Blood Pressure Variability and Left Ventricular Diastolic Dysfunction

In the past decades, blood pressure variability has been deeply and widely investigated for its role in cardiovascular prediction and prevention. It is derived from blood pressure measurement and can be classified into very short-term (beat-to-beat), short-term (reading-to-reading within 24 hours), mid-term (day-to-day), and long-term blood pressure variabilities (visit-to-visit over weeks, months, and years). These indices, especially those for long-term blood pressure variability, have been considered as an important cardiovascular risk factor.1,2 Rothwell et al. demonstrated that visit-to-visit systolic blood pressure variability was a strong predictor of stroke independent of mean systolic blood pressure from cohorts including the UK-transient ischemic attack (UK-TIA) trial and Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA).3 Another meta-analysis of prospective studies also showed a significant association between increased long-term systolic blood pressure variability and the risk of all-cause and cardiovascular mortality, cardiovascular events, coronary heart disease, and stroke.4 Although its mechanism is not fully understood, accumulative evidence indicated possible pathophysiology related to arterial stiffness and remodeling. In a post hoc analysis of 7 randomized clinical trials involving 3,912 patients, Clark et al. found that increased blood pressure variability, particularly systolic blood pressure variability, was significantly associated with coronary atheroma progression and adverse clinical outcomes.5 In the Multi-Ethnic Study of Atherosclerosis (MESA), Shimbo et al. found negative significant correlation between visit-to-visit systolic blood pressure variability and large aortic arterial distensibility even after adjustment for cardiovascular risk factors and average systolic blood pressure.6 All these findings support the notion that long-term systolic blood pressure variability might be associated with cardiovascular disease via arterial stiffness increase independent of average blood pressure level.7