Cardiovascular disease (CVD) remains a major health concern globally, contributing to a considerable disease burden. However, few studies have considered long-term cumulative blood pressure (cBP) exposure in middle-aged and older population in China. The aim of this study was to investigate whether long-term cBP was associated with subsequent cardiovascular outcomes among participants without CVD at baseline in Chinese over 45 years old.

6435 participants in China of the CHARLS (The China Health and Retirement Longitudinal Study) were included. Cumulative BP was calculated as the area under the curve using measurements from wave 1 (2011) to wave 2 (2013). Outcomes included CVD, heart disease and stroke.

During a median follow-up period of 5 years, 1101 CVD events, 826 heart disease, and 351 stroke were recorded. Each 1-SD increase in cumulative systolic blood pressure (cSBP), cumulative diastolic blood pressure (cDBP), and cumulative mean arterial pressure (cMAP) was associated with increased risk of CVD (HR, 1.12; 95%, 1.05-1.20, HR, 1.14; 95%, 1.07-1.22, HR, 1.14; 95%, 1.07-1.22), heart disease (HR, 1.05; 95%, 0.97-1.13, HR, 1.09; 95%, 1.01-1.17, HR, 1.08; 95%, 1.00-1.16) and stroke (HR, 1.35; 95%, 1.21-1.51, HR, 1.31; 95%, 1.17-1.46, HR, 1.36; 95%, 1.22-1.51). The relationship between cBP and CVD has only been found in people younger than 60 years of age. A significant association was observed for cumulative pulse pressure (cPP) with stroke (HR, 1.23; 95%, 1.10-1.38). None nonlinear relationships were identified (p-nonlinear > .05). For the prediction of cardiovascular outcomes, cBP load outperformed baseline BP in terms of C statistics (p < .001).

Long-term cSBP, cDBP and cMAP were associated with subsequent CVD and only found in people younger than 60 years of age, whereas cPP was associated with stroke only across all ages. Cumulative BP may provide a better prediction of cardiovascular outcomes compared with single BP measurement. Efforts are required to control long-term BP in assessing cardiovascular risks.

Sudden fluctuations in blood pressure (BP) over a short period may trigger cardiovascular events, and outdoor temperature may be a risk factor. There is a lack of conclusive observational evidence linked hourly temperature with ambulatory BP indicators. We aimed to explore the effects of hourly outdoor temperature on ambulatory BP, BP variability and load. A large-scale, multicenter study among 31,838 adults from 7 Chinese cities was conducted between March 2016 and November 2020. Hourly temperature was obtained from the nearest weather stations. We collected ambulatory systolic (SBP), diastolic blood pressure (DBP), the BP variability and load of the day, and used linear mixed-effect model combined with distributed lag model to analyze data. Outdoor temperature was inversely associated with most ambulatory BP indicators. The effects of low temperature on BP appeared and peaked at the concurrent hour, then gradually attenuated and disappeared around at lag 20h. Compared to the referent temperature (P99), exposure to low temperature (P1) was associated with cumulative increments (over lag 0-20 h) of 9.71 mmHg, 4.85 mmHg and 20.58 mmHg for 24-h, nighttime and morning SBP, respectively, as well as 8.71 mmHg, 4.72 mmHg and 14.32 mmHg for 24-h, nighttime and morning DBP. Furthermore, there were significant associations between decreasing temperature and increased BP variability and load at lag 0 d. Our study provides compelling evidence that low temperature can elevate BP-related indicators, underscoring the necessity of flexible treatment strategies and targeted public health interventions, especially for susceptible populations during the cold season.

Elevated blood pressure (BP) is a key contributor to the progression of arterial stiffness and the incidence of diabetic kidney disease (DKD). Cumulative BP load enables the evaluation of long-term BP exposure, but the BP targets used to calculate it vary across studies. This study aimed to compare the predictive performance of cumulative BP load calculated using different clinically recommended BP targets.

This multicenter longitudinal study included participants with type 2 diabetes from 10 diabetes centers. Cumulative BP load was calculated using various clinically recommended BP targets (SBP < 140 mmHg, < 130 mmHg, and < 120 mmHg). The primary outcomes were the progression of arterial stiffness, assessed by brachial-ankle pulse wave velocity (ba-PWV) changes, and the incidence of DKD, defined as an estimated glomerular filtration rate < 60 mL/min/1.73m2 or urine albumin-to-creatinine ratio ≥ 3.39 mg/mmol. The predictive ability of cumulative BP load calculated under different clinically recommended targets was compared using adjusted R squared (adjusted R2) for continuous outcomes and net reclassification improvement (NRI) for binary outcomes.

Among the 18,168 participants included (mean age 54.5 years; 57.5% male), 13,388 met all eligibility criteria for the analysis of arterial stiffness progression, and 11,145 for the analysis of DKD incidence. Over a mean follow-up of 3.5 years, the median ba-PWV increase was 0.19 m/s per year and 2,855 (25.6%) developed DKD. When cumulative BP load was added to a model containing traditional risk factors, the adjusted R2 values for predicting the absolute annual change in ba-PWV were 0.193 (95% CI 0.180-0.200), 0.184 (0.169-0.191), and 0.172 (0.158-0.180) with BP targets of SBP < 120, < 130, and < 140 mmHg, respectively. For the incidence of DKD, the NRIs were 15.8% (11.5-20.0%), 12.5% (8.3-16.7%), and 6.4% (2.3-10.6%) with BP targets of SBP < 120, < 130, and < 140 mmHg, respectively.

Cumulative BP load is an effective indicator for predicting the progression of arterial stiffness and incidence of DKD, with the best predictive performance observed when the target SBP is set at < 120 mmHg.

Ambulatory hypertension is associated with elevated left ventricular mass index (LVMI), cardiac dysfunction, and increased arterial stiffness in adolescents. Whether the addition of measures of BP variability improves the prediction of subclinical cardiovascular target organ damage (TOD) over mean BP measures is not known.

We assessed clinic and ambulatory BP (ABP), anthropometrics, and TOD in 397 adolescents. ABP means standard deviation (SD), BP, and heart rate (HR) dipping were calculated; coefficients of variability (CV) were calculated (SD/mean) to assess ABP variabilities. Measures of TOD included LVMI, left ventricular hypertrophy (LVH), LV systolic shortening, LV diastolic function (e'/a'), and pulse wave velocity. General linear models were used to determine if increased ABP variability measures were significant determinants of TOD in models containing mean ABP percentiles, age, sex, race/ethnicity, BMI z-score, and HR.

Mean participant age was 15.6 ± 1.7 years (63% white, 59% male) with mean casual BP 122.6/71.6 mmHg ±12.4/10.5, and mean awake systolic ABP 124.2/72.0 ± 11.3/7.7 mmHg. In linear models, increased awake CV-DBP and HR dipping were significant determinants of LVMI. CV-HR was an independent determinant of diastolic (e'/a') but not systolic dysfunction. Using logistic regression, the combination of awake and asleep diastolic ABP variability and awake systolic ABP percentile improved the prediction of LVH.

