Skip to main content
SpringerLink
Log in

Blood Pressure Variability as Elusive Harbinger of Adverse Health Outcomes

  • Chapter
Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

  • 1361 Accesses

Abstract

Over the past decade, blood pressure variability has been at the center of a debate about its value in predicting adverse cardiovascular outcomes. Blood pressure variability includes short-term, circadian, and long-term components. Assessment of blood pressure variability requires multiple readings obtained within a single or several visits, by conventional office, home or 24-h ambulatory blood pressure monitoring, or by beat-to-beat recordings. Current indexes of blood pressure variability raise methodological issues related to their poor reproducibility, their interdependence, and their association with the level of blood pressure.

This chapter reviews the currently available literature. Preference should be given to indexes of blood pressure variability that are independent of the blood pressure level. The reviewed evidence indicates that blood pressure variability does not substantially add to risk stratification over and beyond the blood pressure level. Blood pressure variability remains a research tool in need of further prospective studies with hard endpoints to define its potential application in day-to-day clinical practice. For now, clinicians should concentrate on blood pressure level, the predominant risk factor manageable by lifestyle modifications, and skillfully managed antihypertensive drug treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. White WB. Diagnostic evaluation: ambulatory blood pressure monitoring in clinical hypertension management. J Am Soc Hypertens. 2014;8:939–41.

    Article  PubMed  Google Scholar 

  2. de la Sierra A, Redon J, Banegas JR, Segura J, Parati G, Gorostidi M, de la Cruz JJ, Sobrino J, Llisterri JL, Alonso J, Vinyoles E, Pallarés V, Sarria A, Aranda P, Ruilope LM, Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension. 2009;53:466–72.

    Article  PubMed  Google Scholar 

  3. Schutte R, Thijs L, Liu Y, Asayama K, Jin Y, Odili AN, Gu YM, Kuznetsova T, Jacobs L, Staessen JA. Within-subject blood pressure level—not variability - predicts fatal and nonfatal outcomes in a general population. Hypertension. 2012;60:1138–47.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  4. Rothwell PM, Howard SC, Dolan E, Dobson JE, Dahlöf B, Poulter NR, Sever PS, on behalf of the ASCOT-BPLA and MRC Trial Investigators. Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9:469–80.

    Article  PubMed  CAS  Google Scholar 

  5. Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in general population. Findings from NHANES III, 1988 to 1994. Hypertension. 2011;57:160–6.

    Article  PubMed  CAS  Google Scholar 

  6. Hickson DA, Diez Roux AV, Wyatt SB, Gebreab SY, Ogedegbe G, Sarpong DF, Taylor HA, Wofford MR. Socioeconomic position is positively associated with blood pressure dipping among African-American adults : the Jackson Heart Study. Am J Hypertens. 2011;24:1015–21.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens. 1987;5:93–8.

    Article  PubMed  CAS  Google Scholar 

  8. Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G, Schillaci G, De Caterina R. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension. 2007;50:325–32.

    Article  PubMed  CAS  Google Scholar 

  9. Matsui Y, Ishikawa J, Eguchi K, Shibasaki S, Shimada S, Kario K. Maximum value of home blood pressure: a novel indocator of target organ damage in hypertension. Hypertension. 2011;57:1087–93.

    Article  PubMed  CAS  Google Scholar 

  10. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M, Ota M, Nagai K, Araki T, Satoh H, Ito S, Hisamichi S, Imai Y. Prognostic significance of blood pressure and heart rate variabilities. The Ohasama Study. Hypertension. 2000;36:901–6.

    Article  PubMed  CAS  Google Scholar 

  11. Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895–905.

    Article  PubMed  Google Scholar 

  12. Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375:938–48.

    Article  PubMed  Google Scholar 

  13. Webb AJS, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke : a systematic review and meta-analysis. Lancet. 2010;375:906–15.

    Article  PubMed  CAS  Google Scholar 

  14. Johansson JK, Niiranen TJ, Puukka PJ, Jula AM. Prognostic value of the variability in home-measured blood pressure and heart rate. The Finn-Home study. Hypertension. 2012;59:212–8.

