Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects

Hypertension. 2007 Aug;50(2):325-32. doi: 10.1161/HYPERTENSIONAHA.107.090084. Epub 2007 Jun 11.


Growing evidence associates blood pressure (BP) variability with cardiovascular events in hypertensive patients. Here we tested the existence of a relationship between awake BP variability and target-organ damage in subjects referred for suspected hypertension. Systolic and diastolic BP variability were assessed as the standard deviation of the mean out of 24-hour, awake and asleep BP recordings in 180 untreated subjects, referred for suspected hypertension. Measurements were done at 15-minute intervals during daytime and 30-minute intervals during nighttime. Left ventricular mass index (by echo), intima-media thickness (by carotid ultrasonography), and microalbuminuria were assessed as indices of cardiac, vascular and renal damage, respectively. Intima-media thickness and left ventricular mass index progressively increased across tertiles of awake systolic BP variability (P for trend=0.001 and 0.003, respectively). Conversely, microalbuminuria was similar in the 3 tertiles (P=NS). Multivariable analysis identified age (P=0.0001), awake systolic BP (P=0.001), awake systolic BP variability (P=0.015) and diastolic BP load (P=0.01) as independent predictors of intima-media thickness; age (P=0.0001), male sex (P=0.012), awake systolic (P=0.0001) and diastolic BP (P=0.035), and awake systolic BP variability (P=0.028) as independent predictors of left ventricular mass index; awake systolic BP variability (P=0.01) and diastolic BP load (P=0.01) as independent predictors of microalbuminuria. Therefore, awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels. Such relationship, found in subjects referred for recently suspected hypertension, likely appears early in the natural history of hypertension.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Analysis of Variance
  • Blood Pressure Monitoring, Ambulatory
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / epidemiology
  • Carotid Artery Diseases / physiopathology*
  • Circadian Rhythm*
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / epidemiology
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / epidemiology
  • Hypertrophy, Left Ventricular / physiopathology*
  • Incidence
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Probability
  • Prognosis
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Tunica Intima / diagnostic imaging
  • Tunica Intima / physiopathology
  • Ultrasonography