Blood pressure variability in hypertension associated with coronary heart disease: prognostic value and management approaches

The review discusses the role of blood pressure variability as a novel risk factor and its prognostic value in hypertension associated with the coronary artery disease. We discuss the modern approaches to calculation of blood pressure variability, its classification. The choice of antihypertensive drugs based on the blood pressure variability is discussed considering hypertension associated with coronary artery disease. We pay special attention to angiotensin enzyme converting inhibitors and calcium channel blockers, as well as their combinations. We present the evidence of the effects of perindopril and amlodipine and their fixed combination on the blood pressure variability and the decrease in cardiovascular risk in hypertension associated with coronary artery disease.

1. Hassan AKM, Abd-El Rahman H, Mohsen K, Dimitry SR. Impact of in-hospital blood pressure variability on cardiovascular outcomes in patients with acute coronary syndrome. J Clin Hypertens (Greenwich) 2017;19(12):1252–1259. doi:10.1111/jch.13107

2. Gorbunov VM. Modern views on the variability of blood pressure. Rational Pharmacotherapy in Cardiology. 2012;8(6):810–818. In Russian

3. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure and episodic hypertension. Lancet. 2010;375(9718):895–905. doi:10.1016/S0140-6736 (10)60308-X

4. Höcht C. Blood pressure variability: prognostic value and therapeutic implications. ISRN Hypertension 2013;2013: ID 398485.

5. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens. 1987;5(1):93–98.

6. Mancia G, Parati G, Hennig M, Flatau B, Omboni S, Glavina F et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens. 2001;19 (11):1981–1989.

7. Sega R, Corrao G, Bombelli M, Beltrame L, Facchetti R, Grassi G et al. Blood pressure variability and organ damage in a general population: results from the PAMELA study. Hypertension 2002;39(2):710–714.

8. McMullan CJ, Bakris GL, Phillips RA, Forman JP. Association of blood pressure variability with mortality among African Americans with CKD. Clin J Am Soc Nephrol. 2013;8 (5):731–738.

9. Kawai T, Ohishi M, Kamide K. Differences between daytime and nighttime blood pressure variability regarding systemic atherosclerotic change and renal function. Hypertens Res. 2013;36:232–239.

10. Schillaci G, Bilo G, Pucci G, Laurent S, Macquin-Mavier I, Boutouyrie P et al. Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension 2012;60(2):369–377. doi:10.1161/HYPERTENSIONAHA.112.197491

11. Schutte AE, Schutte R, Huisman HW, van Rooyen JM, Fourie CM, Malan NT et al. Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study. Hypertens Res. 2011;34(10):1127–1134.

12. Sakakura K, Ishikawa J, Okuno M, Shimada K, Kario K. Exaggerated ambulatory blood pressure variability is associated with cognitive dysfunction in the very elderly and quality of life in the younger elderly. Am J Hypertens. 2007;20(7):720–727.

13. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M et al.; ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet. 2005;366(9489):895–906.

14. Parati G, Ulian L, Santucciu C, Omboni S, Mancia G. Blood pressure variability, cardiovascular risk and antihypertensive treatment. J Hypertens Suppl. 1995;13(4): S27-S34.

15. Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens 1993;11(10):1133–1137.

16. Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G. Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am J Hypertens. 2007;20(2):154–161.

17. Cuspidi C, Tadic M, Grassi G. Short-term blood pressure variability in acute coronary syndrome. J Clin Hypertens (Green-wich). 2017;19(12):1249–1251. doi:10.1111/jch.13105

18. Ostroumova OD, Borisova EV, Pavleeva EE. Blood pressure variability. Inter-visit blood pressure variability. Kardiologiia. 2017;57(11):68–75. In Russian

19. Ostroumova OD. The variability of blood pressure and the risk of complications in arterial hypertension. Ter Arkhiv. 2012;10:91–97. In Russian

20. Bilo G, Giglio A, Styczkiewicz K, Caldara G, Maronati A, Kawecka-Jaszcz 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(10):2058–2066.

21. Parati G, Ochoa JE, Lombardi C, Bilo G. Blood pressure variability: assessment, predictive value, and potential as a therapeutic target. Curr Hypertens Rep. 2015;17(4):537. doi:10.1007/ s11906-015-0537-1

22. Platonova EV, Gorbunov VM, Shal'nova SA, Deev AD. Potential and paradoxes of home blood pressure variability. Kardiologiia. 2015;8:68–75. doi:https://dx.doi.org/10.18565/cardio.2015.8.68–75 In Russian

23. Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T. A reliable index for the prognostic significance of blood pressure variability. J Hypertens 2003;23(3):505–511.

24. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B et al.; ASCOT-BPLA and MRC Trial Investigators. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9(5):469–480. doi:10.1016/S1474-4422 (10)70066-1

25. Diaz KM, Tanner RM, Falzon L, Levitan EB, Reynolds K, Shimbo D et al. Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis. Hypertension. 2014;64(5):965–982. doi:10.1161/ HYPERTENSIONAHA.114.03903

26. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension. 2007;49(6):1265–1270.

