Assessment and management of blood-pressure variability

@article{Parati2013AssessmentAM,
  title={Assessment and management of blood-pressure variability},
  author={Gianfranco Parati and Juan Eugenio Ochoa and Carolina Lombardi and Grzegorz Bilo},
  journal={Nature Reviews Cardiology},
  year={2013},
  volume={10},
  pages={143-155}
}
Blood pressure (BP) is characterized by marked short-term fluctuations occurring within a 24 h period (beat-to-beat, minute-to-minute, hour-to-hour, and day-to-night changes) and also by long-term fluctuations occurring over more-prolonged periods of time (days, weeks, months, seasons, and even years). Rather than representing 'background noise' or a randomly occurring phenomenon, these variations have been shown to be the result of complex interactions between extrinsic environmental and… 

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References

SHOWING 1-10 OF 160 REFERENCES

Short- and long-term blood pressure variability: present and future.

TLDR
This article summarizes current knowledge on short-term (within the 24 hours) and long-term BP variability and discusses the relationship of BP variability with BP mean values in absence and during antihypertensive treatment, and the prognostic significance ofBP variability.

Blood pressure variability: Its measurement and significance in hypertension

TLDR
It has been suggested that drugs capable of providing smooth 24-hour BP control, reducing BPV, may confer additional target-organ protection and further studies are still needed to confirm that, in humans, interventions that can reduce BPV can also reduce the rate of cardiovascular events.

Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension.

TLDR
The findings demonstrate that the severity of hypertension is more closely related to 24-h mean BP than to cuff BP values, and confirmed that 24-H BP may be variably different from cuff BP among subjects.

Long-Term Prognostic Value of Blood Pressure Variability in the General Population: Results of the Pressioni Arteriose Monitorate e Loro Associazioni Study

TLDR
The data show that the relationship of blood pressure to prognosis is complex and that phenomena other than 24-hour mean values are involved, and provide the first evidence that short-term erratic components of blood Pressure variability play a prognostic role.

Weather-Related Changes in 24-Hour Blood Pressure Profile: Effects of Age and Implications for Hypertension Management

TLDR
The results show for the first time that hot weather is associated with an increase in systolic pressure at night in treated elderly hypertensive subjects, which may be because of a nocturnal BP escape from the effects of a lighter summertime drug regimen.

Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

TLDR
The IDACO observations support the concept that BP variability adds to risk stratification, but above all highlight that 24-h ambulatory BP level remains the main predictor to be considered in clinical practice.

Relationship Between Short-Term Blood Pressure Variability and Large-Artery Stiffness in Human Hypertension: Findings From 2 Large Databases

TLDR
It is concluded that short-term variability of 24-hour SBP shows an independent, although moderate, relation to aortic stiffness in hypertension, and this relationship is stronger with measures of BP variability focusing on short- term changes, such as ARV and weighted 24- hour SD.

Prognostic value of 24-hour blood pressure variability

TLDR
The results confirm that the level of blood pressure achieved by treatment and the degree of end-organ damage at the time of initial evaluation are important determinants of future end- Organ damage related to hypertension and constitute the first longitudinal evidence that the cardiovascular complications of hypertension may depend on the degree on 24-h blood pressure variability.

Mechanisms and clinical implications of blood pressure variability.

TLDR
The main features of blood pressure variability in hypertension are discussed and the mechanisms involved in this phenomenon are examined, with particular emphasis on the pathogenetic role of sympathetic neural factors.
...