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Meta-Analysis
. 2017 Oct 19;6(10):e006895.
doi: 10.1161/JAHA.117.006895.

24-Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta-Analysis

Luis J Mena  1 , Vanessa G Felix  2 , Jesus D Melgarejo  3 , Gladys E Maestre  3   4
Affiliations
Meta-Analysis

24-Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta-Analysis

Luis J Mena et al. J Am Heart Assoc. .

Abstract

Background: Although 24-hour blood pressure (BP) variability (BPV) is predictive of cardiovascular outcomes independent of absolute BP levels, it is not regularly assessed in clinical practice. One possible limitation to routine BPV assessment is the lack of standardized methods for accurately estimating 24-hour BPV. We conducted a systematic review to assess the predictive power of reported BPV indexes to address appropriate quantification of 24-hour BPV, including the average real variability (ARV) index.

Methods and results: Studies chosen for review were those that presented data for 24-hour BPV in adults from meta-analysis, longitudinal or cross-sectional design, and examined BPV in terms of the following issues: (1) methods used to calculate and evaluate ARV; (2) assessment of 24-hour BPV determined using noninvasive ambulatory BP monitoring; (3) multivariate analysis adjusted for covariates, including some measure of BP; (4) association of 24-hour BPV with subclinical organ damage; and (5) the predictive value of 24-hour BPV on target organ damage and rate of cardiovascular events. Of the 19 assessed studies, 17 reported significant associations between high ARV and the presence and progression of subclinical organ damage, as well as the incidence of hard end points, such as cardiovascular events. In all these cases, ARV remained a significant independent predictor (P<0.05) after adjustment for BP and other clinical factors. In addition, increased ARV in systolic BP was associated with risk of all cardiovascular events (hazard ratio, 1.18; 95% confidence interval, 1.09-1.27). Only 2 cross-sectional studies did not find that high ARV was a significant risk factor.

Conclusions: Current evidence suggests that ARV index adds significant prognostic information to 24-hour ambulatory BP monitoring and is a useful approach for studying the clinical value of BPV.

Keywords: blood pressure variability; cardiovascular events; target organ damage.

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Figures

Figure 1
Figure 1
Flow chart showing the process for selection of articles. ARV indicates average real variability; BP, blood pressure; and BPV, BP variability.
Figure 2
Figure 2
Random‐effects meta‐analysis of hazard ratios for increases of systolic average real variability and all cardiovascular events.
See this image and copyright information in PMC

References

    1. Narkiewicz K, Winnicki M, Schroeder K, Phillips BG, Kato M, Cwalina E, Somers VK. Relationship between muscle sympathetic nerve activity and diurnal blood pressure profile. Hypertension. 2002;39:168–172. - PubMed
    1. Nishi EE, Bergamaschi CT, Campos RR. The crosstalk between the kidney and the central nervous system: the role of renal nerves in blood pressure regulation. Exp Physiol. 2015;100:479–484. - PubMed
    1. Elghozi JL, Laude D, Girard A. Effects of respiration on blood pressure and heart rate variability in humans. Clin Exp Pharmacol Physiol. 1991;18:735–742. - PubMed
    1. Mancia G, Grassi G, Giannattasio C, Seravalle G. Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension. 1999;34:724–728. - PubMed
    1. Parati G, Saul JP, Di Rienzo M, Mancia G. Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation: a critical appraisal. Hypertension. 1995;25:1276–1286. - PubMed

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