Relationships of vascular function with measures of ambulatory blood pressure variation


      • Relationships of short-term BP variation with vasodilator function were explored.
      • Measures of BP variation were significantly associated with vasodilator function.
      • Inverse associations for rate of BP variation were largely explained by age and BP.
      • Night time BP dip was independently positively associated with smooth muscle function.



      Characteristics of short-term blood pressure (BP) variation may influence cardiovascular disease risk via effects on vascular function.


      In a cross-sectional study of a group of treated hypertensive and untreated largely normotensive subjects we investigated the relationships of measures of short-term BP variation with brachial artery vasodilator function.


      A total of 163 treated hypertensive (n = 91) and untreated largely normotensive (n = 72) men and women were recruited from the general population. Measures of systolic and diastolic BP variation were calculated from 24 h ambulatory BP assessments and included: (i) rate of measurement-to-measurement BP variation (SBP-var and DBP-var); and (ii) day-to-night BP dip (SBP-dip and DBP dip). Endothelium-dependent vasodilation was assessed as flow-mediated dilation (FMD) and endothelium-independent vasodilation was assessed in response to glyceryl trinitrate (GTN). Relationships were explored using univariate and multivariate linear regression.


      The relationships of brachial artery vasodilator function with BP variation were not significantly different between treated hypertensive and untreated subjects, therefore these groups were combined for analysis. In univariate analysis, higher SBP-var (P < 0.001) and lower DBP-dip (P = 0.004) were associated with lower FMD; and higher SBP-var (P = 0.002) and lower SBP-dip (P = 0.003) and DBP-dip (P = 0.001) were associated with lower GTN-mediated dilation. In multivariate analysis, lower SBP-dip (P = 0.007) and DBP-dip (P = 0.03) were independently associated with lower GTN response.


      Our results indicate that a lower day-to-night BP dip is independently associated with impaired smooth muscle cell function. Although rate of BP variation was associated with measures of endothelial and smooth muscle cell function, relationships were attenuated after accounting for age and BP.