Consideration of ABP variability in addition to ABP percentile may aid in identifying adolescents at risk for LVH.

This study investigates the relationship between intraoperative blood pressure variability (BPV) and postoperative delirium (POD) after hip fracture surgery in geriatric patients. A retrospective analysis was conducted on 1002 geriatric patients who underwent hip fracture surgery. Intraoperative BPV was mainly quantified using the coefficient of variation in mean arterial pressure (CV-MAP). Patients were stratified into two groups (CV-MAP ≤ 10% vs. > 10%). Propensity score matching (PSM) balanced baseline characteristics. Multivariable logistic regression evaluated the association between CV-MAP and POD. Restricted cubic spline (RCS) analysis examined dose-response relationships. Subgroup analyses and interaction tests were conducted to examine effect modifications. POD occurred in 198 patients (19.8%). Patients with CV-MAP > 10% showed a significantly higher occurrence of POD than those with CV-MAP ≤ 10%, both before (24.6% vs. 16.4%, p < 0.001) and after PSM (25.2% vs. 18.9%, p = 0.032). Adjusted logistic regression confirmed CV-MAP > 10% as an independent predictor of POD (adjusted OR: 1.45, 95% CI 1.03-2.03, p = 0.033). RCS analysis revealed a nonlinear positive association between CV-MAP and POD risk. Subgroup analyses identified significant interactions between CV-MAP and variables such as age and ASA classification (p < 0.05). Elevated intraoperative BPV is independently associated with an increased risk of POD in elderly hip fracture patients, with nonlinear effects and potential modifiers. These findings underscore the importance of individualized blood pressure management to mitigate POD risk.

In this study, we aimed to analyze all-cause mortality according to interdialytic blood pressure variability (BPV) in patients undergoing hemodialysis.

Data on predialysis blood pressure (BP) and clinical information were extracted from four dialysis units through the DialysisNet system, which enables efficient hemodialysis management using common data elements. Interdialytic BPV was evaluated as the coefficient of variation (CV) of predialysis BP at each dialysis session over a 12-month period. The CV of systolic BP (SBP) and diastolic BP (DBP) was divided into tertiles. The primary outcome was all-cause mortality according to the CV of predialysis SBP, which was analyzed using Cox regression analysis.

The data of 357 patients undergoing hemodialysis were analyzed. Compared with the first SBP CV tertile, the third tertile showed significantly increased all-cause mortality after adjustment (hazard ratio [HR], 2.11; 95% confidence interval [CI] 1.04-4.24). Compared with the first DBP CV tertile, the third tertile showed significantly increased mortality in univariable analysis (HR, 2.18; 95% CI 1.10-4.30) but not in multivariable analysis (HR, 1.88; 95% CI 0.89-3.95).

Increased interdialytic BPV in patients undergoing hemodialysis is associated with all-cause mortality. This was more prominent in SBP than in DBP. Particular attention should be paid to large BPVs in older adults, women, and patients with a relatively longer dialysis vintage.

The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short-term outcome remains unknown.

We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Copenhagen, Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease.

Among 951 patients included, mean age was 64 (standard deviation; 17) with 44% women. During 3-month follow-up, 284 (30%) patients met a primary outcome and 69 (7,2%) a secondary outcome. In adjusted Cox models, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome [hazard ratio 0.971, 95% confidence interval (CI) 0.948-0.995, P = 0.017] for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV greater than 10 mmHg was associated with increased cardiovascular events (hazard ratio 2.019, 95% CI 1.142-3.569, P = 0.016).

In this study, low admission SBP was associated with all-cause readmissions and mortality, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.

Vascular Ehlers-Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol is a β1-adrenoceptor antagonist with partial β2 agonist activity capable of reducing rates of vascular events in this setting, though the underlying mechanisms have yet to be elucidated. In particular, no conclusive evidence exists on its impact on blood pressure (BP) parameters in patients with vEDS. Accordingly, the aim of our study was to perform a comprehensive assessment of BP profile in a cohort of patients with vEDS receiving celiprolol titrated to the maximum tolerated dose. Consecutive outpatients with molecularly confirmed vEDS undergoing office BP measurement and 24-h ambulatory BP monitoring (ABPM) were retrospectively evaluated. Using 24-h systolic BP, diastolic BP, mean BP, and pulse pressure (PP) (mmHg) values, indices of short-term BP variability were calculated. A generalized linear regression model was applied to analyze the correlation between initial values of BP parameters and their variation with celiprolol therapy. Overall, 20 subjects were included (12 females). Eight patients (40%) had 24-h ABPM values consistent with hypertension. Five subjects (25%) defined hypertensives at 24-h ABPM had optimal BP control at office BP measurement, suggesting a "masked" hypertension. A significant correlation was found between initial values of indices of short-term PP variability and their change with celiprolol therapy, with a particularly high Pearson's index for PP coefficient of variation (r = -0.926; p < 0.001). In patients with vEDS, 24-h ABPM is confirmed a reliable tool in identifying hypertension phenotypes. Treatment with celiprolol may reduce PP variability proportionally to its initial magnitude. Dedicated studies on larger cohorts should evaluate whether short-term PP variability is a reliable prognostic marker and therapeutic target in this clinical setting. In our study, treatment with celiprolol seemed to reduce short-term PP variability proportionally to its initial magnitude in patients with vEDS. Furthermore, two out of four patients experiencing vascular events during the study period displayed the highest short-term PP variability values recorded in the entire cohort. Further research should evaluate whether such parameters are reliable prognostic markers and therapeutic targets in this clinical setting. ABPM ambulatory blood pressure monitoring, ARV average real variability, BP blood pressure, CV coefficient of variation, DBP diastolic blood pressure, PP pulse pressure, SBP systolic blood pressure, SD standard deviation, TRI time-rate index, vEDS vascular Ehlers-Danlos syndrome.

Resting beat-to-beat blood pressure variability is a strong predictor of cardiovascular events and mortality. However, its underlying mechanisms remain incompletely understood. Given that the sympathetic nervous system plays a pivotal role in cardiovascular regulation, we hypothesized that alpha-1 adrenergic receptors (the main sympathetic receptor controlling peripheral vasoconstriction) may contribute to resting beat-to-beat blood pressure variability.

Beat-to-beat heart rate (electrocardiography) and blood pressure (photoplethysmography) were continuously measured before and 2 h following, selective blockade of alpha-1 adrenergic receptors via oral administration of prazosin (1 mg/20 kg) in ten young healthy adults (two women). Cardiac output and total peripheral resistance were estimated using the ModelFlow method.

