title: Reducing Visit-To-Visit Variability in Systolic Blood Pressure for Improving the Progression of Carotid Atherosclerosis and Endothelial Dysfunction in Patients with Hypertension Management.
abstract: BACKGROUND
  Visit-to-visit variability (VVV) in blood pressure (BP) creates challenges to hypertension control and was independent associated with increased all-cause mortality in hypertensive patients. The major goal of the present study was to investigate the association of VVV in systolic (S)BP with progression of carotid atherosclerosis and en-dothelial dysfunction in on-treated hypertensive patients.
  
  
  METHODS
  Overall, 356 hypertensive patients were enrolled and completed the trial. Clinic BP was measured at baseline and at 3 monthly thereafter. Carotid artery ultrasound and endothelial function were evaluated at baseline and annually follow-up visit. VVV in BP was assessed by standard deviation (SD) and coefficient of variation (CV) of serial follow-up BP measurements. The patients were divided into low, middle, and high group by tertile of SD in SBP.
  
  
  RESULTS
  Decrease percentage of maximum intima-media thickness (IMT) and stiffness index β and increase percentage of brachial flow-mediated dilation (FMD) and nitric oxide (NO) in lower groups were significant greater than in higher groups (P < 0.05). Change percentage of stiffness index β and endothelin-1 positively, and change percentage of FMD and NO negatively correlated with SD, CV, maximum, and delta of SBP (P < 0.05). SD and CV of SBP were risk factors for change percentage of IMT, stiffness index β, FMD, NO, and endothelin-1 independently of other influential factors, such as age, and mean SBP.
  
  
  CONCLUSIONS
  Excessive VVV in SBP maybe increase carotid atherosclerosis and impair endothelial function in on-treated hypertensive patients. Reducing VVV in SBP is benefit for patients with hypertension management.
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China ; 2. School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Hongbin
authors.initials: H
authors.lastname: Song
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Yingxin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: 3. Dept. of Cardiology, Shandong Provencial Hospital , Shandong, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Ye
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Fanghong
authors.initials: F
authors.lastname: Lu
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Yutao
authors.initials: Y
authors.lastname: Diao
authors.affiliation: 1. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences , Shandong, China ; 2. School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences , Shandong, China.
authors.forename: Jianchao
authors.initials: J
authors.lastname: Xu
keywords: Antihypertension; Atherosclerosis; Blood pressure variability; Endothelial dysfunction