Relationship Between Circadian Blood Pressure Patterns and Progression of Early Carotid Atherosclerosis

TLDR

Hypertension is a major cardiovascular risk factor, and prior studies indicate that high blood pressure variability is linked to greater target organ damage; this study followed 286 adults over 3.3 years to examine how circadian BP changes relate to early carotid atherosclerosis progression. Researchers monitored long‑term circadian blood pressure patterns with ambulatory devices and measured carotid intima‑media thickness, then stratified patients by blood pressure variability. Patients with higher daytime systolic BP variability showed a markedly faster IMT increase (0.11 mm yr⁻¹ vs 0.05 mm yr⁻¹), and multivariate analysis identified daytime systolic variability as the strongest predictor of IMT progression, with values >15 mm Hg conferring a 3.9‑fold higher risk of early atherosclerosis and a 1.9‑fold higher risk of cardiovascular events.

Abstract

Arterial hypertension is a major risk factor for cardiovascular damage. The results of several studies suggest that target organ damage is greater in hypertensive persons with high blood pressure variability.During 3.3 years of follow-up, we studied the relationship between circadian blood pressure changes and the progression of early carotid atherosclerosis in 286 patients aged >55 years. Blood pressure patterns were evaluated with a long-term blood pressure monitor, and the extent of atherosclerosis was measured as the intima-media wall thickness (IMT) of the common carotid artery. Patients were subdivided according to blood pressure variability. The progression of IMT was significantly greater in the patients with increased systolic blood pressure variability (0.11 mm/y [95% CI 0.09 to 0.14] versus 0.05 mm/y [0.03 to 0.08]; P:<0.005) even after adjustment for other risk factors. Multivariate regression analysis revealed the daytime systolic blood pressure variability to be the best predictor for the progression of IMT. Raised daytime systolic blood pressure variability (>15 mm Hg) is associated with an increased relative risk of the development of early atherosclerosis (3.9 [1.4 to 11.1]; P:<0.01) and of cardiovascular events (1.87 [1.08 to 3.20]; P:<0.01).The daytime systolic blood pressure variability is a strong predictor of early carotid atherosclerosis progression and is useful to define the risk-benefit ratio of therapeutic approaches.