This Article Full Text Full Text (PDF) CME: Take the course for this article: Hypertension: August 2007, Volume 50, Number 2 All Versions of this Article: 50/2/325    most recent HYPERTENSIONAHA.107.090084v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tatasciore, A. Articles by De Caterina, R. Search for Related Content PubMed PubMed Citation Articles by Tatasciore, A. Articles by De Caterina, R. Related Collections Cerebrovascular disease/stroke Risk Factors Other hypertension Hypertrophy Clinical Studies Related Article

(Hypertension. 2007;50:325.)
© 2007 American Heart Association, Inc.

Original Articles

Awake Systolic Blood Pressure Variability Correlates With Target-Organ Damage in Hypertensive Subjects

Alfonso Tatasciore; Giulia Renda; Marco Zimarino; Manola Soccio; Grzegorz Bilo; Gianfranco Parati; Giuseppe Schillaci; Raffaele De Caterina

From the Institute of Cardiology and Center of Excellence on Aging (A.T., G.R., M.Z., M.S., R.D.C.), "G. d’Annunzio" University, Chieti; the Department of Cardiology (G.B., G.P.), S. Luca Hospital, Italian Auxologic Institute & Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan; and the Department of Clinical and Experimental Medicine (G.S.), the University of Perugia, Italy.

Correspondence to Raffaele De Caterina, MD, PhD, Institute of Cardiology, "G. d’Annunzio" University—Chieti, c/o Ospedale S. Camillo de Lellis, Via Forlanini, 50, 66100 Chieti, Italy. E-mail rdecater{at}unich.it

Growing evidence associates blood pressure (BP) variability with cardiovascular events in hypertensive patients. Here we tested the existence of a relationship between awake BP variability and target-organ damage in subjects referred for suspected hypertension. Systolic and diastolic BP variability were assessed as the standard deviation of the mean out of 24-hour, awake and asleep BP recordings in 180 untreated subjects, referred for suspected hypertension. Measurements were done at 15-minute intervals during daytime and 30-minute intervals during nighttime. Left ventricular mass index (by echo), intima-media thickness (by carotid ultrasonography), and microalbuminuria were assessed as indices of cardiac, vascular and renal damage, respectively. Intima-media thickness and left ventricular mass index progressively increased across tertiles of awake systolic BP variability (P for trend=0.001 and 0.003, respectively). Conversely, microalbuminuria was similar in the 3 tertiles (P=NS). Multivariable analysis identified age (P=0.0001), awake systolic BP (P=0.001), awake systolic BP variability (P=0.015) and diastolic BP load (P=0.01) as independent predictors of intima-media thickness; age (P=0.0001), male sex (P=0.012), awake systolic (P=0.0001) and diastolic BP (P=0.035), and awake systolic BP variability (P=0.028) as independent predictors of left ventricular mass index; awake systolic BP variability (P=0.01) and diastolic BP load (P=0.01) as independent predictors of microalbuminuria. Therefore, awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels. Such relationship, found in subjects referred for recently suspected hypertension, likely appears early in the natural history of hypertension.

Key Words: hypertension • blood pressure variability • target-organ damage • intima-media thickness • left ventricular mass index

Related Article:

Is the Case for ABPM as a Routine Investigation in Clinical Practice Not Overwhelming?

Eoin O’Brien
Hypertension 2007 50: 284-286. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				J. T. Becker, L. Kingsley, J. Mullen, B. Cohen, E. Martin, E. N. Miller, A. Ragin, N. Sacktor, O. A. Selnes, B. R. Visscher, et al. Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men Neurology, October 20, 2009; 73(16): 1292 - 1299. [Abstract] [Full Text] [PDF]

				K. McConnell, V. K. Somers, T. Kimball, S. Daniels, R. VanDyke, M. Fenchel, A. Cohen, P. Willging, A. Shamsuzzaman, and R. Amin Baroreflex Gain in Children with Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., July 1, 2009; 180(1): 42 - 48. [Abstract] [Full Text] [PDF]

				A. Ceroni, L. J. Chaar, R. L. Bombein, and L. C. Michelini Chronic absence of baroreceptor inputs prevents training-induced cardiovascular adjustments in normotensive and spontaneously hypertensive rats Exp Physiol, June 1, 2009; 94(6): 630 - 640. [Abstract] [Full Text] [PDF]

				A. E. Simms, J. F. R. Paton, A. E. Pickering, and A. M. Allen Amplified respiratory-sympathetic coupling in the spontaneously hypertensive rat: does it contribute to hypertension? J. Physiol., February 1, 2009; 587(3): 597 - 610. [Abstract] [Full Text] [PDF]

				F. Lopez-Jimenez, F. H. Sert Kuniyoshi, A. Gami, and V. K. Somers Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease Chest, March 1, 2008; 133(3): 793 - 804. [Full Text] [PDF]

				M. F. Schreuder, J. A.E. van Wijk, and H. A. Delemarre-van de Waal Increased Blood Pressure Variability in Aging Rats After Intrauterine Growth Restriction Hypertension, November 1, 2007; 50(5): e158 - e158. [Full Text] [PDF]

				E. O'Brien Is the Case for ABPM as a Routine Investigation in Clinical Practice Not Overwhelming? Hypertension, August 1, 2007; 50(2): 284 - 286. [Full Text] [PDF]