Hemodynamic determinants of the short-term blood pressure variability: Differential roles of arterial stiffness and wave reflection

Pai Feng Hsu, Hao Min Cheng, Shih Hsien Sung, Shao Yuan Chuang, Edward G. Lakatta, Frank C.P. Yin, Pesus Chou, Chen Huan Chen

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND A high 24-hour ambulatory diastolic (DBP) but not systolic (SBP) blood pressure variability (BPV) is significantly predictive of long-term cardiovascular mortality in untreated hypertensive subjects, independent of office or 24-hour SBP. The present study was aimed to investigate hemodynamic factors that are independently associated with systolic and diastolic BPV from the 24-hour ambulatory blood pressure monitoring (ABPM). METHODS A cohort of 624 normotensive and 633 untreated hypertensive participants with baseline ABPM was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour SBP and DBP (ARVs and ARVd, respectively). Hemodynamic variables including total peripheral resistance (TPR), carotid-femoral pulse wave velocity (cf-PWV), and amplitudes of the decomposed forward (Pf ) and backward (Pb) carotid pressure waves were analyzed. RESULTS In multivariable analyses, hemodynamic variables independently associated with 24-hour SBP were 24-hour heart rate (HR), TPR, cf-PWV, Pf, and Pb (model r2 = 0.535). Hemodynamic factors independently associated with ARV were 24-hour HR, Pf, and Pb for ARVs, and 24-hour HR, cf-PWV, Pf, and Pb for ARVd (model R2 = 0.345 and 0.220, respectively). Addition of 24-hour SBP to the ARV models only slightly improved variance explained by the models (R2 = 0.383 and 0.224, respectively). Pb accounted for >50% of total variance of ARVs and ARVd, whereas cf-PWV was a minor determinant of ARVd (<5% of total variance). CONCLUSIONS ARVd was associated with fewer hemodynamic variables than to 24-hour SBP. Among those hemodynamic variables wave reflection but not arterial stiffness had the dominant independent association with ARV.

Original languageEnglish (US)
Pages (from-to)256-263
Number of pages8
JournalAmerican Journal of Hypertension
Volume30
Issue number3
DOIs
StatePublished - 2017

Keywords

  • Ambulatory blood pressure
  • Blood pressure variability
  • Hemodynamics
  • Hypertension

ASJC Scopus subject areas

  • Internal Medicine

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