    Article  PubMed  CAS  Google Scholar 

  15. Shimbo D, Newman JD, Aragaki AK, LaMonte MJ, Bavry AA, Allison M, Manson JE, Wassertheil-Smoller S. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women. Data from the Women’s Health Initiative. Hypertension. 2012;60:625–30.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  16. Pierdomenico SD, Lapenna D, Di Tommaso R, Di Carlo S, Esposito AL, Di Mascio R, Ballone E, Cuccurullo F, Mezzetti A. Blood pressure variability and cardiovascular risk in treated hypertensive patients. Am J Hypertens. 2006;19:991–7.

    Article  PubMed  Google Scholar 

  17. Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Pedersen CT, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Imai Y, Wang J, Ibsen H, O’Brien E, Staessen JA, for the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55:1049–57.

    Article  PubMed  CAS  Google Scholar 

  18. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, Murata M, Kuroda T, Schwartz JE, Shimada K. Morning surge in blood pressure as predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107:1401–6.

    Article  PubMed  Google Scholar 

  19. Metoki H, Ohkubo T, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai K. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: The Ohasama Study. Hypertension. 2006;47:149–54.

    Article  PubMed  CAS  Google Scholar 

  20. Gosse P, Lasserre R, Minifie C, Lemetayer P, Clementy J. Blood pressure surge on rising. J Hypertens. 2004;22:1113–8.

    Article  PubMed  CAS  Google Scholar 

  21. Li Y, Thijs L, Hansen TW, Kikuya M, Boggia J, Richart T, Metoki H, Ohkubo T, Pedersen CT, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Sandoya E, Kawecka-Jaszcz K, Ibsen H, Imai Y, Wang J, Staessen JA, for International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension. 2010;55:1040–8.

    Article  PubMed  CAS  Google Scholar 

  22. Verdecchia P, Angeli F, Mazzotta G, Garofoli M, Ramundo E, Gentile G, Ambrosio G, Reboldi G. Day-night dip and early-morning surge in blood pressure in hypertension: prognostic implications. Hypertension. 2014;60:34–42.

    Article  Google Scholar 

  23. Bombelli M, Fodri D, Toso E, Macchiarulo M, Cairo M, Facchetti R, Dell’Oro R, Grassi G, Mancia G. Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population. Hypertension. 2014;64:943–50.

    Article  PubMed  CAS  Google Scholar 

  24. Clement DL, Mussche MM, Vanhoutte G, Pannier R. Is blood pressure variability related to activity of the sympathetic system? Clin Sci. 1979;57:217s–9.

    Article  PubMed  Google Scholar 

  25. Mancia G, Ferrari A, Gregorini L, Parati G, Pomidossi G, Bertinieri G, Grassi G, Zanchetti A. Blood pressure variability in man : its relation to high blood pressure, age and baroreflex sensitivity. Clin Sci (Lond). 1980;59 Suppl 6:401s–4.

    Article  Google Scholar 

  26. Parati G, Pomidossi G, Casadei R, Groppelli A, Trazzi S, Di Rienzo M, Mancia G. Role of heart rate variability in the production of blood pressure variability in man. J Hypertens. 1987;5:557–60.

    Article  PubMed  CAS  Google Scholar 

  27. Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens. 1993;11:1133–7.

    Article  PubMed  CAS  Google Scholar 

  28. Bilo G, Giglio A, Styczkiewicz K, Caldara G, Maronati A, Kawecka-Jaszcz K, Mancia G, Parati G. A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J Hypertens. 2007;25:2058–66.

    Article  PubMed  CAS  Google Scholar 

  29. Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005;23:505–11.

    Article  PubMed  CAS  Google Scholar 

  30. Levitan EB, Kaciroti N, Oparil S, Julius S, Muntner P. Relationships between metrics of visit-to-visit variability of blood pressure. J Hum Hypertens. 2013;27(10):589–93.

    Article  PubMed  CAS  Google Scholar 

  31. Stergiou GS, Mastorantonakis SE, Roussias LG. Intraindividual reproducibility of blood pressure surge upon rising after nighttime sleep and siesta. Hypertens Res. 2014;31:1859–64.

