Novel Indices of Home Blood Pressure Variability and Hypertension-Mediated Organ Damage in Treated Hypertensive Patients

Abstract

Introduction: Although multiple home blood pressure variability (HBPV) indices have been proposed, the superiority of one over another is not clear in treated hypertensives. Aim: We evaluated the correlation between different indices of HBPV and hypertension-mediated organ damage (HMOD) in this population and determined predictors of greater HBPV. Methods: We included adult treated hypertensives who performed an HBP monitoring (duplicate sitting BP readings in the morning, afternoon, and evening for 4 days, Omron HEM-705CP-II), laboratory measurements, transthoracic echocardiogram and carotid-femoral pulse wave velocity. We selected HBPV indices from three different calculation approaches: coefficient of variation (CoV), difference between maximum and minimum BP (MMD), and morning BP increase (MI), and evaluated their correlation with left ventricular mass index, relative wall thickness (RWT), ejection fraction, arterial stiffness and estimated glomerular filtration rate through a correlation matrix. For those variability indices significantly associated with HMOD, we constructed multiple linear regression models to determine independent predictors of HBPV. Results: We included 204 patients, mean age 67.2 (± 13.8) years, 64% female. CoV and MMD for systolic BP showed the greatest correlation with HMOD. Factors independently associated both with CoV and MMD were: older age (b = 0.07; 95% CI 0.04–0.07; p < 0.001 and b = 0.4; 95% CI 0.2–0.5; p < 0.001, respectively), history of stroke (b = 3.6; 95% CI 0.9–6.4; p = 0.01 and b = 25.7; 95% CI 10.1–41.2; p = 0.001, respectively), and body mass index [b = − 0.1; 95% CI − 0.2 to (− 0.02); p = 0.01 and b = − 0.5; 95% CI − 0.9 to (− 0.1); p = 0.01, respectively]. Conclusion: CoV and MMD showed the greatest association with HMOD in treated hypertensives. Older age, history of stroke and lower body mass index were easy-to-detect predictors.