27. Głuszek J, Kosicka T. Visit-to-visit blood pressure variability and cardiovascular and kidney diseases. Arterial Hypertens. 2016;20 (1):26–31. doi:10.5603/AH.2016.0006

28. Hussein WF, Chang TI. Visit to visit variability of systolic blood pressure and cardiovascular disease. Curr Hypertens. Rep. 2015;17:14.

29. Mancia G, Parati G, Castiglioni P, Tordi R, Tortorici E, Glavina F et al. Daily life blood pressure changes are steeper in hypertensive than in normotensive subjects. Hypertension. 2003;42:277–282.

30. Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS et al.; American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension. 2015;65(6):1372–407. doi:10.1161/HYP.0000000000000018

31. Baguet JP, Mallion JM. Hypertension and coronary heart disease. The European Society of Hypertension Scientific Newsletter: Update on Hypertension Management. 2005;06 (14R) (http://www.eshonline.org/esh-content/uploads/2014/12/14r_ Newsletter-Hypertension-and-Coronary-Heart-Disease.pdf)

32. Ostroumova OD, Dudaev VA, Fomina VM. Arterial hypertension and coronary artery disease: how to choose the drug. Lechebnoye Delo = Medical Practice. 2014;4:41–49. In Russian

33. Grassi G, Seravalle G, Maloberti A, Facchetti R, Cuspidi C, Bombelli M et al. Within-visit BP variability, cardiovascular risk factors, and BP control in central and eastern Europe: findings from the BP-CARE study. J Hypertens. 2015;33(11):2250–2256. doi:10.1097/ HJH.0000000000000700

34. Ke X, Sun Y, Yang R, Liang J, Wu S, Hu C, Wang X. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc Disord. 2017;17(1):287. doi:10.1186/s12872-017-0723-y

35. Muntner P, Whittle J, Lynch AI, Colantonio LD, Simpson LM, Einhorn PT et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: a cohort study. Ann Intern Med. 2015;163(5):329–338. doi:10.7326/M14– 2803

36. Vidal-Petiot E, Stebbins A, Chiswell K, Ardissino D, Aylward PE, Cannon CP et al.; STABILITY Investigators. Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial. Eur Heart J. 2017;38(37):2813–2822. doi:10.1093/eurheartj/ehx250

37. Cay S, Cagirci G, Demir AD, Balbay Y, Erbay AR, Aydogdu S et al. Ambulatory blood pressure variability is associated with restenosis after percutaneous coronary intervention in normotensive patients. Atherosclerosis. 2011;219(2):951–7. doi:10.1016/j. atherosclerosis.2011.09.039

38. Gondo K, Miura SI, Suematsu Y, Shiga Y, Kuwano T, Sugihara M et al. Association between visit-to-visit variability in blood pressure and cardiovascular events in hypertensive patients after successful percutaneous coronary intervention. J Clin Med Res. 2015;7(7):545–550. doi:10.14740/jocmr2173w

39. Tamura K, Tsurumi Y, Sakai M, Tanaka Y, Okano Y, Yamauchi J et al. A possible relationship of nocturnal blood pressure variability with coronary artery disease in diabetic nephropathy. Clin Exp Hypertens. 2007;29(1):31–42.

40. Gosmanova EO, Mikkelsen MK, Molnar MZ, Lu JL, Yessayan LT, Kalantar-Zadeh K et al. Association of systolic blood pressure variability with mortality, coronary heart disease, stroke, and renal disease. J Am Coll Cardiol. 2016;68 (13):1375–1386. doi:10. 1016/j.jacc.2016.06.054.

41. Chazova IE, Ratova LG, Boitsov SA, Nebieridze DV. Recommendations for the management of arterial hypertension Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Sistemnye Gipertenzii = Systemic Hypertension. 2010;3:5–26. In Russian

42. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31 (7):1281–1357. doi:10.1097/01.hjh.0000431740.32696.cc

43. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71 (6):1269–1324. doi:10.1161/HYP.0000000000000066

44. Fox KM; EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362(9386):782–788.

45. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHATLLT). J Am Med Assoc. 2002;288(23):2998–3007.

46. Webb AJS, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in BP and risk of stroke: a systematic review and meta-analysis. Lancet. 2010;375(9718): 906–915. doi:10.1016/S0140–6736(10) 60235–8

47. Rothwell PM, Webb AJS. Effect of dose and combination of antihypertensives on interindividual blood pressure variability: a systematic review. Stroke. 2011;42(10):2860–2865. doi:10.1161/ STROKEAHA.110.611566

48. Ostroumova OD. First results of the Russian database of international prospective observational registry variability of blood pressure in patients with hypertension. Systemnye Gipertenzii = Systemic Hypertension. 2014;11(4):9–16. In Russian