Abstract
Blood pressure variability is one of the characteristic features of hypertension in the elderly. However, its clinical significance remains to be determined. We therefore examined the impact of blood pressure variability on the development of cardiovascular events in elderly hypertensive patients. A total of 106 consecutive hypertensive patients aged more than 60 years old (mean age, 73.9±8.1 years old; male, 54%), all of whom underwent 24-h ambulatory blood pressure monitoring, were followed up (median, 34 months; range, 3−60 months). During the follow-up period, 39 cardiovascular events were observed, including 14 cases of cerebral infarction and 7 cases of acute myocardial infarction. The coefficient of variation (CV) of 24-h systolic blood pressure (SBP) values was used as an index of blood pressure variability. The patients showed a mean CV value of 10.6%, and were divided into two groups according to this mean value as a cut-off point: a high CV group (n=46) and a low CV group (n=60). Although baseline clinical characteristics were similar in the two groups, Kaplan-Meier plots for event-free survival revealed that the rate of cardiovascular events was significantly higher in high CV group than in low CV group (p<0.05). Cox's proportional hazards analysis showed that increased blood pressure variability (a high CV value of 24-h SBP) was an independent predictive variable for cardiovascular events. The CV value of daytime SBP and the SD value of both 24-h SBP and daytime SBP also had positive correlations with the onset of cardiovascular events. These results suggest that increased blood pressure variability may be an independent risk factor for cardiovascular events in elderly hypertensive patients.
Similar content being viewed by others
Article PDF
References
Kannel WB : Blood pressure as a cardiovascular risk factor. Prevention and treatment. JAMA 1996; 275: 1571– 1576.
National High Blood Pressure Education Program Working Group : National High Blood Pressure Education Program Working Group report on hypertension in the elderly. Hypertension 1994; 23: 275– 285.
Vogat TM, Ireland CC, Black D, Camel G, Hughes G : Recruitment of elderly volunteers for a multicenter clinical trial: the SHEP Pilot Study. Control Clin Trials 1986; 7: 118– 133.
Floras JS, Hassan MO, Jones JV, Osikowska BA, Sever PS, Sleight P : Factors influencing blood pressure and heart rate variability in hypertensive humans. Hypertension 1988; 11: 273– 281.
Convanico V, De Caprio L, Vigorito C, et al : Differences in blood pressure profile between young and elderly hypertensive patients. J Hum Hypertens 1990; 4: 405– 409.
Rutan GH, Hermanson B, Bild DE, Kittner SJ, LaBaw F, Tell GS : Orthostatic hypotension in older adults. The Cardiovascular Health Study. Hypertension 1992; 19: 508– 519.
Appelegate WB, Davis BR, Black HR, Smith WM, Miller ST, Burlando AJ : Prevalence of postural hypotension at baseline in the Systolic Hypertension in the Elderly Program (SHEP) cohort. J Am Geriatr Soc 1991; 39: 1057– 1064.
Jansen RWMM, Lipsitz LA : Postprandial hypotension: epidemiology, pathophysiology and clinical management. Ann Intern Med 1995; 122: 286– 295.
Shimada K, Kitazumi T, Sadakane N, Ogura H, Ozawa T : Age-related changes in baroreflex function, plasma norepinephrine and blood pressure. Hypertension 1985; 7: 113– 117.
Gribbin B, Pickering LTG, Slight P, Petro R : Effects of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424.
Drayer JIM, Weber MA, DeYoung JL, Wyle FA : Circadian blood pressure patterns in ambulatory hypertensive patients. Effects of age. Am J Med 1982; 73: 493– 499.
White WB, Lund-Johansen P, McCabe EJ : Clinical evaluation of the Colin ABPM 630 at rest and during exercise: an ambulatory blood pressure monitoring with gas-powered cuff inflation. J Hypertens 1989; 7: 477– 483.
SHEP Cooperative Research Group : Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255– 3264.
Staessen JA, Fagard R, Thijis L, et al : Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757– 764.
O'Brien E, Sheridan J, O'Malley K : Dippers and non-dippers. Lancet 1988; ii: 397.
Kario K, Shimada K : Change in diurnal blood pressure rhythm due to small lacunar infarct. Lancet 1994; 344: 200.
Kario K, Matsuo T, Kobayashi H, Imiya M, Matsuo M, Shimada K : Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension 1996; 27: 130– 135.
