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(Hypertension. 2006;47:137.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Prognostic Relevance of Blood Pressure Variability

Gianfranco Parati; Mariaconsuelo Valentini

From the Department of Clinical Medicine, Prevention, and Applied Biotechnology, University of Milano-Bicocca, and II Cardiology Unit, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy.

Correspondence to Gianfranco Parati, MD, Dept of Clinical Medicine, San Luca Hospital, Istituto Auxologico Italiano, Via Spagnoletto, 3, 20149 Milan; Italy. E-mail gianfranco.parati@unimib.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The possible prognostic relevance of different patterns characterizing blood pressure (BP) fluctuations during the day and night was first suggested in the late 1980s,¹ based on observations made possible by 24-hour continuous intraarterial ambulatory BP monitoring in normotensive and hypertensive subjects. Since then, this issue has been repeatedly addressed in studies carried out either in animals and in humans and is still matter of debate.

Evidence is available that in normal subjects 24-hour ambulatory BP recordings are characterized by a fairly smooth BP profile during daytime activities and by a significant BP decline during night sleep. Most, although not all, studies exploring the prognostic relevance of BP variations have shown that alterations in these 24-hour BP variability patterns are associated with hypertensive target organ damage and with a higher rate of cardiovascular events.² This is the case for an increased amplitude and frequency of BP variations occurring during the daytime,^3,4 the night-time,⁵ or the entire 24-hour period.⁶ It is also the case for alterations in the components of 24-hour BP variability related to the shift between wakefulness and sleep, namely the nocturnal BP decline and the morning BP surge.

A reduced degree of nocturnal BP fall, and even more so the reverse pattern characterized by a BP increase at night, has been found to be associated with cardiac, cerebral, renal, and vascular damage. Several studies have also shown that lack of nocturnal dipping carries a higher risk of stroke,^7–10 whereas conflicting findings were reported on the prognostic relevance of an . . . [Full Text of this Article]

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