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Gianfranco Parati - One of the best experts on this subject based on the ideXlab platform.
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Blood Pressure Variability: clinical relevance and application.
Journal of Clinical Hypertension, 2018Co-Authors: Gianfranco Parati, George S. Stergiou, Eamon Dolan, Grzegorz BiloAbstract:Blood Pressure Variability is an entity that characterizes the continuous and dynamic fluctuations that occur in Blood Pressure levels throughout a lifetime. This phenomenon has a complex and yet not fully understood physiological background and can be evaluated over time spans ranging from seconds to years. The present paper provides a short overview of methodological aspects, clinical relevance, and potential therapeutic interventions related to the management of Blood Pressure Variability.
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Arterial Stiffness and Blood Pressure Variability
2015Co-Authors: Gianfranco Parati, Juan Eugenio Ochoa, Paolo Salvi, Giuseppe SchillaciAbstract:Epidemiological evidence has indicated that the risk of cardiovascular complications associated with hypertension may not only depend on the magnitude of Blood Pressure elevation per se, but also, on the presence of increased Blood Pressure Variability. Although the neurogenic influences to the peripheral vasculature and the heart are major determinants of Blood Pressure fluctuations (in particular in the short-term), evidence has also been provided that the degree of Blood Pressure Variability is directly related to stiffness of large arteries, that is, known to be a strong and independent predictor of cardiovascular risk. The aim of this chapter is to critically review the evidence exploring the association between large artery stiffness and different components of Blood Pressure Variability (BPV, i.e., short-term, mid-term, and long-term BPV) focusing on potential mechanisms underlying this relationship that is, alterations in carotid baroreflex and arterial mechanical properties.
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Mechanisms of Blood Pressure Variability in man.
Clinical and Experimental Hypertension, 2009Co-Authors: Giuseppe Mancia, Gianfranco Parati, M. Di Rienzo, G. Bertinieri, Anita Cavallazzi, Guido Pomidossi, Agustin J. Ramirez, Alberto ZanchettiAbstract:This paper will touch on three points derived from the studies our group has performed by means of continuous 24 hour Blood Pressure recording in humans. The first point will concern a description of the factors involved in the production of spontaneous Blood Pressure Variability and in particular of our evidence that the magnitude of this phenomenon depends on arterial baroreflexes but also, and perhaps to a larger extent, on central modulation of the cardiovascular system. The second point will deal with the differences in Blood Pressure Variability we have observed in subjects with normal and high Blood Pressure. Finally, the third point will briefly address the changes in Blood Pressure Variability that take place with ageing.
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Blood Pressure Variability: its measurement and significance in hypertension.
Journal of Hypertension, 2005Co-Authors: Gianfranco ParatiAbstract:The occurrence of Blood Pressure fluctuations over time has been documented since the 18th century, but the clinical importance of this phenomenon is only now being recognized. The introduction of ambulatory Blood Pressure monitoring in the late 1960s represented a major step forward in the study of Blood Pressure behaviour and helped to characterize the relationship between Blood Pressure Variability and cardiovascular disease. In hypertension, Blood Pressure Variability increases with increasing Blood Pressure and correlates closely with target-organ damage, independently of absolute Blood Pressure values. This has important consequences for treatment, which in the past has focused on reducing mean Blood Pressure values as the main goal. Experimental evidence suggests that drugs capable of buffering or reducing Blood Pressure Variability may confer additional benefits on target-organ protection. Effective target-organ protection could best be afforded by antihypertensive agents that provide efficient 24-h Blood Pressure control and also stabilize Blood Pressure Variability. Mathematical indices, such as the trough:peak ratio and the smoothness index, provide useful measures of the homogeneity of the antihypertensive effect over 24 h; optimum control is provided by drugs with a trough:peak ratio close to 1 and a smoothness index > 1, as is observed with long-acting drugs such as telmisartan or amlodipine. Recently, a direct relationship was demonstrated between homogeneous Blood Pressure control and treatment-induced regression of left ventricular hypertrophy, emphasizing the importance of smooth 24-h Blood Pressure control. In conclusion, the goals of antihypertensive treatment should consider the reduction of both 24-h mean Blood Pressure and its Variability. Long-lasting drugs or drug combinations are preferable to ensure a homogeneous and smooth 24-h Blood Pressure profile.
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Blood Pressure Variability and silent cerebral damage in essential hypertension.
