Published Online
on June 11, 2007

A more recent version of this article appeared on August 1, 2007

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Submitted on February 26, 2007
Revised on March 14, 2007

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; and 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.

^* To whom correspondence should be addressed. E-mail: rdecater{at}unich.it.

Abstract--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

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