Advances in Research on Correlation between Blood Pressure Variability Indicators and Risk of Target Organ Damage in Hypertension

doi:10.12114/j.issn.1007-9572.2019.00.334

Abstract

Abstract: Hypertension is a recognized risk factor for target organ damage（TOD）and vascular events.However，office blood pressure（OBP）is difficult to accurately reflect changes of circadian blood pressure.Blood pressure variability（BPV）indicators as important predictors of cardiovascular events obtained by ambulatory blood pressure monitoring（ABPM）can provide more accurate prognostic information than OBP.TOD caused by hypertension is closely related to BPV.This article reviews the recent researches on BPV and the risk of TOD caused by hypertension，such as heart，brain，kidney，fundus and blood vessels，to illustrate the important roles of BPV indicators in evaluating the therapeutic effect and adjusting the treatment plan，and to provide a basis for individualized treatment strategies for hypertension.

Key words: Hypertension, Blood pressure variability parameters, Target organ damage, Correlation, Review

摘要： 高血压是靶器官损伤和血管事件的公认风险因素。然而，在临床中诊室血压很难精确地反映昼夜血压的变化。动态血压监测（ABPM）获得的血压变异性（BPV）指标作为心血管事件的重要预测因子能提供比诊室血压更准确的预后信息。高血压的靶器官损害（TOD）与BPV密切相关。本文综述了BPV与高血压导致的心、脑、肾、眼底、血管等靶器官损害风险相关性的研究近况，以说明BPV指标在评价治疗效果及调整治疗方案中的重要作用，为临床优化高血压个体化治疗策略提供依据。

关键词: 高血压, 血压变异参数, 靶器官损害, 相关性, 综述

YUAN Qingdan,SHEN Xiaomei. Advances in Research on Correlation between Blood Pressure Variability Indicators and Risk of Target Organ Damage in Hypertension　[J]. Chinese General Practice, 2019, 22(22): 2766-2770. DOI: 10.12114/j.issn.1007-9572.2019.00.334.
原庆丹,沈小梅. 血压变异指标与高血压靶器官损害风险相关性研究进展[J]. 中国全科医学, 2019, 22(22): 2766-2770. DOI: 10.12114/j.issn.1007-9572.2019.00.334.