Selective blockade of alpha-1 adrenergic receptors was confirmed by the marked reduction in the pressor response to intravenous infusion of phenylephrine hydrochloride (-80 ± 15%, P = 0.001 versus pre-prazosin). The blockade significantly decreased the standard deviation of the systolic (pre-prazosin versus post-prazosin: 5.6 ± 1.4 versus 3.8 ± 0.7 mmHg, P = 0.002), diastolic (3.2 ± 1.2 versus 2.2 ± 0.5 mmHg, P = 0.022), and mean blood pressure (3.7 ± 1.2 versus 2.5 ± 0.5 mmHg, P = 0.009), as well as total peripheral resistance (0.8 ± 0.5 versus 0.5 ± 0.1 mmHg/L/min, P = 0.047), but not cardiac output (521 ± 188 versus 453 ± 160 mL/min, P = 0.321). Similar results were found using different indices of variability.

These findings indicate that alpha-1 adrenergic receptors play a significant role in regulating resting beat-to-beat blood pressure variability in young, healthy adults.

People with diabetes often have increased blood pressure (BP) variability because of autonomic dysfunction and arterial stiffness, making it a critical factor in predicting clinical outcomes. We investigated the reproducibility of long-term visit-to-visit BP variability (VVV) and the minimum number of BP readings to reliably determine VVV in people with diabetes.

This multicenter retrospective study used data from electronic health records of the Korea University Medical Center database. Altogether, 10 475 people with diabetes who had more than nine BP readings during a maximum period of 2 years were identified. This study focused on the coefficient of variation of these readings and their correlation with major adverse cardiovascular events (MACE) over a 3-year follow-up period.

The mean age of the participants was 65.2 years. Of these, 53.2% were men, and 87.4% had hypertension. The mean coefficient of variation of multiple SBP readings that best predicted the 3-year MACE were 8.4, 9.5, 9.0, 9.0, and 9.7 for three, five, seven, nine, and all readings, respectively. Patients with high VVV (coefficient of variation of five SBP readings >9) exhibited a higher incidence of 3-year MACE (10.1%) than those with low VVV (5.4%, P  < 0.001). In the multivariable analysis, high VVV of both SBP and DBP were independently associated with 3-year MACE.

Long-term VVV in the BP is a reproducible and reliable predictor of cardiovascular outcomes in people with diabetes. A minimum of five BP measurements are recommended for effective intraindividual VVV estimation and cardiovascular risk assessment.

Long-term blood pressure (BP) variability (BPV) is associated with adverse prognosis in patients with heart failure. However, the clinical significance of very short-term (beat-to-beat) BPV is unclear. We collected data on nighttime pulse transit time-based continuous beat-to-beat BP measurement in patients with heart failure (n = 366, median age 72.0, male sex 53.3%). Coefficient of variation (CoV) of pulse transit time-based BP was considered as very short-term BPV. The primary outcome was a composite of heart failure hospitalization or cardiac death. Median values (25th and 75th percentiles) of systolic and diastolic BP CoV were 3.6% (2.8%, 4.5%) and 5.1% (3.8%, 6.5%), respectively. During a median follow-up period of 1084 days after BPV evaluation, 71 patients experienced the primary outcome. When the patients were divided into tertiles based on the systolic and diastolic BPV, the primary outcome occurred most frequently in the highest tertile of BPV. Multivariable Cox proportional hazard analysis revealed that systolic and diastolic BPV, as continuous variables, were independently associated with the primary outcome (hazard ratio 1.199 and 1.101, respectively). In conclusion, high nighttime very short-term BPV was associated with adverse prognosis in patients with heart failure.

The objective of this study was to investigate the efficacy of the nitrendipine/atenolol combination in comparison with standard-dose nitrendipine or atenolol monotherapy in reducing blood pressure (BP) and blood pressure variability (BPV) as assessed by ambulatory BP monitoring.

In a randomized, crossover trial, 32 patients (30-65 years) with grade 1 hypertension and elevated daytime reading-to-reading BPV were randomly assigned to receive either the nitrendipine/atenolol combination (10/20 mg) or standard-dose nitrendipine (10 mg) or atenolol (25 mg) monotherapy for 6 weeks, followed by a crossover to another treatment for 6 weeks.

The final analysis included 31 patients (mean [±SD] age, 49.2 ± 9.6 years) and 12 men. The nitrendipine/atenolol combination significantly reduced from baseline clinic and ambulatory BP and pulse rate ( P  ≤ 0.002), and 24 h and daytime systolic and diastolic BPV as assessed by SD and average real variability ( P  ≤ 0.042), but not the coefficient of variation nor nighttime BPV indices ( P  ≥ 0.06). Significant differences between the nitrendipine/atenolol combination and nitrendipine or atenolol monotherapy at the end of treatment were observed in clinic BP and pulse rate ( P  ≤ 0.042), but not in 24 h, daytime and nighttime blood pressure and pulse rate, except for daytime DBP and 24 h and daytime pulse rate ( P  ≤ 0.049). There were no significant differences in BPV between the combination and monotherpy groups at the end of treatment ( P  ≥ 0.25).

The nitrendipine/atenolol combination reduced daytime reading-to-reading BPV, but did not show superiority to nitrendipine or atenolol monotherapy.

The relationship of beat-to-beat blood pressure variability (BPV) with prognosis after mechanical thrombectomy (MT) is unclear. Consecutive patients with acute ischemic stroke with large vessel occlusion treated with and without MT matched 1:1 by age, sex, and National Institutes of Health Stroke Scale were included. Beat-to-beat BPV was calculated for both systolic (SBP) and diastolic blood pressure (DBP) as standard deviation, coefficient of variation, successive variation (SV), and average real variability (ARV) at 24-72 h after MT. Additionally, hour-to-hour (first 24 h after MT) and day-by-day BPV (first 7 days after MT) were also measured. The outcome was modified Rankin Scale (mRS) at 3 months. Of 168 patients, 84 patients received MT and 84 did not. MT closely correlated with lower beat-to-beat BPV parameters. Beat-to-beat SBP-SV and SBP-ARV were significantly higher in patients with unfavorable outcome than in those with favorable outcome (median 3.40 vs 2.71; P = 0.016; median 2.81 vs 2.20, P = 0.003). After adjusting for confounders, higher beat-to-beat SBP-SV and SBP-ARV were independently associated with unfavorable outcome in patients with MT (all P < 0.05). However, no association was found between hour-to-hour and day-by-day BPV and outcome at 3 months (P > 0.05). The patients with MT had lower beat-to-beat BPV values in the acute phase, which indicated that MT has a positive effect on beat-to-beat BPV. Furthermore, beat-to-beat BPV, rather than hour-to-hour or day-by-day BPV, is an independent risk factor for unfavorable outcome in patients after MT.

