Association of Ambulatory Blood Pressure Variability With Brain Atrophy in Hypertensive Patients

Objective: Several studies have demonstrated that increased blood pressure (BP) variability is associated with target-organ damage development in hypertensive patients. However, the impact of BP variability (BPV) on asymptomatic brain lesions is unclear. Aim of the study was to evaluate the association between ambulatory BPV and brain atrophy in hypertensive patients. Design and method: A total of 47 hypertensive patients without history of diabetes mellitus and stoke or neurological disease were referred for evaluation at the Hypertension Unit of our department. The patients underwent office BP measurements and 24-h ambulatory BP monitoring. The presence of brain atrophy was assessed by brain MRI. The ambulatory BPV indices used in our study were 24-h standard deviation, 24-h coefficient of variation, and weighted standard deviation. Independent T-test and logistic regression analyses were used to evaluate the association between BPV and brain atrophy. Results: The study population had a mean age of 68 years. The office BP was 149/84mmHg, the 24-h BP 138/85mmHg, the 24-h standard deviation 16/11mmHg, the 24-h coefficient of variation 12/13 and the weighted standard deviation 17/10mmHg. The brain MRI revealed 27 patients with brain atrophy. The logistic regression analysis demonstrated that 24-h systolic standard deviation was significantly and positively associated with the presence of brain atrophy (B=1.340 95%CI 1.047 – 1.714, p=0.020) after adjusting for age, sex, smoking, hyperlipidemia, body mass index and 24-h systolic BP. Conclusions: 24-h systolic standard deviation was significantly associated with brain atrophy independently of demographic characteristics, risk factors and 24-h BP in hypertensive patients.