American Journal of Hypertension, 2004Co-Authors: Elisenda Gómez-angelats, Gianfranco Parati, Giuseppe Mancia, Alejandro De La Sierra, Cristina Sierra, Antonio CocaAbstract:Background It is recognized that Blood Pressure (BP) Variability has prognostic significance in determining target organ damage and cardiovascular mortality and morbidity. The aim of this study was to analyze the association between Blood Pressure Variability and the presence of silent cerebral white matter lesions in middle-aged asymptomatic essential hypertensives. Methods We studied 43 middle-aged untreated hypertensive patients. Blood Pressure variabilities (short-term and long-term) were evaluated by using both non-invasive, beat-to-beat, continuous finger 24-hour monitoring (Portapres) and oscillometric automated discontinuous ambulatory Blood Pressure monitoring. All patients underwent cerebral magnetic resonance imaging to detect the presence or not of white matter lesions. Results Hypertensive patients with cerebral white matter lesions exhibited significantly higher values of long-term systolic Blood Pressure Variability (standard deviation of 24-hour Blood Pressure) measured both by continuous beat-to-beat monitoring (16.2 ± 3.7 v 13.7 ± 3.6 mmHg; P = 0.047) and by ambulatory Blood Pressure monitoring (15.2 ± 3.8 v 12.8 ± 2.7 mmHg; P = 0.022). However, these differences were not independent on Blood Pressure elevation and did not maintain their significance after adjusting for 24-hour systolic Blood Pressure. Neither short-term systolic Blood Pressure Variability, nor short-term or long-term diastolic Blood Pressure variabilities showed differences between patients with and without white matter lesions. Conclusion The present study indicates that long-term systolic Blood Pressure Variability is significantly related to the presence of silent cerebral white matter lesions in essential hypertensive patients, although this relationship is partially dependent on absolute Blood Pressure elevation.
Giuseppe Mancia - One of the best experts on this subject based on the ideXlab platform.
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Mechanisms and clinical implications of Blood Pressure Variability.
Journal of Cardiovascular Pharmacology, 2016Co-Authors: Giuseppe Mancia, Guido GrassiAbstract:Several studies have unequivocally shown that the target-organ damage associated with the hypertensive condition is more closely related to 24 h average Blood Pressure values than to clinic Blood Pressure. Blood Pressure, however, is highly variable over the daytime and night-time period, and of major interest is whether average 24 h Blood Pressure values, as well as 24 h Blood Pressure Variability, correlate with, and are possibly responsible for, the hypertension-related alterations of the target-organ structure and function. This paper will address this issue by discussing the main features of Blood Pressure Variability in hypertension. It will also examine the mechanisms involved in this phenomenon, with particular emphasis on the pathogenetic role of sympathetic neural factors. The clinical relevance of Blood Pressure Variability in promoting target-organ damage, as well as its therapeutic implications, will finally be highlighted.
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Mechanisms of Blood Pressure Variability in man.
Clinical and Experimental Hypertension, 2009Co-Authors: Giuseppe Mancia, Gianfranco Parati, M. Di Rienzo, G. Bertinieri, Anita Cavallazzi, Guido Pomidossi, Agustin J. Ramirez, Alberto ZanchettiAbstract:This paper will touch on three points derived from the studies our group has performed by means of continuous 24 hour Blood Pressure recording in humans. The first point will concern a description of the factors involved in the production of spontaneous Blood Pressure Variability and in particular of our evidence that the magnitude of this phenomenon depends on arterial baroreflexes but also, and perhaps to a larger extent, on central modulation of the cardiovascular system. The second point will deal with the differences in Blood Pressure Variability we have observed in subjects with normal and high Blood Pressure. Finally, the third point will briefly address the changes in Blood Pressure Variability that take place with ageing.
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Blood Pressure Variability and silent cerebral damage in essential hypertension.
American Journal of Hypertension, 2004Co-Authors: Elisenda Gómez-angelats, Gianfranco Parati, Giuseppe Mancia, Alejandro De La Sierra, Cristina Sierra, Antonio CocaAbstract:Background It is recognized that Blood Pressure (BP) Variability has prognostic significance in determining target organ damage and cardiovascular mortality and morbidity. The aim of this study was to analyze the association between Blood Pressure Variability and the presence of silent cerebral white matter lesions in middle-aged asymptomatic essential hypertensives. Methods We studied 43 middle-aged untreated hypertensive patients. Blood Pressure variabilities (short-term and long-term) were evaluated by using both non-invasive, beat-to-beat, continuous finger 24-hour monitoring (Portapres) and oscillometric automated discontinuous ambulatory Blood Pressure monitoring. All patients underwent cerebral magnetic resonance imaging to detect the presence or not of white matter lesions. Results Hypertensive patients with cerebral white matter lesions exhibited significantly higher values of long-term systolic Blood Pressure Variability (standard deviation of 24-hour Blood Pressure) measured both by continuous beat-to-beat monitoring (16.2 ± 3.7 v 13.7 ± 3.6 mmHg; P = 0.047) and by ambulatory Blood Pressure monitoring (15.2 ± 3.8 v 12.8 ± 2.7 mmHg; P = 0.022). However, these differences were not independent on Blood Pressure elevation and did not maintain their significance after adjusting for 24-hour systolic Blood Pressure. Neither short-term systolic Blood Pressure Variability, nor short-term or long-term diastolic Blood Pressure variabilities showed differences between patients with and without white matter lesions. Conclusion The present study indicates that long-term systolic Blood Pressure Variability is significantly related to the presence of silent cerebral white matter lesions in essential hypertensive patients, although this relationship is partially dependent on absolute Blood Pressure elevation.