Home blood pressure (BP) variability (BPV) and BP phenotypes such as white-coat hypertension (WCH), white-coat uncontrolled hypertension (WUCH), masked hypertension (MH) and masked uncontrolled hypertension (MUCH) are predictors of adverse cardiovascular events. This study compared home BPV across BP phenotypes built from abnormal office BP (OBP) and home BP monitoring (HBPM) thresholds defined by three distinct societies [European Society of Hypertension (ESH): OBP ≥ 140/90 mmHg and HBPM ≥ 135/85 mmHg; American College of Cardiology/American Heart Association (ACC/AHA): OBP and HBPM ≥ 130/80 mmHg and Brazilian Society of Cardiology (BSC): OBP ≥ 140/90 mmHg and HBPM ≥ 130/80 mmHg].

This cross-sectional study evaluated 51 194 treated (37% men, age = 61 ± 15 years) and 56 100 untreated (41% men, age = 54 ± 16 years) individuals from 1045 Brazilian centers who underwent OBP and HBPM measurements. Systolic and diastolic home BPV were estimated as the: standard deviation, coefficient of variation, and the variability independent of the mean of HBPM.

Results of adjusted analysis showed that home BPV parameters were significantly greater in individuals with WCH/WUCH according to the BSC criteria, in those with MH/MUCH defined by the ACC/AHA criteria, and tended to be greater in individuals with either MH/MUCH or WCH/WUCH defined by the ESH criteria.Furthermore, restricted cubic spline analysis showed a U-shaped association between BPV and the difference between OBP and HBPM in treated and untreated individuals.

Home BPV was greater in WCH/WUCH and/or MH/MUCH depending on the criteria used to define abnormal OBP and HBPM thresholds. These findings underscore the need to standardize abnormal BP criteria in clinical practice.

The impact of baseline estimated glomerular filtration rate (eGFR) on the risk of adverse outcomes according to metabolic parameter variabilities in chronic kidney disease has rarely been investigated.

We conducted a retrospective nationwide cohort study using the National Health Insurance System data in Korea from 2007 to 2013 to identify individuals with three or more health screenings. The metabolic components variability was defined as intraindividual variability between measurements using the variability independent of the mean. The metabolic variability score was defined as the total number of high-variability metabolic components. Multivariable-adjusted Cox regression analysis was conducted to evaluate the risks of all-cause mortality, myocardial infarction, and ischemic stroke.

During a mean follow-up of 6.0 ± 0.7 years, 223,531 deaths, 107,140 myocardial infarctions, and 116,182 ischemic strokes were identified in 9,971,562 patients. Low eGFR categories and higher metabolic variability scores were associated with a higher risk of adverse outcomes. The degree of association between metabolic variability and adverse outcomes was significantly larger in those with low eGFR categories than in those with preserved eGFR (p for interaction < 0.001). Representatively, those with high metabolic variability in the eGFR of <15 mL/min/1.73 m2 group showed a prominently higher risk for all-cause mortality (adjusted hazard ratio [aHR], 5.28; 95% confidence interval [CI], 4.02-6.94) when the degree was compared to the findings in those with preserved (eGFR of ≥60 mL/min/1.73 m2) kidney function (aHR, 2.55; 95% CI, 2.41-2.69).

The degree of adverse association between metabolic variability and poor prognosis is accentuated in patients with impaired kidney function.

Accurate blood pressure (BP) measurement is crucial for the diagnosis, risk assessment, treatment decision-making, and monitoring of cardiovascular diseases. Unfortunately, cuff-based BP measurements suffer from inaccuracies and discomfort. This study is the first to access the feasibility of machine learning-based BP estimation using impedance cardiography (ICG) data.

We analyzed ICG data from 71 young and healthy adults. Nine different machine learning algorithms were evaluated for their BP estimation performance against quality controlled, oscillometric (cuff-based), arterial BP measurements during mental (Trier social stress test), and physical exercise (bike ergometer). Models were optimized to minimize the root mean squared error and their performance was evaluated against accuracy and regression metrics.

The multi-linear regression model demonstrated the highest measurement accuracy for systolic BP with a mean difference of -0.01 mmHg, a standard deviation (SD) of 10.79 mmHg, a mean absolute error (MAE) of 8.20 mmHg, and a correlation coefficient of r = 0.82. In contrast, the support vector regression model achieved the highest accuracy for diastolic BP with a mean difference of 0.15 mmHg, SD = 7.79 mmHg, MEA = 6.05 mmHg, and a correlation coefficient of r = 0.51.

The study demonstrates the feasibility of ICG-based machine learning algorithms for estimating cuff-based reference BP. However, further research into limiting biases, improving performance, and standardized validation is needed before clinical use.

Hypertension is a major risk factor for cardiovascular events worldwide, and little is known about its association with sleep quality (SQ) among Africans. We evaluated the association of SQ with hypertension among adults in Ibadan, Nigeria. In Ibadan and its suburbs, we identified 3635 participants in the door-to-door Community-based Investigation of the Risk Factors for Cardiovascular Diseases (COMBAT-CVDs) study. SQ was self-reported, and SQ scores were classified by the tertile distribution in this sample as good (<9), moderate (10-18), and poor (≥19), and hypertension was defined as one of the following conditions: systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or prior diagnosis by a certified health professional or current use of blood pressure-lowering drugs. Using good SQ as a reference, logistic regression models were used to estimate the multivariable-adjusted odds ratio and 95% confidence interval (CI) for odds of hypertension by tertiles of SQ scores in a two-sided test at p < 0.05. In all, 1182 (32.5%) had poor SQ, 903 (24.8%) had hypertension, and the mean(±SD) age was 35.3 ± 15.2 years in this sample. The multivariable-adjusted odds of hypertension by tertiles of SQ scores (using good SQ as reference) were OR: 1.13 (95% CI: 0.92, 1.38) for moderate SQ, and OR: 1.29 (95% CI: 1.05, 1.59) for poor SQ; P for trend = 0.06 after adjusting for relevant covariates. Poor SQ is associated with higher odds of hypertension in this sample. The imperative of culturally sensitive interventions to improve SQ would be promising in managing poor sleep-associated hypertension burden in this population.

This study examines how heart rate (HR) affects hemodynamics in a South African infant with Coarctation of the Aorta. Computed tomography angiography segments aortic coarctation anatomy; Doppler echocardiography derives inlet flow waveforms. Simulations occur at 100, 120, and 160 beats per minute, representing reduced, resting, and elevated HR levels. Turbulence was analyzed over time and space using turbulence-resolving and pulsatile large-eddy simulations. Specifically, a 60% reduction in HR led to a reduction in maximum velocity by 45%, and a 57% decrease in pressure drop. The reduction in turbulence-related metrics was less significant. The ratio of turbulent kinetic energy to total kinetic energy decreased by 2%, while turbulent wall shear stress decreased by 3%. These results demonstrate that HR significantly affects velocity and pressure drop, while turbulence arising from the coarctation region is relatively unaffected. The balance between turbulent kinetic energy and total kinetic energy shows minimal enhancement due to the complex interplay among HR, turbulence, and geometry. This complexity prompts discussion on how HR-slowing medications, such as beta-blockers or ivabradine, could positively influence hemodynamic stresses. In particular, the results indicate that while HR modulation can influence flow dynamics, it may not significantly reduce turbulence-induced shear stresses within the coarctation zone. Therefore, further investigation is necessary to understand the potential impact of HR modulation in the management of CoA, and whether interventions targeting the anatomical correction of the coarctation may be more effective in improving hemodynamic outcomes.