    Article  Google Scholar 

  32. Wizner B, Dechering DG, Thijs L, Atkins N, Fagard R, O’Brien E, de Leeuw PW, Parati G, Palatini P, Clement D, Grodzicki T, Kario K, Staessen JA. Short-term and long-term reproducibility of the morning blood pressure in older patients with isolated systolic hypertension. J Hypertens. 2008;26:1328–35.

    Article  PubMed  CAS  Google Scholar 

  33. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O’Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A, for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension [correction published in Lancet 1997, volume 350, November 29, p 1636]. Lancet. 1997;350:757–64.

    Article  PubMed  CAS  Google Scholar 

  34. Wolk R, Gami AS, Garcia-Touchard A, Somers VK. Sleep and cardiovascular disease. Curr Probl Cardiol. 2005;30:625–62.

    Article  PubMed  Google Scholar 

  35. Kuo TB, Hong CH, Hsieh IT, Lee GS, Yang CC. Effects of cold exposure on autonomic changes during the last rapid eye movement sleep transition and morning blood pressure surge in humans. Sleep Med. 2014;15:986–97.

    Article  PubMed  Google Scholar 

  36. O’Brien E, Sheridan J, O’Malley K. Dippers and non-dippers. Lancet. 1988;2:397.

    Article  PubMed  Google Scholar 

  37. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M, Matsubara M, Hashimoto J, Hoshi H, Araki T, Tsuji I, Satoh H, Hisamichi S, Imai Y. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure : the Ohasama study. J Hypertens. 2002;20:2183–9.

    Article  PubMed  CAS  Google Scholar 

  38. Hansen TW, Jeppesen J, Rasmussen F, Ibsen H, Torp-Pedersen C. Ambulatory blood pressure monitoring and mortality : a population-based study. Hypertension. 2005;45:499–504.

    Article  PubMed  CAS  Google Scholar 

  39. Ingelsson E, Björklund K, Lind L, Ärnlöv J, Sundström J. Diurnal blood pressure pattern and risk of congestive heart failure. JAMA. 2006;295:2859–66.

    Article  PubMed  CAS  Google Scholar 

  40. Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47:846–53.

    Article  PubMed  CAS  Google Scholar 

  41. Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Guerrieri M, Gatteschi C, Zampi I, Santucci A, Santucci C, Reboldi G. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994;24:793–801.

    Article  PubMed  CAS  Google Scholar 

  42. Staessen JA. Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW, Mancia G, Nachev C, Palatini P, Parati G, Tuomilehto J, Webster J, for the Systolic Hypertension in Europe Trial Investigators. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA. 1999;282:539–46.

    Article  PubMed  CAS  Google Scholar 

  43. Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension. 2001;38:852–7.

    Article  PubMed  CAS  Google Scholar 

  44. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, Gheeraert PJ, Missault LH, Braun JJ, Six RO, Van der Niepen P, O’Brien E, for the Office versus Ambulatory Pressure Study investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407–15.

    Article  PubMed  Google Scholar 

  45. Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, Den Hond E, McCormack P, Staessen JA, O’Brien E. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality. The Dublin Outcome Study. Hypertension. 2005;46:156–61.

    Article  PubMed  CAS  Google Scholar 

  46. Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Predictors of all-cause mortality in clinical ambulatory monitoring. Unique aspects of blood pressue during sleep. Hypertension. 2007;167(19):2116–21.

    Google Scholar 

  47. Schwartz GL, Bailey KR, Mosley T, Knopman DS, Jack Jr CR, Canzanello VJ, Turner ST. Association of ambulatory blood pressure with ischemic brain injury. Hypertension. 2007;49:1228–34.

    Article  PubMed  CAS  Google Scholar 

  48. Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Kuznetsova T, Torp-Pedersen C, Lind L, Ibsen H, Imai Y, Wang JG, Sandoya E, O’Brien E, Staessen JA, on behalf of the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO) investigators. Prognostic accuracy of day versus night ambulatory blood pressure : a cohort study. Lancet. 2007;370:1219–29.

