The event rate per 100 patient-years was 1.71 in the global population. After adjustment for other covariates, Cox regression analysis showed that cardiovascular risk was higher in subjects with high ARV of daytime systolic BP in initially untreated, initially treated, and all the subjects (high vs. low ARV, hazard ratio (HR) 2.29 (1.06-4.94), HR 1.90 (1.06-3.39), and HR 2.07 (1.31-3.28), respectively). ARV of daytime diastolic BP and night time BP, and s.d. of daytime and night time BP were not significantly associated with risk or were not independent predictors of outcome.
  
  
  CONCLUSIONS
  In this study, high ARV of daytime systolic BP resulted in an independent predictor of cardiovascular risk in hypertensive patients, while high s.d. did not. Our data suggest that, in comparison to s.d., ARV could be a more appropriate index of BP variability and a more useful predictor of outcomes.
authors.affiliation: Dipartimento di Medicina e Scienze dell'Invecchiamento, Università Gabriele d'Annunzio, Chieti, Italy. pierdomenico@unich.it
authors.forename: Sante D
authors.initials: SD
authors.lastname: Pierdomenico
authors.forename: Marta
authors.initials: M
authors.lastname: Di Nicola
authors.forename: Anna L
authors.initials: AL
authors.lastname: Esposito
authors.forename: Rocco
authors.initials: R
authors.lastname: Di Mascio
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballone
authors.forename: Domenico
authors.initials: D
authors.lastname: Lapenna
authors.forename: Franco
authors.initials: F
authors.lastname: Cuccurullo
mesh_terms: D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012044:Regression Analysis
chemical_list: D000959:Antihypertensive Agents