Abstract 10276: Visit-to-visit Blood Pressure Variations: New Independent Determinants for Carotid Artery Measures in the High Risk Elderly of Cardiovascular Disease.
Background: Recently, visit-to-visit variability in clinic systolic blood pressure (SBP) and maximum SBP have been shown to be strong predictors of stroke. However, the relationship between visit-to-visit BP variation and vascular risk is not clear. In this study, we investigated the relationship of visit-to-visit BP variations with intima-media thickness (IMT) and stiffness in the common carotid artery (CCA).
Method: BP measurement and carotid ultrasoundsonography in CCA were performed among 201 elderly subjects (79.9±6.4 years old, female 75%) with one or more cardiovascular risks (hypertension, diabetes, dyslipidemia, and smoking). From 12 visits (once a month), visit-to-visit BP variability (expressed as standard deviation [SD]), maximum, minimum, and delta (maximum-minimum) BP were measured.
Result: Max-IMT was significantly correlated with age (r=0.18), female gender (r=−0.27), smoking (r=0.15), high density lipoprotein (HDL) (r=−0.18), minimum (r=−0.16) and delta (r=0.25) in SBP. Stiffness parameter β (SPβ) was significantly correlated with age (r=0.29), smoking (r=−0.14), HDL (r=−0.18), SD (r=0.17), maximum (r=0.18) and delta (r=0.22) in SBP, and mean (r=−0.15), SD (r=0.18), minimum (r=−0.23), and delta (r=0.23) in diastolic BP (DBP). In the multiple linear regression analysis, the delta SBP was significantly associated with max-IMT (p=0.0003) after adjustment for age, gender, smoking, and lower HDL level. The delta SBP (p=0.04), and mean (p=0.048), SD (p=0.04), minimum (p=0.01), and delta (p=0.008) in DBP were significantly associated with SPβ after adjustment for age, smoking, and lower HDL level. These relationships of delta in both SBP and DBP with max-IMT and SPβ remained significant even after adjustment for mean SBP or DBP.
Conclusion: In the high risk elderly, exaggerated visit-to-visit BP fluctuations were strong indicators for carotid artery atherosclerosis and stiffness, independent of mean BP. Visit-to-visit BP variations may act as a causal link of stroke via cerebral arteriopathy.
- © 2010 by American Heart Association, Inc.