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Blood Pressure Variability as a risk factor.
Blood Pressure Monitoring, 2001Co-Authors: Gianfranco Parati, Giuseppe ManciaAbstract:Blood Pressure Variability is clinically relevant because of the evidence that the degree of Blood Pressure fluctuation may independently contribute to organ damage and to the cardiovascular risk of hypertensive patients. This review will focus on the evidence available to support this concept. As s
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Blood Pressure Variability
Italian heart journal: official journal of the Italian Federation of Cardiology, 2001Co-Authors: Gianfranco Parati, Elena Tortorici, Fabio Glavina, D. Zaniboni, S. Gritti, A. Groppelli, P. Castiglioni, M. Di Rienzo, Giuseppe ManciaAbstract:This review deals with a number of issues related to Blood Pressure Variability. These include: historical aspects, with reference to the first pioneering observations; methodological aspects, focusing on the different methods for quantifying Blood Pressure Variability; description of the characteristics of Blood Pressure Variability over the 24 hours; mechanisms involved in determining the different magnitude of this phenomenon in different subjects, such as behavioral factors, central and reflex neural influences, humoral and mechanical factors; Blood Pressure Variability as a probe to assess spontaneous baroreflex sensitivity; effects of aging and hypertension on Blood Pressure Variability, with a discussion of the clinical relevance of this phenomenon in the prognostic evaluation of patients; effects of drugs on Blood Pressure Variability. Finally methodological aspects related to the use of noninvasive ambulatory Blood Pressure monitoring in the assessment of Blood Pressure Variability are discussed.
Johan Sundrom - One of the best experts on this subject based on the ideXlab platform.
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prognostic impact of systolic Blood Pressure Variability in people with diabetes
PLOS ONE, 2018Co-Authors: Katy J L Bell, Lamiae Azizi, Peter M Nilsson, Andrew Hayen, Les Irwig, Carl Johan Ostgren, Johan SundromAbstract:Objective: Blood Pressure Variability (BPV) has been associated with risk of cardiovascular events in observational studies, independently of mean BP levels. In states with higher autonomic imbalan ...
A. Frattola - One of the best experts on this subject based on the ideXlab platform.
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Blood Pressure Variability. Importance in research and in clinical hypertension.
Arquivos Brasileiros De Cardiologia, 1996Co-Authors: Gianfranco Parati, M. Di Rienzo, A. Frattola, G. ManciaAbstract:mean value, but also 24h Blood Pressure Variability seems to be independently related to the end organ damage of hypertension. This is illustrated in figure 1, which is taken from a study where 108 hypertensive patients underwent a 24h intra-arterial Blood Pressure monitoring in ambulatory conditions by Oxford technique 16. A score based on clinical and laboratory examinations was used to quantify the severity and the rate of end organ damage related to hypertension. The 108 patients were subdivided into five groups with progressively higher 24h mean Blood Pressure levels. In each group, the hypertensive patients with greater Blood Pressure Variability (evaluated as the standard deviation of the 24h mean Blood Pressure) showed more severe and more frequent end organ damage than the patients with similar 24h mean values but less pronounced 24h Blood Pressure Variability.
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Blood Pressure Variability and organ damage.
Journal of Cardiovascular Pharmacology, 1994Co-Authors: Giuseppe Mancia, Gianfranco Parati, A. Frattola, Cinzia Santucciu, Luisa UlianAbstract:Several studies have now shown that hypertension-induced end-organ damage is more closely related to 24-h average Blood Pressure than to clinic measurements. Furthermore, the degree of Variability of Blood Pressure during a 24-h period bears a relation to organ damage that is independent of average Blood Pressure value. The measurement of Blood Pressure Variability is a complex task, however, because data from automatic ambulatory Blood Pressure monitoring should be interpreted with caution, especially if the interval between Blood Pressure measurements is more than 15 min, and different types of Blood Pressure Variability (e.g., short-term and long-term) can make calculation of Variability by standard deviation of 24-h Blood Pressure values difficult, which further complicates measurement procedures and interpretation. Evidence is growing to suggest that Blood Pressure Variability in hypertension is clinically significant. We have recently shown that over a 7.5-year period, end-organ damage is independently related to the initial Blood Pressure Variability. Although information on the effect of antihypertensive treatment on 24-h Blood Pressure Variability is limited, the available data suggest more of an effect on 24-h average Blood Pressure levels than on 24-h Blood Pressure changes. Further studies should investigate treatment effects on different types of Blood Pressure Variability and the impact of treatment on patient protection and prognosis.
