Blood Pressure Variability and Blood Pressure Load
A large body of evidence has consistently supported the relationship between blood pressure (BP) levels and the risk of cardiovascular complications. A series of studies in the last decades have indicated that this risk may not only depend on the magnitud
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Blood Pressure Variability and Blood Pressure Load Gianfranco Parati and Juan Eugenio Ochoa
3.1
Introduction
Blood pressure (BP) values change significantly over time as a result of the interaction between extrinsic environmental and behavioral factors and intrinsic cardiovascular regulatory mechanisms. Although these variations represent a continuous phenomenon, they may be evaluated over different time windows: from beat to beat [very short-term BP variability (BPV)], within 24 h (from minute to minute, hour to hour, and from day to night; short-term BPV), over different days (mid-term BPV), or between clinic visits performed over weeks, months, seasons, and years (long-term BPV) [1]. These different types of BPV appear to be influenced by several cardiovascular regulatory mechanisms and by subjects’ individual characteristics. While in physiological conditions, these variations may represent a response to environmental stimulations from daily life, they may also reflect, however, alterations in mechanisms responsible for cardiovascular homeostasis. Over the last decades, a series of experimental and clinical studies have indicated that increased BPV (either in the short- or in the long term) is associated with development, progression, and severity of cardiac, vascular, and renal target organ damage (TOD) and with an increased risk of cardiovascular events and cardiovascular and all-cause mortality (Fig. 3.1). The analysis of 24 h ABP recordings allows not only the quantification of average BP levels and of BP fluctuations over the recording period but also the assessment of the so-called BP
G. Parati (*) Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy e-mail: [email protected] J. E. Ochoa Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_3
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↑SOD † ↑CV events (stroke, Ml) ↑CV mortality ↑All cause mortality ↑MA and proteinuria ↑eGFR, progression to ESRD
↑short term BPV (over 24h)
↑SOD † ↑CV events (stroke, Ml) ↑CV mortality ↑All cause mortality ↑MA ↑eGFR
↑Mid term BPV (day-to-day)
Improper dosing or titration of AHT ↓ Arterial compliance Age
↑SOD † ↑CV events (stroke, Ml) ↑CV mortality ↑Non-CV mortality ↑All cause mortality ↑MA and proteinuria ↑eGFR
↑Long term BPV (visit-to-visit
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