Until recently, there has been a focus on exploring the influence of average blood pressure (BP) on risk of mortality. We go beyond average BP to also investigate mortality risk with respect to variation in BP over 2 timescales-short-term variation among multiple measures at 1 visit, and medium-term variation among the measures at 2 visits several months apart. We present an application of Bayesian hierarchical modeling to the problem of estimating the effect of BP variability on all-cause and cardiovascular mortality. We use data from the Third National Health and Nutrition Examination Survey linked with up to 27 years of mortality follow-up. We find that medium-term systolic BP variability had a very significant predictive value for all-cause mortality in addition to mortality from cardiovascular disease, cerebrovascular disease and heart-attacks combined, approximately 1/3 as large as the well-established impact of mean systolic BP. Medium-term diastolic variability had an additional, although smaller, predictive effect. Short-term variability, in contrast, had little or no measurable predictive value. The medium-term variability effect persisted when controlling for Framingham Risk Score.

Blood pressure (BP) variability (BPV) and time in target range (TTR) are emerging vascular risk factors for dementia, independent of traditionally targeted mean BP.

Determine whether BPV or TTR is most strongly associated with cognitive risk.

In this post hoc analysis of the SPRINT trial, 8034 participants underwent repeated BP measurement and cognitive testing at baseline and follow-up. Visit-to-visit BPV was calculated as average real variability. TTR was the percent of time in desired treatment arm target range (standard: 120-140 mmHg systolic BP; intensive: 110-130 mmHg systolic BP). Adjudicated clinical outcomes were no cognitive impairment, mild cognitive impairment (MCI), and probable dementia. We investigated a direct comparison of BPV and TTR in predicting cognitive risk, stratified by BP treatment group.

Elevated BPV was associated with increased risk for MCI (adjusted HR: 1.21 [95% CI 1.10, 1.33], p < 0.001) and MCI/dementia (HR: 1.17 [95% CI 1.07, 1.27], p < 0.001) in the standard group, and dementia (HR: 1.17 [95% CI 1.01, 1.36], p = 0.039) in the intensive group. Higher TTR was related to lower dementia risk (HR: 0.72 [95% CI 0.60, 0.86], p < 0.001) in the intensive group only.

Visit-to-visit BPV outperformed TTR in predicting risk for MCI and MCI/dementia. TTR was more strongly associated with dementia risk under intensive treatment. Findings were independent of mean BP in a cohort with rigorously controlled BP and suggest newer aspects of BP control may be harnessed to further reduce cognitive risk.

ClinicalTrials.gov; NCT01206062.

Early neurological deterioration (END) following endovascular treatment (EVT) in acute ischemic stroke (AIS) patients is associated with poor long-term outcomes. Although unstable systolic blood pressure (SBP) after EVT is recognized as a risk factor for END, it remains unclear whether this association persists after excluding identifiable causes of END. In this prospective, observational cohort study, AIS patients who underwent EVT within 24 h of stroke onset were included. Invasive arterial blood pressure (BP) monitoring recorded hourly BP readings during the first 24 h post-EVT. Unexplained END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale score 24 h after EVT without any identifiable cause. Two distinct SBP trajectories-high and low-were identified within 24 h post-EVT. The high-trajectory group, characterized by elevated mean SBP and increased SBP variability (SBPV), exhibited a significantly higher incidence of unexplained END (odds ratio [OR] = 3.28, p < 0.01). SBPV alone was an independent risk factor for unexplained END (OR = 1.11, p < 0.05). Moreover, patients with both higher mean SBP and increased SBPV had a markedly greater risk of unexplained END (OR = 13.79, p < 0.05). Notably, the harmful threshold for SBPV was lower during nighttime compared to daytime. These findings suggest that increased SBPV, particularly when combined with elevated mean SBP, significantly heightens the risk of unexplained END post-EVT. Therefore, comprehensive post-EVT blood pressure management should address both absolute BP levels and BPV, with particular emphasis on nighttime monitoring, to optimize early neurological recovery.

Pre-eclampsia has long been proven to be an independent risk factor for postpartum depression (PPD). Excessive increase in body mass index (BMI) during pregnancy is an important factor inducing pre-eclampsia. Increased blood pressure is the main symptom of patients with pre-eclampsia. However, whether there is a correlation between BMI and blood pressure variability during pregnancy and PPD occurrence in pregnant women with pre-eclampsia remains unclear.

To investigate the relationship between BMI, blood pressure variability, and PPD in pregnant women with pre-eclampsia.

Using a cross-sectional survey research, 201 pregnant women with pre-eclampsia who were treated and delivered in Suzhou Ninth People's Hospital from May 2016 to June 2024 were selected as this study's subjects. At 42 days after delivery, the subjects were re-examined in the hospital's outpatient department. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate whether PPD symptoms, divided the subjects into two groups: The PPD and non-PPD groups. We analyzed clinical data, changes in BMI during pregnancy, and blood pressure variability in the two groups. The Pearson method was used to test the correlation between BMI increase, blood pressure variability during pregnancy, and EPDS score in patients with pre-eclampsia. Logistic regression analysis was performed to explore whether increased BMI and blood pressure variability during pregnancy are influencing factors for PPD occurrence in patients with pre-eclampsia.

Of the 201 pre-eclamptic women who underwent an outpatient review 42 days after delivery, 37 had PPD symptoms based on the EPDS scale evaluation, resulting in an incidence rate of 18.41% (37/201). The differences between the PPD and non-PPD groups in terms of age, educational level, place of residence, reproductive history, gestational age, mode of delivery, newborn gender, and newborn birth weight were not statistically significant (P > 0.05). The gestational BMI increase, 24-hour systolic blood pressure (SBP) variability, and 24-hour diastolic blood pressure (DBP) variability in the PPD group were significantly higher than those in the non-PPD group; the differences were statistically significant (P < 0.001). Pearson correlation analysis showed that BMI increase, SBP variability, and DBP variability during pregnancy correlated positively with the EPDS score of pregnant women with pre-eclampsia (r = 0.349, 0.336, and 0.241; P < 0.001). Logistic regression analysis showed that a high increase in BMI during pregnancy [odds ratio (OR) = 4.614, 95% confidence interval (CI): 1.749-12.170, P = 0.002], large variability in 24-hour SBP (OR = 2.910, 95%CI: 1.322-6.404, P = 0.008), and large variability in 24-hour DBP (OR = 2.347, 95%CI: 1.138-4.831, P = 0.021) were factors affecting PPD occurrence in patients with pre-eclampsia.

