Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension

Am J Hypertens. 2007 Feb;20(2):154-61. doi: 10.1016/j.amjhyper.2006.07.017.


Background: The independent prognostic value of daytime and night-time blood pressure (BP) variability estimated by noninvasive 24-h BP monitoring is unclear.

Methods: We followed 2649 initially untreated subjects with essential hypertension for up to 16 years (mean, 6). Variability of BP was estimated by the standard deviation of daytime or night-time systolic BP (SBP) and diastolic BP (DBP). A BP variability either less than or equal to the group median or greater than the group median (12.7/10.4 mm Hg for daytime SBP/DBP and 10.8 and 8.9 mm Hg for night-time SBP/DBP) identified subjects at low or high BP variability.

Results: During follow-up there were 167 new cardiac and 122 new cerebrovascular events. The rate of cardiac events (x100 person-years) was higher (all P < .05) in the subjects with high than in those with low BP variability (daytime SBP: 1.45 v 0.72, daytime DBP: 1.29 v 0.91; night-time SBP: 1.58 v 0.62; night-time DBP: 1.32 v 0.85). The rate of cerebrovascular events was also higher (all P < .05) in the subjects with high than in those with low BP variability. In a multivariate analysis, after adjustment for several confounders, a high night-time SBP variability was associated with a 51% (P = .024) excess risk of cardiac events. The relation of daytime BP variability to cardiac events and that of daytime and night-time BP variability to cerebrovascular events lost significance in the multivariate analysis.

Conclusions: An enhanced variability in SBP during the night-time is an independent predictor of cardiac events in initially untreated hypertensive subjects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Pressure Monitoring, Ambulatory*
  • Blood Pressure*
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology
  • Cerebrovascular Disorders / diagnosis*
  • Cerebrovascular Disorders / etiology
  • Circadian Rhythm
  • Female
  • Humans
  • Hypertension / complications*
  • Italy
  • Male
  • Middle Aged
  • Prognosis
  • Sleep