References

［1］WILLIAMS B，GIUSEPPE M，SPIERING W，et al．2018 ESC/ESH guidelines for the management of arterial hypertension［EB/OL］．（2018-09-04）［2018-10-09］．https：//www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/09/04/14/41/2018-esc-esh-guidelines-for-the-management-of-arterial.
［2］ROTHWELL P M，HOWARD S C，DOLAN E，et al．Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke［J］．Lancet Neurology，2010，9（5）：469-480．DOI：10.1016/S1474-4422（10）70066-1.
［3］刘春霞，陈明．血压变异的检测方法及参考值研究进展［J］．中华高血压杂志，2012，20（6）：530-533．DOI：10.16439/j.cnki.1673-7245.2012.06.033.
LIU C X，CHEN M．Research progress on detection methods and reference values of blood pressure variability［J］．Chinese Journal of Hypertension，2012，20（6）：530-533．DOI：10.16439/j.cnki.1673-7245.2012.06.033.
［4］HANSEN T W，THIJS L，LI Y，et al．Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8 938 subjects from 11 populations［J］．Hypertension，2010，55（4）：1049-1057．DOI：10.1161/HYPERTENSIONAHA.109.140798.
［5］JUHANOJA E P，NIIRANEN T J，JOHANSSON J K，et al．Outcome-driven thresholds for increased home blood pressure variability［J］．Hypertension，2017，69（4）：599-607．DOI：10.1161/HYPERTENSIONAHA.116.08603.
［6］BILO G，PARATI G．Rate of blood pressure changes assessed by 24 h ambulatory blood pressure monitoring：another meaningful index of blood pressure variability?［J］．Journal of Hypertension，2011，29
（6）：1054-1058．DOI：10.1097/HJH.0b013e328347bb24．
［7］邢瑞芳，刘巍．血压变异性的假设检验［J］．科技视界，2018，8（4）：40-41，85.
XING R F，LIU W．Hypothesis testing of blood pressure variability［J］．Science and Technology Vision，2018，8（4）：40-41，85.
［8］MANCIA G，BOMBELLI M，FACCHETTI R，et al．Long-term prognostic value of blood pressure variability in the general population：results of the Pressioni Arteriose Monitorate e Loro Associazioni Study［J］．Hypertension，2007，49（6）：1265-1270．DOI：10.1161/hypertensionaha.107.088708．
［9］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］．Journal of Hypertension，2007，25（10）：2058-2066．
［10］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［J］．Hypertension，2005，45（4）：505-512．
［11］GIJóN-CONDE T，GRACIANI A，LóPEZ-GARCíA E，et al．Short-term variability and nocturnal decline in ambulatory blood pressure in normotension，white-coat hypertension，masked hypertension and sustained hypertension：a population-based study of older individuals in Spain［J］．Hypertens Res，2017，40（6）：613-619．DOI：10.1038/hr.2017.9.
［12］RíOS M T，DOMíNGUEZ-SARDI?A M，AYALA D E，et al．Prevalence and clinical characteristics of isolated-office and true resistant hypertension determined by ambulatory blood pressure monitoring［J］．Chronobiology International，2013，30（1/2）：207-220．DOI：10.3109/07420528.2012.701135．
［13］MANCIA G，CARUGO S，GRASSI G，et al．Prevalence of left ventricular hypertrophy in hypertensive patients without and with blood pressure control：data from the PAMELA population．Pressioni Arteriose Monitorate E Loro Associazioni［J］．Hypertension，2002，39（3）：744-749．
［14］于佳岚，姜东炬．血压变异性对靶器官损害的影响探讨［J］．医学综述，2012，18（20）：3368-3371.
YU J L，JIANG D J．Investigation on the effect of blood pressure variability on the target organ damage［J］．Medical Recapitulate，2012，18（20）：3368-3371.
［15］徐梦丹，戴秋艳．血压变异性与脉搏波传导速度及左心室质量指数的相关性［J］．上海交通大学学报（医学版），2018，38（2）：184-191．DOI：10.3969/j.issn.1674-8115.2018.02.013．
XU M D，DAI Q Y．Correlation of blood pressure variability with brachial ankle pulse wave velocity and left ventricular mass index［J］．Journal of Shanghai Jiao Tong University（Medical Science），2018，38（2）：184-191．DOI：10.3969/j.issn.1674-8115.2018.02.013．
［16］戴功强，黎鹏，刘利宏．高血压患者动态血压变异性与左心室肥厚的关系分析［J］．当代医学，2018，24（17）：64-67．DOI：10.3969/j.issn.1009-4393.2018.017.024．
DAI G Q，LI P，LIU L H．The relationship analysis of ambulatory blood pressure variation with left ventricular hypertrophy in dipper and non-dipper essential hypertension patients［J］．Contemporary Medicine，2018，24（17）：64-67．DOI：10.3969/j.issn.1009-4393.2018.017.024.
［17］SCHUTTE A E，SCHUTTE R，HUISMAN H W，et al．Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans：the SABPA study［J］．Hypertension Research，2011，34（10）：1127-1134．
［18］PARATI G，OCHOA J E，LOMBARDI C，et al．Blood pressure variability：assessment，predictive value，and potential as a therapeutic target［J］．Current Hypertension Reports，2015，17（4）：537．DOI：10.1007/s11906-015-0537-1．
［19］WANG J，SHI X，MA C，et al．Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease：a systematic review and meta-analysis［J］．Journal of Hypertension，2017，35（1）：10-17．DOI：10.1097/HJH.0000000000001159．
［20］AOYAMA R，TAKANO H，SUZUKI K，et al．The impact of blood pressure variability on coronary plaque vulnerability in stable angina：an analysis using optical coherence tomography［J］．Coronary Artery Disease，2016，28（3）：225-231．
［21］MATSUI Y，ISHIKAWA J，EGUCHI K，et al．Maximum value of home blood pressure：a novel indicator of target organ damage in hypertension［J］．Hypertension，2011，57（6）：1087-1093．DOI：10.1161/HYPERTENSIONAHA.111.171645.
［22］NAGAI M，HOSHIDE S，ISHIKAWA J，et al．Visit-to-visit blood pressure variations：new independent determinants for carotid artery measures in the elderly at high risk of cardiovascular disease［J］．Journal of the American Society of Hypertension，2011，5（3）：184-192．DOI：10.1016/j.jash.2011.03.001.
［23］GAO Y，GUO Q，ZHANG J，et al．The underlying risks of circadian blood pressure variation for carotid plaque in treated hypertensive patients with normal blood pressure［J］．Blood Pressure Monitoring，2017，22（4）：191-195．DOI：10.1097/mbp.0000000000000253．
［24］VASUNTA R L，KES?NIEMI Y A，YLITALO A，et al．Nondipping pattern and carotid atherosclerosis in a middle-aged population：OPERA study［J］．American Journal of Hypertension，2012，25（1）：60-66．DOI：10.1038/ajh.2011.159．
［25］WANG Y，YANG Y，WANG A，et al．Association of long-term blood pressure variability and brachial-ankle pulse wave velocity：a retrospective study from the APAC cohort［J］．Scientific Reports，2016，6：21303．DOI：10.1038/srep21303．
［26］SCHILLACI G，BILO G，PUCCI G，et al．Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension：findings from 2 large databases［J］．Hypertension，2012，60（2）：369-377．DOI：10.1161/HYPERTENSIONAHA.112.197491．
［27］SHIMBO D，SHEA S，MCCLELLAND R L，et al．Associations of aortic distensibility and arterial elasticity with long-term visit-to-visit blood pressure variability：the Multi-Ethnic Study of Atherosclerosis（MESA）［J］．American Journal of Hypertension，2013，26（7）：896-902．DOI：10.1093/ajh/hpt040．
［28］TEDLA Y G，YANO Y，CARNETHON M，et al．Association between long-term blood pressure variability and 10-year progression in arterial stiffness：the multiethnic study of atherosclerosis［J］．Hypertension，2017，69（1）：118-127．DOI：10.1161/HYPERTENSIONAHA.116.08427．
［29］韩笑．原发性高血压患者血流介导的血管舒张功能与血压变异性的相关性［D］．太原：山西医科大学，2017．
［30］KAWAI T，OHISHI M，KAMIDE K，et al．The impact of visit-to-visit variability in blood pressure on renal function［J］．Hypertension Research，2012，35（2）：239-243．DOI：10.1038/hr.2011.170．