Increased BMI and blood pressure variability during pregnancy can increase the risk of PPD in patients with pre-eclampsia. Strengthening pregnancy guidance and controlling fluctuations in BMI and blood pressure variability during pregnancy within a reasonable range can help reduce the risk of PPD in patients with pre-eclampsia.

Continuous monitoring of nocturnal blood pressure is crucial for hypertension management and cardiovascular risk assessment. However, current clinical methods are invasive and discomforting, posing challenges. These traditional techniques often disrupt sleep, impacting patient compliance and measurement accuracy. Here we introduce a non-contact system for continuous monitoring of nocturnal blood pressure, utilizing ballistocardiogram signals. The key component of this system is the utilization of advanced, flexible fiber optic sensors designed to capture medical-grade ballistocardiogram signals accurately. Our artificial intelligence model extracts deep learning and fiducial features with physical meanings and implements an efficient, lightweight personalization scheme on the edge device. Furthermore, the system incorporates a crucial algorithm to automatically detect the user's sleeping posture, ensuring accurate measurement of nocturnal blood pressure. The model underwent rigorous evaluation using open-source and self-collected datasets comprising 158 subjects, demonstrating its effectiveness across various blood pressure ranges, demographic groups, and sleep states. This innovative system, suitable for real-world unconstrained sleeping scenarios, allows for enhanced hypertension screening and management and provides new insights for clinical research into cardiovascular complications.

Purpose: There is evidence that blood pressure variability (BPV) is associated with cerebral small vessel disease (SVD) and may therefore increase the risk of stroke and dementia. It remains unclear if BPV is associated with SVD progression over years. We examined whether visit-to-visit BPV is associated with white matter hyperintensity (WMH) progression over 14 years and MRI markers after 14 years.

Materials and methods: We included participants with SVD from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) who underwent baseline assessment in 2006 and follow-up in 2011, 2015 and 2020. BPV was calculated as coefficient of variation (CV) of BP at all visits. Association between WMH progression rates over 14 years and BPV was examined using linear-mixed effects (LME) model. Regression models were used to examine association between BPV and MRI markers at final visit in participants.

Results: A total of 199 participants (60.5 SD 6.6 years) who underwent four MRI scans and BP measurements were included, with mean follow-up of 13.7 (SD 0.5) years. Systolic BPV was associated with higher progression of WMH (β = 0.013, 95% CI 0.005 - 0.022) and higher risk of incident lacunes (OR: 1.10, 95% CI 1.01-1.21). There was no association between systolic BPV and grey and white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD) or microbleed count after 13.7 years.

Conclusions: Visit-to-visit systolic BPV is associated with increased progression of WMH volumes and higher risk of incident lacunes over 14 years in participants with SVD. Future studies are needed to examine causality of this association.

Remote patient monitoring (RPM) beat-to-beat blood pressure (BP) provides an opportunity to measure poststroke BP variability (BPV), which is associated with clinical stroke outcomes. BP sampling interval (SI) influences ambulatory BPV, but RPM BP SI optimisation research is limited. SI and RPM device capabilities require compromises, meaning SI impact requires investigation. Therefore, this study assessed healthy and stroke subtype BPV via optimised BP sampling, aiding sudden BP change identification and potentially assisting cardiovascular event (recurrent stroke) prediction.

Leicester Cerebral Haemodynamic Database ischaemic [acute ischaemic stroke (AIS), n  = 68] and haemorrhagic stroke (intracerebral haemorrhage, n  = 12) patient and healthy control (HC, n  = 40) baseline BP data were analysed. Intrasubject and interpatient SD (SD i /SD p ) represented individual/population variability with synthetically altered SIs. Matched-filter approaches using cross-correlation function detected sudden BP changes.

At SIs between 1 and 180 s, SBP and DBP SD i staticised while SD p increased at SI < 30 s. Mean BP and HR SD i and SD p increased at SI < 60s. AIS BPV, normalised to SI1s, increased at SI30s (26%-131%) and SI120s (1%-274%). BPV increased concomitantly with SI. Cross-correlation analysis showed HC and AIS BP sudden change detection accuracy reductions with increasing SI. Positive BP deviation detection fell 48.48% (SI10s) to 78.79% (SI75s) in HC and 67.5% (SI10s) to 100% (SI75s) in AIS. Negative BP deviation detection fell 50% (SI10s) to 82.35% (SI75s) in HC and 52.27% (SI10s) to 95.45% (SI75s) in AIS.

Sudden BP change detection and BPV are relatively robust to SI increases within certain limits, but accuracy reductions generate unacceptable estimates, considerable within RPM device design. This research warrants further SI optimisation.

The clinical relevance of blood pressure variability (BPV) is still unknown, despite increasing evidence associating BPV to negative health outcomes (NHOs). There is currently no gold standard to define high BPV and normal reference values for BPV are lacking.

The primary aim was to examine whether high BPV can predict NHO in adults aged ≥65. The predictive value of BPV was compared to mean BP (mBP) when both parameters were available.

PubMed and Web of Science were systematically screened; 49 articles (12 retrospective, 18 prospective and 19 cross-sectional studies) were included and evaluated for methodological quality. Meta-analyses were conducted to examine the association of BPV (and mBP when available) with NHO.

Systolic BPV and systolic mBP seem to indicate at least comparable odds for cardiovascular disease (BPV: odds ratio (OR) = 1.33 (95% CI: 1.19-1.48, P < .00001) vs mBP: OR = 1.06 (95% CI: 1.03-1.09, P = .0002)) and cerebral deterioration (BPV: OR = 1.28 (95% CI: 1.17-1.41, P < .00001) vs mBP: OR = 1.06 (95% CI: 1.04-1.09, P < .00001)). Increased diastolic BPV was associated with higher odds of cerebral deterioration (OR = 1.18 (95% CI: 1.04-1.35), P = .01).

High systolic BPV and high systolic mBP are associated with 33% and 6% higher odds of cardiovascular disease in adults aged ≥65, respectively. High BPV is also related to an 18%-28% and 11% increased odds of cerebral deterioration and poor stroke recovery. An overview of cut-off values is provided for the most often reported BPV parameters in literature, which can be used as a guideline to identify elevated BPV in clinical practice.

Recent studies revealed the importance of tracking continuous blood pressure (BP) changes in monitoring and controlling hypertension and diagnosing cardiovascular diseases. However, current evaluation protocols utilize distance measures as primary metrics, which cannot properly evaluate the ability of the estimation model to track BP changes. This paper proposes a comprehensive evaluation framework which evaluates the distance and trend similarity metrics, and the composite metric of both between the reference and estimated BPs. The results of applying both widely used conventional metrics and the new proposed metrics for BP estimations are demonstrated in an example of comparing the reference with a set of different BP estimations. Then, the metrics are applied to BP estimations obtained using state-of-the-art (SOTA) algorithms. It is shown that even though SOTA algorithms have a low mean and standard deviation of absolute difference, they are not capable of tracking short-term blood pressure changes. Additionally, the proposed metrics are normalized metrics and range from -1 to 1, making them intuitively interpretable, similar to well-known correlation coefficients. Therefore, we suggest that the proposed evaluation framework should be used regularly in evaluating continuous BP monitoring systems.