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prognostic value of 24 hour Blood Pressure Variability
Journal of Hypertension, 1993Co-Authors: A. Frattola, Gianfranco Parati, Cesare Cuspidi, Fabio Albini, Giuseppe ManciaAbstract:Objectives: Evaluation of the prognostic value of 24-h Blood Pressure averages and 24-h Blood Pressure Variability. Design: After an initial thorough clinical and laboratory evaluation which included 24-h continuous ambulatory Blood Pressure monitoring, a group of hypertensive patients were re-examined after an average of 7.4 years. End-organ damage at the follow-up visit was related to different measures of Blood Pressure levels and Variability obtained at the initial or the follow-up visit or both
Jan A. Staessen - One of the best experts on this subject based on the ideXlab platform.
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Blood Pressure Variability as Elusive Harbinger of Adverse Health Outcomes
Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics, 2016Co-Authors: Kei Asayama, Fang-fei Wei, Azusa Hara, Tine W. Hansen, Jan A. StaessenAbstract:Over the past decade, Blood Pressure Variability has been at the center of a debate about its value in predicting adverse cardiovascular outcomes. Blood Pressure Variability includes short-term, circadian, and long-term components. Assessment of Blood Pressure Variability requires multiple readings obtained within a single or several visits, by conventional office, home or 24-h ambulatory Blood Pressure monitoring, or by beat-to-beat recordings. Current indexes of Blood Pressure Variability raise methodological issues related to their poor reproducibility, their interdependence, and their association with the level of Blood Pressure.
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Prognosis in Relation to Blood Pressure Variability: Con Side of the Argument
Hypertension, 2015Co-Authors: Kei Asayama, Fang-fei Wei, Azusa Hara, Tine W. Hansen, Jan A. StaessenAbstract:Blood Pressure Variability includes short-term, circadian, and long-term components. Assessment of Blood Pressure Variability requires multiple readings obtained within a single or several visits, by home or 24-hour ambulatory Blood Pressure monitoring, or by beat-to-beat recordings. Factors that affect visit-to-visit and diurnal Blood Pressure Variability, as reviewed elsewhere1–6 include ethnicity,1 sex,2,3 age,2,3 hypertension,3 body mass index,2,3 use of β-blockers,3,4 a history of cardiovascular disease,2,5 renal dysfunction,5 diabetes mellitus,2 a sedentary lifestyle,5 and socioeconomic position.6 The prognostic significance of Blood Pressure Variability remains controversial. Some studies reported association of end-organ damage,7–9 cardiovascular events,4,10–15 or mortality5 with Blood Pressure Variability, whereas others failed to do so or found Variability to be inferior to the level of Blood Pressure.3,16,17 Several publications proposing that the magnitude of the morning Blood Pressure surge predicted stroke,18 in particular cerebral hemorrhage,19 or cardiovascular endpoints20 remained unconfirmed in recently published large-scale observational studies.21–23 This review will address the current controversy on the morning Blood Pressure surge, highlight the methodological problems in capturing Blood Pressure Variability, and illustrate how large international population studies and a clinical trial do not support Blood Pressure Variability as target in the management of hypertension. Current indexes of Blood Pressure Variability raise methodological issues related to their poor reproducibility, their interdependence, and their association with the level of Blood Pressure. We will use the morning surge in Blood Pressure as a showcase to highlight how inconsistent definitions and poor reproducibility limit the clinical applicability of indexes of Blood Pressure Variability. In 2003, Kario et al18 introduced 2 definitions of …
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Blood Pressure Variability in risk stratification: What does it add?
Clinical and Experimental Pharmacology and Physiology, 2013Co-Authors: Kei Asayama, Tine W. Hansen, Rudolph Schutte, Jan A. StaessenAbstract:Summary In this minireview we address the predictive value of Blood Pressure Variability, over and beyond level of Pressure, in randomly selected population samples. All reviewed studies had sufficient power, long follow-up duration and a wide age range. We assessed Blood Pressure Variability derived from home visit, self-measured home Pressure and 24 h ambulatory monitoring. The conclusions are based mainly on novel indices of Blood Pressure Variability: Variability independent of the mean, difference between maximum and minimum Blood Pressure and average real Variability. None of these Variability indices or morning surge in Blood Pressure substantially refined risk profiling over and beyond the Blood Pressure level. In risk stratification, clinicians should concentrate on Blood Pressure level, the predominant risk factor modifiable by lifestyle measures and antihypertensive drug treatment.