Key result
Low visit-to-visit blood pressure variability was associated with a significantly greater reduction in maximum carotid IMT compared with high BPV (mean difference 0.06; 95% CI 0.01-0.11; P=0.0271).
Why the study?
Does low visit-to-visit blood pressure variability reduce the progression of atherosclerosis in carotid and coronary arteries in patients with CAD?
Observational (n=949)
Does low visit-to-visit blood pressure variability reduce the progression of atherosclerosis in carotid and coronary arteries in patients with CAD?
In patients with CAD, low visit-to-visit blood pressure variability is associated with reduced progression of carotid atherosclerosis but not coronary atherosclerosis.
Answers are grounded in this paper and cite their sources.
May inform BP management to favor carotid IMT regression in CAD; hypothesis-generating for BPV as modifiable target.
Aims: To investigate the relationship between visit-to-visit blood pressure variability (BPV) and the progression of both carotid and coronary artery disease (CAD). Methods and results: Data from two cardiovascular endpoint studies [Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic Evaluation (NORMALISE) and Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT)] were analysed separately. Systolic BPV was assessed as within-subject standard deviation of systolic BP across visits from 12-weeks onwards. Follow-up was 24 months (NORMALISE) or 36 months (PREVENT). Any association between BPV and progression of atherosclerosis was assessed using quantitative coronary angiography (QCA), intravascular ultrasound (IVUS), or B-mode ultrasound (depending on study). Patients from NORMALISE (n = 261) and PREVENT (n = 688 for QCA; n = 364 for ultrasound) were stratified within study according to median systolic BPV. No significant difference in change of minimal luminal diameter (by QCA in PREVENT) or change in percent atheroma volume or normalized total atheroma volume (by IVUS in NORMALISE) was detected for subjects with low BPV (BPV < median) compared with high BPV (BPV ≥ median), regardless of treatment. In PREVENT, a significantly greater reduction in maximum carotid intima-media thickness (IMT) (left and right common carotid artery far wall) was observed for patients with BPV < median compared with those with BPV ≥ median [least squares mean difference 0.06 (95% confidence interval 0.01, 0.11); P = 0.0271], after adjusting for treatment, carotid artery segment (left or right), baseline maximum carotid IMT, and other baseline and cardiovascular risk factors/covariates. Conclusions: In patients with existing CAD and well-controlled BP, visit-to-visit BPV was not associated with progression of coronary atherosclerosis; however, a significantly greater reduction in maximum carotid IMT was observed for patients with low BPV.
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Kim et al. (2016) conducted an observational in Carotid and coronary artery disease (CAD) (n=949). Low visit-to-visit blood pressure variability (BPV < median) vs. High visit-to-visit blood pressure variability (BPV ≥ median) was evaluated on Progression of atherosclerosis (change in minimal luminal diameter, atheroma volume, or maximum carotid IMT) (MD 0.06, 95% CI 0.01, 0.11, p=0.0271). Low visit-to-visit blood pressure variability was associated with a significantly greater reduction in maximum carotid IMT compared with high BPV (mean difference 0.06; 95% CI 0.01-0.11; P=0.0271).
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