Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Blood pressure variability and multiple organ damage in primary hypertension

Journal of Human Hypertension volume 27, pages 663–670 (2013)Cite this article

Subjects

Abstract

Organ damage (OD) is an indicator of increased cardiovascular risk. Blood pressure variability (BPV) is related to greater incidence of events, regardless of the severity of hypertension. We investigated the relationship between ambulatory blood pressure monitoring (ABPM)-derived indices of BPV and the presence of multiple OD in primary hypertension (PH). One hundred and sixty-nine untreated patients with PH were evaluated. Systolic (SBP) and diastolic blood pressure (DBP) variability were assessed as the crude and weighted (w.) standard deviation (s.d.), and average real variability (ARV) of the mean value of 24-h, awake and asleep ABPM recordings. Left ventricular mass index, intima-media thickness, estimated-glomerular filtration rate and urinary albumin excretion were assessed as indices of cardiac, vascular and renal damage, respectively. Risk profile progressively increased starting from patients without OD to patients with only one sign of OD, and then to those with multiple OD. In addition to greater severity of the organ involvement, the only variables that were found to significantly differ between subjects with multiple and single OD were office SBP (160±14 vs 154±11 mm Hg, P=0.0423) and DBP (101±7 vs 97±8 mm Hg, P=0.0291), ambulatory arterial stiffness index (AASI) (0.60±0.10 vs 0.50±0.17, P=0.0158) and indices of BPV (24-h SBP s.d., 23±5 vs 20±6 mm Hg, P=0.0300; awake SBP s.d., 22±6 vs 19±6 mm Hg, P=0.0366; 24-h SBP w.s.d., 20±5 vs 17±5 mm Hg, P=0.0385; and 24-h SBP ARV, 18±4 vs 15±5 mm Hg, P=0.0420). All the above mentioned BPV parameters turned out to be determinants of multiple OD, regardless of several confounding variables, including BP levels. Therefore, in hypertensive patients increased SBP variability is associated with multiple signs of OD, regardless of BP values.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187 . Erratum in: J Hypertens 2007; 25: 1749.

    Article  CAS  Google Scholar 

  2. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ et al. European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27: 2121–2158.

    Article  CAS  Google Scholar 

  3. Krause T, Lovibond K, Caulfield M, McCormack T, Williams B and Guideline Development Group. Management of hypertension: summary of NICE guidance. BMJ 2011; 343: d4891.

    Article  Google Scholar 

  4. Sehestedt T, Jeppesen J, Hansen TW, Wachtell K, Ibsen H, Torp-Pedersen C et al. Risk prediction is improved by adding markers of subclinical organ damage to SCORE. Eur Heart J 2010; 31: 883–891 . Erratum in: Eur Heart J 2010; 31: 1662.

    Article  Google Scholar 

  5. Olsen MH, Wachtell K, Bella JN, Palmieri V, Gerdts E, Smith G et al. Albuminuria predicts cardiovascular events independently of left ventricular mass in hypertension: a LIFE substudy. J Hum Hypertens 2004; 18: 453–459.

    Article  CAS  Google Scholar 

  6. Tsioufis C, Vezali E, Tsiachris D, Dimitriadis K, Taxiarchou E, Chatzis D et al. Left ventricular hypertrophy versus chronic kidney disease as predictors of cardiovascular events in hypertension: a Greek 6-year-follow-up study. J Hypertens 2009; 27: 744–752.

    Article  CAS  Google Scholar 

  7. Olsen MH, Wachtell K, Bella JN, Palmieri V, Gerdts E, Smith G et al. Aortic valve sclerosis and albuminuria predict cardiovascular events independently in hypertension: a losartan intervention for endpoint-reduction in hypertension (LIFE) substudy. Am J Hypertens 2005; 18: 1430–1436.

    Article  Google Scholar 

  8. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007; 49: 1265–1270.

    Article  CAS  Google Scholar 

  9. Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G . Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am J Hypertens 2007; 20: 154–161.

    Article  Google Scholar 

  10. Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K et al. International database on ambulatory blood pressure in relation to cardiovascular outcomes investigators. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension 2010; 55: 1049–1057.

    Article  CAS  Google Scholar 

  11. De Keulenaer GW, Chappell DC, Ishizaka N, Nerem RM, Alexander RW, Griendling KK . Oscillatory and steady laminar shear stress differentially affect human endothelial redox state: role of a superoxide-producing NADH oxidase. Circ Res 1998; 82: 1094–1101.

    Article  CAS  Google Scholar 

  12. Chappell DC, Varner SE, Nerem RM, Medford RM, Alexander RW . Oscillatory shear stress stimulates adhesion molecule expression in cultured human endothelium. Circ Res 1998; 82: 532–539.

    Article  CAS  Google Scholar 

  13. 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.

    Article  CAS  Google Scholar 

  14. Mancia G, Parati G, Hennig M, Flatau B, Omboni S, Glavina F et al. ELSA Investigators. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001; 19: 1981–1989.

    Article  CAS  Google Scholar 

  15. Li Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 2006; 47: 359–364.

    Article  CAS  Google Scholar 

  16. Bilo G, Giglio A, Styczkiewicz K, Caldara G, Maronati A, Kawecka-Jaszcz K et al. A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J Hypertens 2007; 25: 2058–2066.

    Article  CAS  Google Scholar 

  17. Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T . A reliable index for the prognostic significance of blood pressure variability. J Hypertens 2005; 23: 505–511.

    Article  CAS  Google Scholar 

  18. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.

    Article  Google Scholar 

  19. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH . Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 1995; 25: 1056–1062.

    Article  CAS  Google Scholar 

  20. Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G et al. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension 2007; 50: 325–532.

    Article  CAS  Google Scholar 

  21. Pringle E, Phillips C, Thijs L, Davidson C, Staessen JA, de Leeuw PW et al. Syst-Eur investigators. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens 2003; 21: 2251–2257.

    Article  CAS  Google Scholar 

  22. Shintani Y, Kikuya M, Hara A, Ohkubo T, Metoki H, Asayama K et al. Ambulatory blood pressure, blood pressure variability and the prevalence of carotid artery alteration: the Ohasama study. J Hypertens 2007; 25: 1704–1710.

    Article  CAS  Google Scholar 

  23. Lacolley P, Bezie Y, Girerd X, Challande P, Benetos A, Boutouyrie P et al. Aortic distensibility and structural changes in sinoaortic-denervated rats. Hypertension 1995; 26: 337–340.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy

    G Leoncini, F Viazzi, G Storace, G Deferrari & R Pontremoli

Authors
  1. G Leoncini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Viazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Storace
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G Deferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Pontremoli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Leoncini.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leoncini, G., Viazzi, F., Storace, G. et al. Blood pressure variability and multiple organ damage in primary hypertension. J Hum Hypertens 27, 663–670 (2013). https://doi.org/10.1038/jhh.2013.45

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.45

Keywords

This article is cited by

Search

Advanced search

Quick links