    Article  PubMed  Google Scholar 

  49. Asayama K, Thijs L, Li Y, Gu YM, Hara A, Liu YP, Zhang Z, Wei FF, Lujambio I, Mena LJ, Boggia J, Hansen TW, Björklund-Bodegård K, Nomura K, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Stolarz-Skrzypek K, Malyutina S, Casiglia E, Nikitin Y, Lind L, Luzardo L, Kawecka-Jaszcz K, Sandoya E, Filipovský J, Maestre GE, Wang J, Imai Y, Franklin SS, O’Brien E, Staessen JA, on behalf of the Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO) Investigators. Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population. Hypertension. 2014;64:935–42.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  50. Fan HQ, Li Y, Thijs L, Hansen TW, Boggia J, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Imai Y, Ibsen H, O’Brien E, Wang J, Staessen JA. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 subjects from 10 populations. J Hypertens. 2010;28:2036–45.

    Article  PubMed  CAS  Google Scholar 

  51. Palatini P, Reboldi G, Beilin LJ, Casiglia E, Eguchi K, Imai Y, Kario K, Ohkubo T, Pierdomenico SD, Schwartz JE, Wing L, Verdecchia P. Added predictive value of night-time blood pressure variability for cardiovascular events and mortality: the Ambulatory Blood Pressure–International study. Hypertension. 2014;64:487–93.

    Article  PubMed  CAS  Google Scholar 

  52. Staessen JA, Byttebier G, Buntinx F, Celis H, O’Brien ET, Fagard R. for the Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators. Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. JAMA. 1997;278:1065–72.

    Article  PubMed  CAS  Google Scholar 

  53. Staessen JA, Thijs L, Birkenhäger WH, Bulpitt CJ, Fagard R, on behalf of the Syst-Eur Investigators. Update on the Systolic Hypertension in Europe (Syst-Eur) Trial. Hypertension. 1999;33:1476–9.

    Article  PubMed  CAS  Google Scholar 

  54. Hara A, Thijs L, Asayama K, Jacobs L, Wang JG, Staessen JA. Randomised double-blind comparison of placebo and active drugs for effects on risks associated with blood pressure variability in the Systolic Hypertension in Europe trial. PLoS One. 2014;9, e103169.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Ushigome E, Fukui M, Hamaguchi M, Senmaru T, Sakabe K, Tanaka M, Yamazaki M, Hasegawa G, Nakamura N. The coefficient variation of home blood pressure is a novel factor associated with macroalbuminuria in type 2 diabetes mellitus. Hypertens Res. 2011;34:1271–5.

    Article  PubMed  CAS  Google Scholar 

  56. Fukui M, Ushigome E, Tanaka M, Hamaguchi M, Tanaka T, Atsuta H, Ohnishi M, Oda Y, Hasegawa G, Nakamura N. Home blood pressure variability on one occasion is a novel factor associated with arterial stiffness in patients with type 2 diabetes. Hypertens Res. 2013;36:219–25.

    Article  PubMed  CAS  Google Scholar 

  57. Nishimura M, Kato Y, Tanaka T, Todo R, Tone A, Yamada K, Ootani S, Kawabe Y, Yoshizumi H, Hoshiyama Y. Significance of estimating the glomerular filtration rate for the management of hypertension in type 2 diabetes with microalbuminuria. Hypertens Res. 2013;36:705–10.

    Article  PubMed  Google Scholar 

  58. Romero MJ. Home blood pressure variability: a new target to monitor in chronic kidney disease patients with low eGFR? Hypertens Res. 2013;36:673–5.

    Article  PubMed  Google Scholar 

  59. Okada T, Matsumoto H, Nagaoka Y, Nakao T. Association of home blood pressure variability with progression of chronic kidney disease. Blood Press Monit. 2012;17:1–7.

    Article  PubMed  Google Scholar 

  60. Kikuya M, Ohkubo T, Metoki H, Asayama K, Hara H, Obara T, Inoue R, Hoshi H, Hashimoto J, Totsune K, Satoh H, Imai K. Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis. The Ohasama study. Hypertension. 2008;52:1045–50.

