title: Aortic arch atherosclerosis in patients with severe aortic stenosis can be argued by greater day-by-day blood pressure variability.
abstract: OBJECTIVE
  Although it is well known that the prevalence of aortic arch plaques, one of the risk factors for ischemic stroke, is high in patients with severe aortic stenosis, the underlying mechanisms are not well understood. Increased day-by-day blood pressure (BP) variability is also known to be associated with stroke; however, little is known on the association between day-by-bay BP variability and aortic arch atherosclerosis in patients with aortic stenosis. Our objective was to clarify the association between day-by-day BP variables (average values and variability) and aortic arch atherosclerosis in patients with severe aortic stenosis.
  
  
  METHODS
  The study population consisted of 104 consecutive patients (mean age 75 ± 8 years) with severe aortic stenosis who were scheduled for aortic valve replacement. BP was measured in the morning in at least 4 consecutive days (mean 6.8 days) prior to the day of surgery. Large (≥4 mm), ulcerated, or mobile plaques were defined as complex plaques using transesophageal echocardiography.
  
  
  RESULTS
  Cigarette smoking and all systolic BP variables were associated with the presence of complex plaques (p < 0.05), whereas diastolic BP variables were not. Multiple regression analysis indicated that day-by-day mean systolic BP and day-by-day systolic BP variability remained independently associated with the presence of complex plaques (p < 0.05) after adjustment for age, male sex, cigarette smoking, hypertension, hypercholesterolemia, and diabetes mellitus.
  
  
  CONCLUSIONS
  These findings suggest that higher day-by-day mean systolic BP and day-by-day systolic BP variability are associated with complex plaques in the aortic arch and consequently stroke risk in patients with aortic stenosis.
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: m1158201@med.osaka-cu.ac.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugioka
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Suwako
authors.initials: S
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Asahiro
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsumura
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Hanatani
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Medicine, Columbia University, New York, NY, USA.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: Department of Medicine, Columbia University, New York, NY, USA.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001018:Aortic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure; D016009:Chi-Square Distribution; D015897:Comorbidity; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors
keywords: Aortic atherosclerosis; Aortic stenosis; Blood pressure variability; Day-by-day blood pressure; Stroke