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. 2014 Jun;43(6):722-35.

Reducing Visit-To-Visit Variability in Systolic Blood Pressure for Improving the Progression of Carotid Atherosclerosis and Endothelial Dysfunction in Patients with Hypertension Management

Hongbin Song  1 , Zhendong Liu  2 , Yingxin Zhao  2 , Lin Ye  3 , Fanghong Lu  2 , Hua Zhang  2 , Yutao Diao  2 , Jianchao Xu  1
Affiliations

Reducing Visit-To-Visit Variability in Systolic Blood Pressure for Improving the Progression of Carotid Atherosclerosis and Endothelial Dysfunction in Patients with Hypertension Management

Hongbin Song et al. Iran J Public Health. 2014 Jun.

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.

Conclusion: 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.

Keywords: Antihypertension; Atherosclerosis; Blood pressure variability; Endothelial dysfunction.

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Figures

Fig. 1
Fig. 1
The process of participants’ recruitment
Fig. 2
Fig. 2
Change percentages of carotid IMT (A) and stiffness index β (B) during the on-treatment period in overall and three groups. Change percentages of carotid IMT and stiffness index β were determined base on the tertile of mean SD of SBP. Results are medians (horizontal bars in boxes) and 25th and 75th percentiles (lower and upper error bars, respectively). IMT, intima-media thickness. *P < 0.05 compared to baseline, †P < 0.05 compared to low group, ‡-P < 0.05 compared to middle group
Fig. 3
Fig. 3
Change percentages of brachial FMD (A), NO (B), and ET-1 (C) during the on-treatment period in overall and three groups. Change percentages of FMD, NO, and ET-1 were determined base on the tertile of mean SD of SBP. Results are medians (horizontal bars in boxes) and 25th and 75th percentiles (lower and upper error bars, respectively). FMD, flow-mediated dilation; NO, nitric oxide; ET-1, endothelin-1. *P < 0.05 compared to baseline, †P < 0.05 compared to low group, ‡P < 0.05 compared to middle group
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