    Article  PubMed  CAS  Google Scholar 

  61. Asayama K, Kikuya M, Schutte R, Thijs L, Hosaka M, Satoh M, Obara T, Inoue R, Metoki H, Hoshi H, Ohkubo T, Staessen JA, Imai Y. Home blood pressure variability as cardiovascular risk factor in the population of Ohasama. Hypertension. 2013;61:61–9.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  62. Wei FF, Li Y, Xi TY, Ding FH, Wang JG, Staessen JA. Beat-to-beat, reading-to-reading, and day-to-day blood pressure variability in relation to organ damage in untreated Chinese. Hypertension. 2014;63:790–6.

    Article  PubMed  CAS  Google Scholar 

  63. Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.

    Article  PubMed  Google Scholar 

  64. Muntner P, Levitan EB. Visit-to-visit variability of blood pressure: current knowledge and future research directions. Blood Press Monit. 2013;18:232–8.

    Article  PubMed  Google Scholar 

  65. Webb AJS, Wilson M, Lovett N, Paul N, Fischer U, Rothwell PM. Response of day-to-day home blood pressure variability by antihypertensive drug class after transient ischemic attack or nondisabling stroke. Stroke. 2014;45:2967–73.

    Article  PubMed  CAS  Google Scholar 

  66. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  67. Grove JS, Reed DM, Yano K, Hwang LJ. Variability in systolic blood pressure — a risk factor for coronary heart disease ? Am J Epidemiol. 1997;145:771–6.

    Article  PubMed  CAS  Google Scholar 

  68. Hsieh YT, Tu ST, Cho TJ, Chang SJ, Chen JF, Hsieh MC. Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes : a 5.5-year prospective analysis. Eur J Clin Invest. 2012;42:245–53.

    Article  PubMed  Google Scholar 

  69. Kilpatrick ES, Rigby AS, Atkin SL. The role of blood pressure variability in the development of nephropathy in type 1 diabetes. Diabetes Care. 2010;33:2442–7.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Tozawa M, Iseki K, Yoshi S, Fujiyama K. Blood pressure variability as an adverse prognostic risk factor in end-stage renal disease. Nephrol Dial Transplant. 1999;14:1976–81.

    Article  PubMed  CAS  Google Scholar 

  71. Brunelli SM, Thadhani RI, Lynch KE, Ankers ED, Joffe MM, Boston R, Chang Y, Feldman HI. Association between long-term blood pressure variability and mortality among incident hemodialysis patients. Am J Kidney Dis. 2008;52:716–26.

    Article  PubMed  Google Scholar 

  72. Rossignol P, Cridlig J, Lehert P, Kessler M, Zannad F. Visit-to-visit variability is a strong variability is a strong predictor of cardiovascular events in hemodialysis : insights from FOSIDIAL. Hypertension. 2012;60:339–46.

    Article  PubMed  CAS  Google Scholar 

  73. McMullan CJ, Lambers Heerspink HJ, Parving HH, Dwyer JP, Forman JP, de Zeeuw D. Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial. Am J Kidney Dis. 2014;64:714–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Kapucijnenvoer 35, Box 7001, Leuven, 3000, Belgium

    Kei Asayama M.D., Ph.D., Fang-Fei Wei M.D., Azusa Hara Ph.D. & Jan A. Staessen M.D., Ph.D.

  2. Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan

    Kei Asayama M.D., Ph.D.

  3. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

    Kei Asayama M.D., Ph.D.

  4. Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Fang-Fei Wei M.D. & Yan Li M.D., Ph.D.

  5. The Steno Diabetes Center, Gentofte and Research Center for Prevention and Health, Copenhagen, Denmark

    Tine W. Hansen M.D., Ph.D.

  6. VitaK Research and Development, Maastricht University, Maastricht, The Netherlands

    Jan A. Staessen M.D., Ph.D.

Authors
  1. Kei Asayama M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fang-Fei Wei M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Azusa Hara Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tine W. Hansen M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yan Li M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jan A. Staessen M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan A. Staessen M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA

    William B. White

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Asayama, K., Wei, FF., Hara, A., Hansen, T.W., Li, Y., Staessen, J.A. (2016). Blood Pressure Variability as Elusive Harbinger of Adverse Health Outcomes. In: White, W. (eds) Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics. Clinical Hypertension and Vascular Diseases. Humana Press, Cham. https://doi.org/10.1007/978-3-319-22771-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22771-9_7

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-22770-2

  • Online ISBN: 978-3-319-22771-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation