Effect of blood pressure variability on ventriculo-arterial coupling

Introduction: To investigate the influence of blood pressure variability on the parameters of arterial load and ventriculo-arterial coupling in apparently healthy individuals. We screened 190 persons in a primary prevention program recording risk factors, blood pressure and ultrasound data: LV systolic/diastolic dimensions and mass, ejection fraction, Doppler parameters, brachial artery Flow Mediated Dilatation (FMD), carotid artery Intima Media Th ickness (IMT). Methods: We calculated: systemic arterial compliance (C = stroke volume/pulse pressure), vascular resistance/cardiac circle length ratio (R/T where R = mean blood pressure/(stroke volume x heart rate)), effective arterial elastance (Ea = 0.9 x systolic BP/stroke volume), as index of artery load. The modified single-beat method was used to estimate left ventricular end-systolic elastance (EES(sb)) and the ratio of Ea/EES(sb) was computed as an index of ventriculo-arterial coupling. All subjects underwent a 24-hour Ambulatory Blood Pressure Monitoring (ABPM) on a working day. We calculated BP variability (BPV) as the Standard Deviation (SD) of mean blood pressure. Results: We investigated the correlations between systolic BPV values and the parameters of arterial load and ventriculo-arterial coupling. We found a weak correlation between BPV and Ea/EES(sb) ratio (r = 0.257, p < 0.001). We did not find any significant correlations between BPV values and arterial compliance, vascular resistance, effective arterial elastance and LV endsystolic elastance. When we examined the correlations between systolic BPV values and the other markers of subclinical injury, we found a moderate correlation with brachial artery FMD (r = -0.399 , p < 0.001) with carotid artery IMT(r = 0.314, p < 0.001) and a weak correlation with LV mass index (r = 0.170, p = 0.019). We did not find significant correlation between systolic BPV and myocardial performance index. Conclusions: Our study indicates that blood pressure variability differences measured in apparently healthy individuals generate an adaptation of the ventriculo-arterial coupling parameters, which correlate with markers of cardiac and vascular remodeling

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