［31］YIN L H，YAN W J，GUO Z X，et al．Relation between blood pressure variability and early renal damage in hypertensive patients［J］．European Review for Medical&Pharmacological Sciences，2017，21（9）：2226-2231.
［32］MEZUE K，GOYAL A，PRESSMAN G S，et al．Blood pressure variability predicts adverse events and cardiovascular outcomes in chronic kidney disease：a post-hoc analysis of the SPRINT trial［J］．American Journal of Hypertension，2017，31（1）：48-52．DOI：10.1093/ajh/hpx128.
［33］SARAFIDIS P A，RUILOPE L M，LOUTRADIS C，et al．Blood pressure variability increases with advancing chronic kidney disease stage：a cross-sectional analysis of 16 546 hypertensive patients［J］．Journal of Hypertension，2018，36（5）：1076-1085．DOI：10.1097/HJH.0000000000001670．
［34］FENG Y，LI Z，LIU J，et al．Association of short-term blood pressure variability with cardiovascular mortality among incident hemodialysis patients［J］．Ren Fail，2018，40（1）：259-264．DOI：10.1080/0886022X.2018.1456456．
［35］祝春华，王圣祥，朱黎．老年高血压病患者眼底动脉硬化与24 h平均脉压关系的研究［J］．现代中西医结合杂志，2009，18（22）：2656-2657．DOI：10.3969/j.issn.1008-8849.2009.22.019.
ZHU C H，WANG S X，ZHU L．Relationship between fundus arteriosclerosis and 24 h mean pulse pressure in elderly patients with hypertension［J］．Modern Journal of Integrated Traditional Chinese and Western Medicine，2009，18（22）：2656-2657．DOI：10.3969/j.issn.1008-8849.2009.22.019．
［36］郭小明，李学良，王力伟．不同分级高血压眼底病变患者动态血压的观察［J］．山西医药杂志，2016，45（5）：594-596．DOI：10.3969/j.issn.0253-9926.2016.05.041．
GUO X M，LI X L，WANG L W．Observation of dynamic blood pressure in patients with different grades of hypertensive fundus lesions［J］．Shanxi Medical Journal，2016，45（5）：594-596．DOI：10.3969/j.issn.0253-9926.2016.05.041．
［37］赵薇，李利华．动态动脉硬化指数、动态血压参数与高血压眼底改变的关系［J］．中华眼底病杂志，2013，29（1）：84-86．DOI：10.3760/cma.j.issn.1005-1015.2013.01.022．
ZHAO W，LI L H．The relationship between dynamic arteriosclerosis index，dynamic blood pressure parameters and fundus changes in hypertension［J］．Chinese Journal of Ocular Fundus Diseases，2013，29（1）：84-86．DOI：10.3760/cma.j.issn.1005-1015.2013.01.022．
［38］LATTANZI S，VERNIERI F，SILVESTRINI M．Blood pressure variability and neurocognitive functioning［J］．Journal of Clinical Hypertension，2018，20（4）：645-647．DOI：10.1111/jch.13232．
［39］CHO N，HOSHIDE S，NISHIZAWA M，et al．Relationship between blood pressure variability and cognitive function in elderly patients with well blood pressure control［J］．American Journal of Hypertension，2018，31（3）：293-298．DOI：10.1093/ajh/hpx155.
［40］MCDONALD C，PEARCE M S，KERR S R，et al．Blood pressure variability and cognitive decline in older people：a 5-year longitudinal study［J］．Journal of Hypertension，2017，35（1）：140-147．DOI：10.1097/HJH.0000000000001120．
［41］YANO Y，NING H，ALLEN N，et al．Long-term blood pressure variability throughout young adulthood and cognitive function in midlife：the coronary artery risk development in young adults（CARDIA）study：blood pressure variability and cognition［J］．Hypertension，2014，64（5）：983-988．DOI：10.1161/HYPERTENSIONAHA.114.03978．
［42］MANNING L，THILAKAWARDHANA R，ROBINSON T．Prognostic significance of blood pressure variability（BPV）in acute stroke：a systematic review of the literature［J］．International Journal of Stroke，2014，9：12．DOI：10.1161/STROKEAHA.115.010075．
［43］刘巧萍．短期血压变异性与颅内出血患者早期预后的关系［D］．福州：福建医科大学，2013.
［44］LUNDHOLM M D，ROONEY M，MAAS M B，et al．Wake-up stroke is associated with greater nocturnal mean arterial pressure variability［J］．Stroke，2017，48（6）：1668-1670．DOI：10.1161/STROKEAHA.116.016202．

