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Objective: Blood pressure variability (BPV), a non-conventional blood pressure parameter, has been shown to contribute hypertensive target organ damage but its association with diastolic dysfunction is unknown. The present study investigates the association of BPV and left ventricular diastolic dysfunction (LVDD) in middle-aged normotensive individuals.
Materials and Methods: 264 normotensive patients aged between 45 and 65 were enrolled. 24-hour ambulatory blood pressure monitoring were performed and BPV was defined as the standard deviation of systolic blood pressure measurements. Patients were divided into 3 groups according to BPV tertiles. Echocardiographic and tissue doppler diastolic function parameters were compared among the groups.
Results: Mean age of the patients were 50.41 and similar among groups. Mitral inflow E/A (Tertile 1 vs 2 vs 3: 1.10[0.33] vs 1.05 [0.22] vs 1.02 [0.30], p=0.02) and average tissue doppler mitral annular E’ velocity (12  vs 10.5 [1.85] vs 10 [1.55], p=0.02) were highest in the tertile 1 and lowest in the tertile 3. Average E/E’ (Tertile 1 vs 2 vs 3: 7.2 [2.2] vs 8.1 [3.2] vs 9.3 [2.9], p<0.001) was lowest in the tertile 1 and highest in the tertile 3. In addition, there was a positive correlation between BPV and Average E/E’ (Rs =0.401, p<0.001). In contrary, E/A (Rs =- 0.286, p<0.001) and average E’ (Rs =- 0.451, p<0.001) were negatively correlated with BPV.
Conclusion: BPV is positively correlated with average E/E’ and negatively correlated with E/A and average E’. Further studies are required to elucidate the relationship of BPV and LVDD.
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Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013; 10: 143- 155 DOI: https://doi.org/10.1038/nrcardio.2013.1
Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. J Clin Hypertens (Greenwich). 2018 Jul;20(7):1133-1137. doi: 10.1111/jch.13304. DOI: https://doi.org/10.1111/jch.13304
Borlaug BA, Kane GC, Melenovsky V, Olson TP. Abnormal right ventricular-pulmonary artery coupling with exercise in heart failure with preserved ejection fraction. Eur Heart J 2016;37:3293–302. DOI: https://doi.org/10.1093/eurheartj/ehw241
Redfield MM, Jacobsen SJ, Burnett JC Jr, et al. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003;289:194–202 DOI: https://doi.org/10.1001/jama.289.2.194
Gaasch WH, Zile MR. Left ventricular diastolic dysfunction and diastolic heart failure. Annu Rev Med 2004;55:373–94. DOI: https://doi.org/10.1146/annurev.med.55.091902.104417
Katz DH, Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KY, Peng J, Sha J, Irvin MR, Eckfeldt JH, Turner ST, Freedman BI, Arnett DK, Shah SJ. Association of low-grade albuminuria with adverse cardiac mechanics: findings from the hypertension genetic epidemiology network (HyperGEN) study. Circulation. 2014 Jan 7;129(1):42-50. doi: 10.1161/CIRCULATIONAHA.113.003429. DOI: https://doi.org/10.1161/CIRCULATIONAHA.113.003429
González A, Ravassa S, Beaumont J, López B, Díez J. New targets to treat the structural remodeling of the myocardium. J Am Coll Cardiol. 2011 Oct 25;58(18):1833-43. doi: 10.1016/j.jacc.2011.06.058. DOI: https://doi.org/10.1016/j.jacc.2011.06.058
Mancia G, Zanchetti A. Blood pressure variability. In: Zanchetti A, Tarazi R, editors. Handbook of Hypertension. Pathophysiology of hypertension. 7th ed. Amsterdam: Elsevier; 1986. p. 125–52.
Mancia G, Ferrari A, Gregorini L, et al. Blood pressure and heart rate variabilities in normotensive and hypertensive human beings. Circ Res. 1983;53:96–104. DOI: https://doi.org/10.1161/01.RES.53.1.96
Frattola A, Parati G, Cuspidi C, Albini F,Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens. 1993;11:1133–7. DOI: https://doi.org/10.1097/00004872-199310000-00019
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;39:710–4. DOI: https://doi.org/10.1161/hy0202.104376
Kikuya M, Hozawa A, Ohokubo T, et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension. 2000;36:901–6. DOI: https://doi.org/10.1161/01.HYP.36.5.901
Mancia G, Bombelli M, Facchetti R, 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;49:1265–70. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.107.088708
Pringle E, Phillips C, Thijs L, Syst-Eur investigators, et al. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens. 2003;21:2251–7. DOI: https://doi.org/10.1097/00004872-200312000-00012
Dawson SL, Manktelow BN, Robinson TG, Panerai RB, Potter JF. Which parameters of beat-to-beat blood pressure and variability best predict early outcome after acute ischemic stroke? Stroke. 2000;31:463–8. DOI: https://doi.org/10.1161/01.STR.31.2.463
Narkiewicz K, Winnicki M, Schroeder K, et al. Relationship between muscle sympathetic nerve activity and diurnal blood pressure profile. Hypertension. 2002;39:168–72. DOI: https://doi.org/10.1161/hy1201.097302
Rouleau JL, Packer M, Moyé L, et al. Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: effect of captopril. J Am Coll Cardiol. 1994;24:583–91. DOI: https://doi.org/10.1016/0735-1097(94)90001-9