Shimada K, Kawamoto A, Matsubayashi K, Nishinaga M, Kimura S, Ozawa T : Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension. J Hypertens 1992; 10: 875– 878.
Suzuki Y, Kuwajima I, Kanemaru A, et al : The cardiac function reserve in elderly hypertensive patients with abnormal diurnal change in blood pressure. J Hypertens 1992; 10: 173– 179.
Verdecchia P, Shillaci G, Guerrieri M, et al : Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528– 536.
Kikuya M, Sugimoto K, Katsuya T, et al : A/C1166 gene polymorphism of the angiotensin II type 1 receptor (AT1) and ambulatory blood pressure: the Ohasama Study. Hypertens Res 2003; 26: 141– 145.
Kario K, Schwartz JE, Gerin W, Robayo N, Maceo E, Pickering TG : Psychological and physical stress-induced cardiovascular reactivity and diurnal blood pressure variation in women with different work shifts. Hypertens Res 2002; 25: 543– 551.
Kario K, James GD, Marion R, Ahmed M, Pickering TG : The influence of work- and home-related stress on the levels and diurnal variation of ambulatory blood pressure and neurohumoral factors in employed women. Hypertens Res 2002; 25: 499– 506.
Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G : Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987; 5: 93– 98.
Frattola A, Parati G, Cuspidi C, Albini F, Mancia G : Prognostic value of 24-hour blood pressure variability. J Hypertens 1993; 11: 1133– 1137.
Sander D, Kukla C, Klingelhofer J, Winbeck K, Conrad B : Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: a 3-year follow-up study. Circulation 2000; 102: 1536– 1541.
Kukla C, Sander D, Schwarze J, Wittich I, Klingelhofer J : Changes of circadian blood pressure patterns are associated with the occurence of lucunar infarction. Arch Neurol 1998; 55: 683– 688.
Veerman DP, de Blok K, van Montfrans A : Relationship of steady state and ambulatory blood pressure variability to left ventricular mass and urinary albumin excretion in essential hypertension. Am J Hypertens 1996; 9: 455– 460.
Sega R, Corrao G, Bombelli M, et al : Blood pressure variability and organ damage in a general population: results from the PAMELA study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertension 2002; 39: 710– 714.
Kanemaru A, Kanemaru K, Kuwajima I : The effects of short-term blood pressure variability and nighttime blood pressure levels on cognitive function. Hypertens Res 2001; 24: 19– 24.
Kikuya M, Hozawa A, Ohokubo T, et al : Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension 2000; 36: 901– 906.
Appenzeller O, Descarries L : Circulatory reflexes in patients with cerebrovascular disease. N Engl J Med 1964; 271: 820– 823.
Sasaki S, Yoneda Y, Fujita H, et al : Association of blood pressure variability with induction of atherosclerosis in cholesterol-fed rats. Am J Hypertens 1994; 7: 453– 459.
van Vliet BN, Hu L, Scott T, Chafe L, Montani JP : Cardiac hypertrophy and telemetered blood pressure 6 wk after baroreceptor denervation in normotensive rats. Am J Physiol 1996; 271: R1759– R1769.
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.
Mancia G, Omboni S, Rovogli A, Parati G, Zanchetti A : Ambulatory blood pressure monitoring in the evaluation of antihypertensive treatment: additional information from a large data base. Blood Press 1995; 4: 148– 156.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eto, M., Toba, K., Akishita, M. et al. Impact of Blood Pressure Variability on Cardiovascular Events in Elderly Patients with Hypertension. Hypertens Res 28, 1–7 (2005). https://doi.org/10.1291/hypres.28.1
Received:
Accepted:
Issue date:
DOI: https://doi.org/10.1291/hypres.28.1
Keywords
This article is cited by
-
Extent of, and variables associated with, blood pressure variability among older subjects
Aging Clinical and Experimental Research (2018)
-
Short-term blood pressure variability and long-term blood pressure variability: which one is a reliable predictor for recurrent stroke
Journal of Human Hypertension (2017)
-
Home blood pressure and cardiovascular risk in treated hypertensive patients: the prognostic value of the first and second measurements and the difference between them in the HONEST study
Hypertension Research (2016)
-
Blood pressure variability in controlled and uncontrolled blood pressure and its association with left ventricular hypertrophy and diastolic function
Journal of Human Hypertension (2016)
-
Comparative effects of telmisartan and valsartan as add-on agents for hypertensive patients with morning blood pressure insufficiently controlled by amlodipine monotherapy
Hypertension Research (2014)
