A reliable index for the prognostic significance of blood pressure variability

TLDR

Blood pressure variability (BPV) has been linked to cardiovascular events, but inconsistent findings—possibly due to the variability index used—have prompted the development of a new metric. The study aims to evaluate whether the average real variability (ARV) index provides reliable prognostic information for BPV compared to the standard deviation. The authors monitored 312 adults ≥55 years with ambulatory BP monitoring and applied logistic regression and survival analyses to compare ARV and SD indices and assess BPV against other risk factors. ARV identified a significant 4.55‑fold increased risk of cardiovascular events in high‑BPV patients (P = 0.006), whereas SD did not, and ARV’s predictive power matched that of systolic BP, indicating added prognostic value.

Abstract

This study presents a reliable index inspired by the total variability concept of real analysis in mathematics, called average real variability (ARV), for the prognostic significance of blood pressure variability (BPV) overcoming the pitfalls of the commonly used standard deviation (SD).Recent studies have suggested that an increase in BPV is associated with an increase in subsequent cardiovascular events/complications. However, there are other studies where the cited association was not found or was lost in the presence of other well-known risk factors. An explanation for these apparently contradictory results may be the selection of the variability index used (SD).Ambulatory blood pressure monitoring in 312 subjects aged > or = 55 years. Logistic regression models and survival methods were used to establish the prognostic significance of awake systolic BPV: in particular, (i) the performance of ARV versus SD, and (ii) the value of BPV relative to other well-known risk factors.The analyses using the ARV index show a statistically significant relative risk equal to 4.548 (P = 0.006) for the group with high BPV with respect to the low BPV group (reference level); in contrast, the corresponding relative risk associated to the SD index was not statistically significant. Furthermore, ARV exhibited a similar predictive value to systolic blood pressure.The proposed ARV index is a more reliable representation of time series variability than SD and may be less sensitive to the relative low sampling frequency of the ambulatory blood pressure monitoring devices. The results suggest that ARV adds prognostic value to the ABPM and could prompt the use of therapeutic measures to control BPV.