Background: Accumulating evidence from clinical trials, large registries, and meta-analyses of population studies shows that increased Blood Pressure Variability (BPV) is predictive of Cardiovascular (CV) outcomes, independently of the average Blood Pressure (BP) values. One of the mechanisms explaining the relationship between BPV and target organ damage is the inflammatory response. The Systemic Immune Inflammation Index (SII), which relies on peripheral blood cell counts, including platelets, neutrophils, and lymphocytes, has emerged as a predictor of prognosis and outcomes in various diseases. The aim of this study was to investigate the association of the SII with Ambulatory Blood Pressure Variability (ABPV) in newly diagnosed hypertensive patients. Methods: This study was designed as a cross-sectional observational study. A total of 1606 consecutive newly diagnosed Hypertension (HT) patients were included in the study. The population was evaluated across 3 different categories according to HT grades (5 groups), eligibility for antihypertensive therapy (2 groups) and ABPV levels (2 groups). Results: Significant differences were observed between ABPV groups in terms of Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio, glucose, SII, high-sensitive CRP, HT grade, Inter-Ventricular Septum, Posterior Wall thickness, and Left Ventricular Mass (p < 0.005). There was a significant relationship between SII and ABPV (r: 0.619, p < 0.05). At the cutoff value of 580.49, SII had 77% sensitivity and 71% specificity for ABPV > 14 (AUC: 0.788). Conclusions: SII may assist in developing an early treatment approach to minimize complications in patients with high ABPV who are at a higher risk of CV events.

We delineated the association between otolithic dysfunction and blood pressure (BP) variability.

We prospectively recruited 145 consecutive patients (age=71 [59-79] years, median [interquartile range]; 76 females) with orthostatic intolerance between December 2021 and December 2023 at a tertiary hospital in South Korea. Each patient underwent evaluations of cervical and ocular vestibular-evoked myogenic potentials (oVEMPs), 24-h noninvasive ambulatory BP monitoring (ABPM), and a head-up tilt-table test using the Finometer device. As measures of BP variability, the standard deviations (SDs) of the systolic BP (SBPSD) and the diastolic BP were calculated based on serial ABPM recordings. Patients were divided into those with orthostatic hypotension (OH, n=68) and those with a normal head-up tilt-table test despite orthostatic intolerance (NOI, n=77) groups.

A multivariable logistic regression analysis showed that OH was associated with bilateral oVEMP abnormalities (p=0.021), SBPSD (p=0.012), and female sex (p=0.004). SBPSD was higher in patients with OH than in those with NOI (p<0.001), and was not correlated with n1-p1 amplitude (p=0.491) or normalized p13-n23 amplitude (p=0.193) in patients with OH. The sensitivity and specificity for differentiating OH from NOI were 72.1% and 67.5%, respectively, at a cutoff value of 12.7 mm Hg for SBPSD, with an area under the receiver operating characteristic curve of 0.73.

Bilaterally deficient oVEMP responses may be associated with OH regardless of 24-h BP variability, reflecting the integrity of the otolith-autonomic reflex during orthostasis. Alternatively, 24-h BP variability is predominantly regulated by the baroreflex, which also participates in securing orthostatic tolerance complementary to the vestibulo-autonomic reflex.

Blood pressure variability (BPV) is a prognostic marker of cardiovascular disease (CVD). Sleep is recognized as a significant risk factor for CVD; however, little is known about the relationship between sleep characteristics and BPV.

In this systematic review, we aimed to (1) describe methods used to measure BPV and sleep and (2) describe the current evidence in the literature on the association between sleep and BPV.

A systematic search was conducted using the search terms "sleep" AND ("blood pressure variability" OR "ambulatory blood pressure monitor") in CINAHL, PubMed, Web of Science, and PsycINFO databases.

Twenty-two studies were included in this systematic review. Sleep was measured using various methods, including polysomnography, actigraphy, sleep diaries, and questionnaires, while BPV was measured over various time intervals using different monitoring devices such as a beat-to-beat blood pressure (BP) monitoring device, a 24-h ambulatory BP monitor, or an automatic upper arm BP monitor. The studies demonstrated mixed results on the associations between sleep parameters (sleep quality, architecture, and duration) and increased BPV.

Although the mechanisms that explain the relationship between sleep and BPV are still unclear, accumulating evidence suggests potential associations between increased BPV with poor sleep quality and longer sleep duration. Given the recent development of sleep and BP monitoring technologies, further research is warranted to assess sleep and BPV under free-living conditions. Such studies will advance our understanding of complex interactions between sleep and CVD risk.

Vaso-occlusive crises (VOCs) are a hallmark symptom of sickle cell disease (SCD). Physical stressors can trigger decreased microvascular blood flow and increase the risk for VOCs. However, the effect of mental and psychological stressors on vascular physiology in SCD is not well-established. We hereby examined fluctuations in continuous blood pressure (BP) to evaluate hemodynamic changes in SCD patients during mental and psychological stress.

Thirteen SCD (HbSS) subjects from the Children's Hospital Los Angeles and 11 healthy (HbAA) volunteers were recruited. Continuous BP was recorded as subjects participated in two mental and one psychological stress tasks. Systolic beat-to-beat BP variability (BPV) measurements were calculated for each subject. Three very short-term BPV metrics served as outcome measures: standard deviation, coefficient of variation, and average real variability. Linear mixed effects models evaluated associations between patient factors and outcome measures.

SCD patients were associated with increased systolic BPV and exhibited a distinct increase in BPV in response to psychological stress. All subjects exhibited a decrease in systolic BPV in response to mental stress tasks. During mental stress, both groups displayed increased augmentation index, reflective of stress-induced vasoconstriction, while psychological stress in SCD patients led to both decreased mean arterial pressure and increased AI, suggestive of uncompensated vasoconstriction.

These findings emphasize the impact of mental and psychological stressors on vascular function in SCD, the potential for monitoring physiological signals to predict VOC events, and the importance of counseling SCD patients on lifestyle practices to reduce their stress to prevent pain.

Management of intracerebral hemorrhage (ICH) is challenged by limited therapeutic options and a complex relationship between blood pressure (BP) dynamics, especially BP variability (BPV) and ICH outcome.

In an exploratory analysis of prospectively collected data on consecutive patients with nontraumatic ICH between 2015 and 2020, continuous BP accessed via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) was analyzed over the first 72 h post admission. Arterial lines were used as part of standard clinical practice in the intensive care, ensuring high fidelity and real-time data essential for acute care settings. BPV was assessed through successive variation (SV), standard deviation (SD), and coefficient of variation using all available BP measurements. Multivariate regression models were applied to evaluate the association between BPV indices and functional outcome at 3 months.

