Abstract
Blood pressure (BP) is highly variable within a 24-h period, as well as between days, months, years, and seasons. Available evidence shows that within 24-h (or short-term) BP, variabilities have prognostic significance, i.e., their size is related to cardiovascular morbid and fatal events independently of other cardiovascular risk factors and mean BP levels. This has more recently also been shown for visit-to-visit BP variations in patients receiving antihypertensive treatment. Controlling BP variability with treatment may thus represent an important future goal.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Mancia G, Zanchetti A (1986) Blood pressure variability. In: Zanchetti A, Tarazi R (eds) Handbook of hypertension. Pathophysiology of hypertension, vol 7. Elsevier, Amsterdam, pp 125–152
Sega R, Cesana G, Bombelli M et al (1998) Seasonal variations in home and ambulatory blood pressure in the PAMELA population. Pressione Arteriose Monitorate E Loro Associazioni. J Hypertens 16:1585–1592
Wolf-Maier K, Cooper RS, Banegas JR et al (2003) Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 289:2363–2369
Parati G, Pomidossi G, Albini F et al (1987) Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 5:93–98
Mancia G, Parati G, Hennig M, Investigators ELSA et al (2001) Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European lacidipine study on atherosclerosis (ELSA). J Hypertens 19:1981–1989
Muiesan ML, Salvetti M, Monteduro C et al (2004) Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension 43:731–738
O’Leary DH, Polak JF, Kronmal RA et al (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research group. N Engl J Med 340:14–22
Zanchetti A, Hennig M, Hollweck R et al (2009) Baseline values but not treatment-induced changes in carotid intima-media thickness predict incident cardiovascular events in treated hypertensive patients: findings in the European lacidipine study on atherosclerosis (ELSA). Circulation 120:1084–1090
Frattola A, Parati G, Cuspidi C et al (1993) Prognostic value of 24-hour blood pressure variability. J Hypertens 11:1133–1137
Sander D, Kukla C, Klingelhöfer J et al (2000) Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: a 3-year follow-up study. Circulation 102:1536–1541
Kikuya M, Hozawa A, Ohokubo T et al (2000) Prognostic significance of blood pressure and heart rate variabilities: the ohasama study. Hypertension 36:901–906
Mancia G, Bombelli M, Facchetti R et al (2007) Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni study. Hypertension 49:1265–1270
Pringle E, Phillips C, Thijs L et al, Syst-Eur investigators (2003) Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens 21:2251–2257
Dawson SL, Manktelow BN, Robinson TG et al (2000) Which parameters of beat-to-beat blood pressure and variability best predict early outcome after acute ischemic stroke? Stroke 31:463–468
Kario K, Matsuo T, Kobayashi H et al (1996) Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension 27:130–135
Verdecchia P, Schillaci G, Guerrieri M et al (1990) Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 81:528–536
Poulsen PL, Ebbehøj E, Hansen KW, Mogensen CE (1997) 24-h blood pressure and autonomic function is related to albumin excretion within the normoalbuminuric range in IDDM patients. Diabetologia 40:718–725
Fan HQ, Li Y, Thijs L et al; International Database on Ambulatory Blood Pressure In Relation to Cardiovascular Outcomes Investigators (2010) Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens 28:2036–2045
Metoki H, Ohkubo T, Kikuya M et al (2006) Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the ohasama study. Hypertension 47:149–154
Kario K, Pickering TG, Umeda Y et al (2003) Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 107:1401–1406
Muller JE, Tofler GH, Stone PH (1989) Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 79:733–743
Elliott WJ (1998) Circadian variation in the timing of stroke onset: a meta-analysis. Stroke 29:992–996
Verdecchia P, Schillaci G, Borgioni C et al (1997) Altered circadian blood pressure profile and prognosis. Blood Press Monit 2:347–352
Hansen TW, Thijs L, Li Y et al; International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators (2010) Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension 55:1049–1057
Mancia G, Parati G, Castiglioni P et al (2003) Daily life blood pressure changes are steeper in hypertensive than in normotensive subjects. Hypertension 42:277–282
di Rienzo M, Grassi G, Pedotti A, Mancia G (1983) Continuous vs intermittent blood pressure measurements in estimating 24-hour average blood pressure. Hypertension 5:264–269
Modesti PA, Morabito M, Bertolozzi I et al (2006) Weather-related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management. Hypertension 47:155–161
Kikuya M, Ohkubo T, Metoki H et al (2008) Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis: the ohasama study. Hypertension 52:1045–1050
Rothwell PM (2010) Limitations of the usual blood pressure hypothesis and importance of variability, instability and episodic hypertensions. Lancet 375:938–948
Rothwell PM, Howard SC, Dolan E et al (2010) Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 375:895–905
Mancia G, Messerli F, Bakris G et al (2007) Blood pressure control and improved cardiovascular outcomes in the international verapamil SR-trandolapril study. Hypertension 50:299–305
Mancia G, De Backer G, Dominiczak A et al; Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology (2007) 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). J Hypertens 25:1105–1187
Mancia G, Parati G, Bilo G et al (2007) Assessment of long-term antihypertensive treatment by clinic and ambulatory blood pressure: data from the European lacidipine study on atherosclerosis. J Hypertens 25:1087–1094
Andersson OK, Almgren T, Persson B et al (1998) Survival in treated hypertension: follow up study after two decades. BMJ 317:167–171
Zanchetti A (2009) Bottom blood pressure or bottom cardiovascular risk? How far can cardiovascular risk be reduced? J Hypertens 27:1509–1520
Mancia G, Schumacher H, Redon J et al (2011) Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET). Circulation 124:1727–1736
Mancia G, Facchetti R, Parati G, Zanchetti A Visit-to-visit blood pressure variability, carotid atherosclerosis and cardiovascualr events in the European study on atherosclerosis (submitted)
Simpson SH, Eurich DT, Majumdar SR et al (2006) A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 333:15
Corrao G, Parodi A, Nicotra F et al (2011) Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens 29:610–618
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Italia
About this chapter
Cite this chapter
Mancia, G. (2012). Short-Term and Long-Term Blood Pressure Variability. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_8
Download citation
DOI: https://doi.org/10.1007/978-88-470-2601-8_8
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2600-1
Online ISBN: 978-88-470-2601-8
eBook Packages: MedicineMedicine (R0)