Modern aspects of short-term blood presssure variability in arterial hypertension

Arterial hypertension is an important public health problem worldwide due to its high incidence and associated risks of cardiovascular and renal diseases such as coronary heart disease, cerebrovascular disease, chronic kidney disease. The level of blood pressure is the main indicator of hypertension treatment effectiveness and leading cardiovascular risk factor. Blood pressure is one of the most dynamic physiological parameters, which is characterized by continuous and significant changes beat-to-beat, over 24 h, day-to-day, and visit-to-visit. Under physiological conditions, these blood pressure variations are mostly represent a response to environmental stimulation aimed at maintaining cardiovascular homeostasis. However, a persistent increase in the blood pressure variability may be the result of pathological changes in the mechanisms of cardiovascular regulation, which leads to alterations in cardiovascular system functioning with the subsequent development of cardiovascular diseases and complications. The phenomenon of blood pressure variability has been known for a long time. It was first described by the English physiologist Stephen Gales in 1733, and its assessment in clinical conditions became possible at the end of the 19th – beginning of the 20th century, after the invention of the sphygmomanometer and the introduction of non-invasive blood pressure measurement using the Riva-Rocci and Korotkov methods. Historically, blood pressure variability has been viewed as a random factor caused by measurement error, which prevents accurate blood pressure measurement. Вlood pressure variability was considered the so-called «background noise», which was not given any importance and tried to overcome with the help of improving monitoring. However, already at the end of the last century, the discussion of the clinical significance of this indicator in patients with hypertension began. The clinical significance and prognostic implications of blood pressure variability have been demonstrated by a series of clinical and population-based studies conducted in recent years, in which elevated blood pressure variability was associated with a higher risk of target organ damage, cardiovascular events, cardiovascular and total mortality independently of blood pressure level. The review presents modern concepts of blood pressure variability, its classification, and assessment methods. The pathogenetic significance of short-term BP variability in patients with arterial hypertension is reviewed, with a discussion of the available evidence regarding the significance of short-term blood pressure variability in cardiovascular risk stratification.