Among 261 patients (mean age 69.6 ± 15.2 years, 47.9% female, median National Institutes of Health Stroke Scale [NIHSS] score 6 [interquartile range 2-12]) analyzed, lower systolic BP upon admission (< 140 mm Hg) and lower systolic BPV were significantly associated with favorable outcome, whereas higher diastolic BPV correlated with improved outcomes. In the multivariate analysis, diastolic BPV (SD, SV) within the first 72 h post admission emerged as an independent predictor of good functional outcome (modified Rankin Scale score < 3; odds ratio 1.123, 95% confidence interval CI 1.008-1.184, p = 0.035), whereas systolic BPV (SD) showed a negative association. Patients with better outcomes also exhibited distinct clinical characteristics, including younger age, lower median NIHSS scores, and less prevalence of anticoagulation therapy upon admission.

This study shows the prognostic value of BPV in the acute phase of ICH. Lower systolic BPV (SD) and higher diastolic BPV (SD, SV) were associated with better functional outcomes, challenging traditional BP management strategies. These findings might help to tailor a personalized BP management in ICH.

Diabetes mellitus (DM), a worldwide disease affecting more than 400 million people, is associated with high blood pressure (BP). In addition to macrovascular complications, high BP in DM patients is potentially linked to microvascular complications. More than 70% of DM patients have retinopathy. To our knowledge, no systematic review and meta-analysis has been conducted on the relationship between visit-to-visit variability in blood pressure and diabetic retinopathy risk.

This systematic review and meta-analysis study was performed on the related articles. The search strategy, screening, and data selection were all checklist-based. A comprehensive search was done in three databases, including PubMed, Google Scholar, and Scopus. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. English clinical studies published up to January 2023 contained diabetic patients as the population, retinopathy as the outcome, and visit-to-visit blood pressure as the intervention. Using the QUIPS technique, two authors independently quantify the risk of bias in included publications. The meta-analysis was conducted using R version 4.4.1. We calculated relative risk (RR) as the effect size, applying the random effect model. Standard deviation (SD) and coefficient of variation (CV), were used as measures of BP variability.

A total number of 8 studies with 743,315 participants were covered in this systematic review. After meta-analysis, we concluded that the group with higher SD of BP variability had 2 percent higher risk than the control group (RR = 1.02, 95% CI = 1.01-1.03, I-squared = 41%); however, results of our analysis for CV of BP variability showed no significant contrast with control group thus no increased risk was reported (RR = 1.04, 95% CI = 0.94-1.15, I-squared = 32%, P-value = 0.23).

In conclusion, an increased SD of BP variability significantly increased the relative risk for the development of retinopathy.

We aimed to investigate the correlation between long-term blood pressure variability (BPV) and the risk of cardiovascular diseases (CVDs) among population with different blood pressure statuses (normotension, well-controlled hypertension, and uncontrolled hypertension).

In this ambispective cohort study, CVD-free residents aged over 50 years were consecutively enrolled from two community health service centers (CHCs) in Tianjin, China from April 2017 to May 2017. Information on blood pressure was retrospectively extracted from electronic medical records of CHCs between January 2010 and May 2017, and the occurrence of new-onset CVDs was prospectively observed during follow-up until September 2019. Long-term variation of SBP and DBP was assessed using four indicators: SD, coefficient of variation (CV), average successive variability (ASV), and average real variability (ARV). Cox proportional hazards regression model was developed to identify the potential impact of BPV on the incidence of CVDs. The receiver operating characteristic curve (ROC) was utilized to evaluate the predictive value of BPV indicators for the occurrence of CVDs.

Of 1275 participants included, 412 (32.3%) experienced new CVD events during the median 7.7 years of follow-up, with an incidence density of 499/10 000 person-year in the whole cohort. Cox regression analysis revealed that almost all SBP and DBP variability indicators (except for SBP-SD) were significantly related to the risk of CVDs, especially among individuals with well-controlled hypertension. A trend toward an increased risk of CVDs across BPV quartiles was also observed. Moderate predictive abilities of BPV were observed, with the area under ROC curves ranging between 0.649 and 0.736. For SBP variability, SD had the lowest predictive ability, whereas for DBP variability, ARV had the lowest predictive ability. No significant association of CVDs with SBP-SD was found in all analyses, no matter as a continuous or categorical variable.

Elevated long-term BPV is associated with an increased risk of CVDs, especially among individuals with well-controlled hypertension. CV and ASV had higher predictive values than SD and ARV.

We performed an analysis of a large intensive care unit electronic database to provide preliminary estimates of various blood pressure parameters in patients with acute stroke receiving intravenous (IV) antihypertensive medication and determine the relationship with in-hospital outcomes.

We identified the relationship between pre-treatment and post-treatment systolic blood pressure (SBP) and heart rate (HR)-related variables and in-hospital mortality and acute kidney injury in patients with acute stroke receiving IV clevidipine, nicardipine, or nitroprusside using data provided in the Medical Information Mart for Intensive Care (MIMIC) IV database.

A total of 1830 patients were treated with IV clevidipine (n = 64), nicardipine (n = 1623), or nitroprusside (n = 143). The standard deviations [SDs] of pre-treatment SBP (16.3 vs. 13.7, p ≤ 0.001) and post-treatment SBP (15.4 vs. 14.4, p = 0.004) were higher in patients who died compared with those who survived, particularly in patients with intracerebral hemorrhage (ICH). The mean SBP was significantly lower post treatment compared with pre-treatment values for clevidipine (130.7 mm Hg vs. 142.5 mm Hg, p = 0.006), nicardipine (132.8 mm Hg vs. 141.6 mm Hg, p ≤ 0.001), and nitroprusside (126.2 mm Hg vs. 139.6 mm Hg, p ≤ 0.001). There were no differences in mean SDs post treatment compared with pre-treatment values for clevidipine (14.5 vs. 13.5, p = 0.407), nicardipine (14.2 vs. 14.6, p = 0.142), and nitroprusside (14.8 vs. 14.8, p = 0.997). The SDs of pre-treatment and post-treatment SBP were not significantly different in patients with ischemic stroke treated with IV clevidipine, nicardipine, or nitroprusside or for patients with ICH treated with IV clevidipine or nitroprusside. However, patients with ICH treated with IV nicardipine had a significantly higher SD of post-treatment SBP (13.1 vs. 14.2, p = 0.0032).

We found that SBP fluctuations were associated with in-hospital mortality in patients with acute stroke. IV antihypertensive medication reduced SBP but did not reduce SBP fluctuations in this observational study. Our results highlight the need for optimizing therapeutic interventions to reduce SBP fluctuations in patients with acute stroke.