Blood Pressure Variability and Autonomic Dysfunction
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Purpose of Review
This review considers the relationship between abnormal blood pressure (BP) variability and autonomic dysfunction through an attempt to answer questions about its clinical relevance and pertinence to diabetes and cardiovascular autonomic neuropathy (CAN) and which therapeutic measures can lessen its cardiovascular impact.
Office, ambulatory, and home BP monitoring identify posture-related, circadian, short-term, and long-term BP variabilities. Abnormal BP variability is a risk marker for organ damage, mortality, and cardiovascular events. Moreover, BP variability changes are common in diabetes and associated with CAN and possibly exacerbated by comorbidities like nephropathy, obstructive sleep apnoea syndrome, and chronic pain. The prognostic role of nondipping and reverse dipping is well documented in diabetes. Some findings suggest the possibility of restoring dipping with the dosage time of antihypertensive agents.
Diabetes is a favorable scenario for altered BP variability, which might mediate the harmful effects of CAN. Preliminary data suggest the protective effect of targeting BP variability. However, further longitudinal outcome studies are needed. In the meantime, BP variability measures and practical expedients in antihypertensive treatment should be implemented in diabetes.
KeywordsBlood pressure variability Prognosis Blood pressure monitoring Diabetic neuropathy Autonomic dysfunction SGLT2i Treatment
I would like to thank the colleagues and researchers who worked with me in the field covered by this review; they include Guido Menzinger, Luciano Bernardi, Sergio Gambardella, Simona Frontoni, Maria Rosaria Maiello, Elena Cicconetti, Salvatore Mandica, Roberto Morganti, Tiziana Fedele, Cinzia D’Amato, Carla Greco, and Federica Di Gennaro. I am also deeply grateful to the persons with diabetes who agreed to participate in the studies.
This research has been supported by the 2017 FFABR funding for research activities of Italian National Agency for the Evaluation of the University and Research Systems (ANVUR).
Compliance with Ethical Standards
Conflict of Interest
Vincenza Spallone declares that she has no conflict of interest with respect to the issues considered in this review.
Human and Animal Rights and Informed Consent
This article does not contain any unpublished studies with human or animal subjects performed by the author.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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