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        • Mathers C.D.
        • Loncar D.
        Projections of global mortality and burden of disease from 2002 to 2030.
        PLoS Med. 2006; 3: e442
        • Kearney P.M.
        • Whelton M.
        • Reynolds K.
        • et al.
        Global burden of hypertension: analysis of worldwide data.
        Lancet. 2005; 365: 217-223
        • Rothwell P.M.
        Does blood pressure variability modulate cardiovascular risk?.
        Curr Hypertens Rep. 2011; 13: 177-186
        • Parati G.
        Blood pressure variability: its measurement and significance in hypertension.
        J Hypertens Suppl. 2005; 23: S19-S25
        • Eguchi K.
        • Ishikawa J.
        • Hoshide S.
        • et al.
        Night time blood pressure variability is a strong predictor for cardiovascular events in patients with type 2 diabetes.
        Am J Hypertens. 2009; 22: 46-51
        • de la Sierra A.
        • Segura J.
        • Gorostidi M.
        • et al.
        Diurnal blood pressure variation, risk categories and antihypertensive treatment.
        Hypertens Res. 2010; 33: 767-771
        • Verdecchia P.
        • Angeli F.
        • Mazzotta G.
        • et al.
        Day-night dip and early-morning surge in blood pressure in hypertension: prognostic implications.
        Hypertension. 2012; 60: 34-42
        • Fagard R.H.
        • Celis H.
        • Thijs L.
        • et al.
        Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension.
        Hypertension. 2008; 51: 55-61
        • Zakopoulos N.A.
        • Tsivgoulis G.
        • Barlas G.
        • et al.
        Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness.
        Hypertension. 2005; 45: 505-512
        • Zakopoulos N.A.
        • Tsivgoulis G.
        • Barlas G.
        • et al.
        Impact of the time rate of blood pressure variation on left ventricular mass.
        J Hypertens. 2006; 24: 2071-2077
        • Manios E.
        • Tsagalis G.
        • Tsivgoulis G.
        • et al.
        Time rate of blood pressure variation is associated with impaired renal function in hypertensive patients.
        J Hypertens. 2009; 27: 2244-2248
        • Sander D.
        • Klingelhofer J.
        Diurnal systolic blood pressure variability is the strongest predictor of early carotid atherosclerosis.
        Neurology. 1996; 47: 500-507
        • Routledge F.S.
        • McFetridge-Durdle J.A.
        • Dean C.R.
        • et al.
        Night-time blood pressure patterns and target organ damage: a review.
        Can J Cardiol. 2007; 23: 132-138
        • Hansen T.W.
        • Li Y.
        • Boggia J.
        • et al.
        Predictive role of the nighttime blood pressure.
        Hypertension. 2011; 57: 3-10
        • Diaz K.M.
        • Veerabhadrappa P.
        • Kashem M.A.
        • et al.
        Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in African Americans.
        Hypertens Res. 2012; 35: 55-61
        • Konrad T.
        • Franke S.
        • Schneider F.
        • et al.
        Nocturnal blood pressure but not insulin resistance influences endothelial function in treated hypertensive patients.
        J Hum Hypertens. 2011; 25: 18-24
        • Higashi Y.
        • Nakagawa K.
        • Kimura M.
        • et al.
        Circadian variation of blood pressure and endothelial function in patients with essential hypertension:a comparison of dippers and non-dippers.
        J Am Coll Cardiol. 2002; 40: 2039-2043
        • Al-Qaisi M.
        • Kharbanda R.K.
        • Mittal T.K.
        • et al.
        Measurement of endothelial function and its clinical utility for cardiovascular risk.
        Vasc Health Risk Manag. 2008; 4: 647-652
        • Endemann D.H.
        • Schiffrin E.L.
        Endothelial dysfunction.
        J Am Soc Nephrol. 2004; 15: 1983-1992
        • Vanhoutte P.M.
        Endothelial dysfunction: the first step toward coronary arteriosclerosis.
        Circ J. 2009; 73: 595-601
        • Zhang X.
        • Zhao S.P.
        • Li X.P.
        • et al.
        Endothelium-dependent and -independent functions are impaired in patients with coronary heart disease.
        Atherosclerosis. 2000; 149: 19-24
        • Lambert E.
        • Ika Sari C.
        • Hering D.
        • et al.
        Dyslipidemia is associated with sympathetic nervous activation and impaired endothelial function in young females.
        Am J Hypertens. 2013; 26: 250-256
        • Dharmashankar K.
        • Widlansky M.E.
        Vascular endothelial function and hypertension: insights and directions.
        Curr Hypertens Rep. 2010; 12: 448-455
        • Montero D.
        • Walther G.
        • Perez-Martin A.
        • et al.
        Vascular smooth muscle function in type 2 diabetes mellitus: a systematic review and meta-analysis.
        Diabetologia. 2013; 56: 2122-2133
        • Inaba Y.
        • Chen J.A.
        • Bergmann S.R.
        Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis.
        Int J Cardiovasc Imaging. 2010; 26: 631-640
        • Ward N.C.
        • Hodgson J.M.
        • Croft K.D.
        • et al.
        The combination of vitamin C and grape-seed polyphenols increases blood pressure: a randomized, double-blind, placebo-controlled trial.
        J Hypertens. 2005; 23: 427-434
        • Hodgson J.M.
        • Croft K.D.
        • Woodman R.J.
        • et al.
        Black tea lowers the rate of blood pressure variation: a randomized controlled trial.
        Am J Clin Nutr. 2013; 97: 943-950
        • Bilo G.
        • Giglio A.
        • Styczkiewicz K.
        • et al.
        A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall.
        J Hypertens. 2007; 25: 2058-2066
        • Dogra G.
        • Rich L.
        • Stanton K.
        • et al.
        Endothelium-dependent and independent vasodilation studies at normoglycaemia in type I diabetes mellitus with and without microalbuminuria.
        Diabetologia. 2001; 44: 593-601
        • Woodman R.J.
        • Playford D.A.
        • Watts G.F.
        • et al.
        Improved analysis of brachial artery ultrasound using a novel edge-detection software system.
        J Appl Physiol. 2001; 91: 929-937
        • Flammer A.J.
        • Anderson T.
        • Celermajer D.S.
        • et al.
        The assessment of endothelial function: from research into clinical practice.
        Circulation. 2012; 126: 753-767
        • Tousoulis D.
        • Antoniades C.
        • Stefanadis C.
        Evaluating endothelial function in humans: a guide to invasive and non-invasive techniques.
        Heart. 2005; 91: 553-558
        • Rothwell P.M.
        Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension.
        Lancet. 2010; 375: 938-948
        • Silber H.A.
        • Bluemke D.A.
        • Ouyang P.
        • et al.
        The relationship between vascular wall shear stress and flow-mediated dilation: endothelial function assessed by phase-contrast magnetic resonance angiography.
        J Am Coll Cardiol. 2001; 38: 1859-1865
        • Benjamin E.J.
        • Larson M.G.
        • Keyes M.J.
        • et al.
        Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study.
        Circulation. 2004; 109 ([Erratum appears in Circulation. 2004 Jun 29;109(25):3256]): 613-619
        • Webb A.J.
        • Fischer U.
        • Mehta Z.
        • et al.
        Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis.
        Lancet. 2010; 375: 906-915