[1]	WU Wenjun, WEI Jingjing, LI Xue, REN Hongjie, YU Rui, PENG Guangcao, ZHU Mingjun. Regularity of Prescriptions for Coronary Heart Disease with Hypertension Based on Latent Structure and Association Rules [J]. Chinese General Practice, 2025, 28(30): 3787-3795.
[2]	BAI Jiaxin, CHEN Yu, ZHOU Yiheng, LIU Lidi, YANG Rong, YAO Yi, YUAN Bo, ZHANG Yonggang, LEI Yi, ZENG Rui, JIA Yu, LIAO Xiaoyang. Assessment and Treatment of Early-onset Hypertension: Position Statement of the British and Irish Hypertension Association and Its Implications for Clinical Management of Early-onset Hypertension in China [J]. Chinese General Practice, 2025, 28(30): 3741-3746.
[3]	QIN Bangguo, SUN Jin, LI Man, QIU Jiaojiao, CHENG Bokai, ZHU Ping, WANG Shuxia. Relationship between Non-high-density Lipoprotein Cholesterol to High-density Lipoprotein Cholesterol Ratio and Left Ventricular Hypertrophy in a Community-based Hypertensive Population [J]. Chinese General Practice, 2025, 28(30): 3753-3760.
[4]	HAN Xiao, LI Qiyu, GE Pu, FAN Siyuan, LIU Diyue, WU Yibo, ZHANG Qingshuang. The Impact of Behavioral Lifestyle on Quality of Life in Hypertensive Patients [J]. Chinese General Practice, 2025, 28(26): 3248-3258.
[5]	YU Zizi, LIU Duli, LI Ximin, RUAN Chunyi, YIN Xiangyang, CAI Le. Analysis of the Prevalence and Self-management of Hypertension and Its Influencing Factors in Rural [J]. Chinese General Practice, 2025, 28(25): 3137-3143.
[6]	TANG Shangfeng, HUANG Yangzhen, PAN Yangyang, ZHENG Yanxi, XIONG Zhongbao, ZHANG Kangkang, SONG Jia, WEI Yilin, WANG Chunying, DONG Heng, CHEN Manwei, QING Hua. Specification for the Integration of Healthcare and Prevention Services in Hypertension at the Primary Level [J]. Chinese General Practice, 2025, 28(25): 3089-3095.
[7]	HAN Bing, DU Shuzhen, MENG Xiaoxue, ZHANG Lu, CHEN Zixian, TENG Fengling. Plasma Periostin Levels Correlated with Myocardial Fibrosis in Patients with Heart Failure with Different Ejection Fraction [J]. Chinese General Practice, 2025, 28(24): 2979-2984.
[8]	WEI Yunhong, YANG Li, WANG Yulu, YE Qiufang, DAI Anni, HE Yan. Study on Cardiopulmonary Function During Different Exercise Stages in Patients with Obesity-related Hypertension [J]. Chinese General Practice, 2025, 28(24): 2972-2978.
[9]	HE Jinyu, ZHULIDUZI Jiesisibieke, ZHANG Ning, LIU Min, LIANG Wannian. Research on Blood Pressure Control and Its Determinants Among Hypertensive Patients Under Standardized Management in China: Status, Challenges, and Future Directions [J]. Chinese General Practice, 2025, 28(24): 2968-2971.
[10]	CHEN Youlan, LAN Yanqi, WU Ahua, ZHANG Haixia, HUANG Jiankang, GUO Zhinan. The Health Management Effect of Contracted Family Doctor Services under the Joint Management of Three Teachers in Xiamen City on Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(22): 2769-2775.
[11]	HAO Aihua, ZENG Ziying, JIN Aiqiong, TANG Lingling, ZHENG Zique, MA Jingtai, ZHAO Jianguo, ZENG Weilin, XIAO Jianpeng, NIE Hui, YANG Ying. Analysis of Factors Influencing Avoidable Hospitalization for Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(19): 2370-2375.
[12]	WANG Zhijun, ZHANG Shibo, LIU Jie, LI Dongqi, ZHENG Meijia, ZHOU Jianzhi. Correlation Analysis between TyG-BMI Index and Nocturnal Hypertension in Patients with Hypertension [J]. Chinese General Practice, 2025, 28(18): 2212-2221.
[13]	ZHANG Zhidong, JIN Hua, HU Jihong, JIANG Lu, WANG Li, LONG Kaichong, ZHANG Ronghua. Analysis and Prediction of the Incidence and Mortality Trends of Hypertensive Nephropathy in China from 1990 to 2021 [J]. Chinese General Practice, 2025, 28(18): 2262-2269.
[14]	HE Yan, CUI Saixian, HU Yang, NI Qing, GAN Lulu, LIU Qian, DAI Anni, LIU Shijie, YANG Li. Influencing Factors on Urinary Sodium Excretion in Patients with Obstructive Sleep Apnea-Associated Hypertension [J]. Chinese General Practice, 2025, 28(18): 2222-2227.
[15]	LYU Lulu, ZHU Wanjie, XIAO Mingyang, LI Yike, ZHANG Juan. Correlation Analysis of the Circadian Rhythmicity of Blood Pressure with Ox-LDL/β2GPI Complex and Carotid Atherosclerosis in Patients with Essential Hypertension [J]. Chinese General Practice, 2025, 28(18): 2228-2233.