title: Systolic and diastolic short-term blood pressure variability and its determinants in patients with controlled and uncontrolled hypertension: a retrospective cohort study.
abstract: Absolute blood pressure (BP) values are not the only causes of adverse cardiovascular consequences. BP variability (BPV) has also been demonstrated to be a predictor of mortality for cardiovascular events; however, its determinants are still unknown. This study considers 426 subjects with ambulatory BP monitoring (ABPM) measuring 24-h, diurnal and nocturnal absolute BP values and their standard deviations of the mean, along with nocturnal fall, age, sex and current treatment. Patients were divided in two subgroups, controlled and uncontrolled BP, and BPV of patients with "true" and "false" resistant hypertension was also analyzed. Nocturnal and 24-h BPV were higher in the group with uncontrolled hypertension. Multiple regression analysis showed that absolute BP, age, nocturnal fall, but not sex predicted BPV. Patients with "true" resistant hypertension had greater BPV than "false" resistant hypertension patients. Absolute BP resulted as the main determinant of 24-h and nocturnal BPV but not daytime BPV. Also nocturnal BP fall and age resulted as predictors of BPV in treated and untreated patients. Patients with "true" resistant hypertension have a higher BPV, suggesting a higher sympathetic activation. Evidence is still limited regarding the importance of short-term BPV as a prognostic factor and assessment of BPV cannot yet represent a parameter for routine use in clinical practice. Future prospective trials are necessary to define which targets of BPV can be achieved with antihypertensive drugs and whether treatment-induced reduction in BPV is accompanied by a corresponding reduction in cardiovascular events.
authors.affiliation: Department of Medicine, University of Padova , Italy.
authors.forename: Martino F
authors.initials: MF
authors.lastname: Pengo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rossitto
authors.forename: Valeria
authors.initials: V
authors.lastname: Bisogni
authors.forename: Daniele
authors.initials: D
authors.lastname: Piazza
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Seccia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maiolino
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
authors.forename: Achille C
authors.initials: AC
authors.lastname: Pessina
authors.forename: Lorenzo A
authors.initials: LA
authors.lastname: Calò
mesh_terms: D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Absolute blood pressure; ambulatory blood pressure monitoring; blood pressure variability; resistant hypertension; sympathetic system