Mal 125, mal 150: Was Blutdruckschwankungen über Ihr Herz verraten

The role of blood pressure variability (BPV) as an important marker of cardiovascular (CV) health, specifically its relationship with arterial stiffness and left ventricular remodeling in patients with hypertension, was investigated. This review aimed to elucidate the intricate relationship between BPV, arterial stiffness, and cardiac remodeling. BPV, as both a risk factor and a target of treatment, was also evaluated. The results point to the pivotal role of BPV in cardiovascular events, serving as an independent factor contributing to arterial stiffness and adverse left ventricular remodeling. The article concludes that BPV is a modifiable risk factor and that there is a need for an intervention in specific regions. BPV is a therapy target that is significant in the treatment of hypertension. The optimization of risk and prevention needs a multidisciplinary approach involving rehabilitation therapy, which will improve cardiovascular conditions and patient outcomes.

Non-dipper hypertension is associated with increased cardiovascular risk and target organ damage. Although endothelial dysfunction and arterial stiffness contribute to impaired nocturnal blood pressure decline, their relationship with the Endothelial Activation and Stress Index (EASIX) remains unclear. This study aimed to evaluate the association between nocturnal dipping status, EASIX score, and arterial stiffness. This retrospective study included 163 newly diagnosed hypertensive patients who underwent 24-hour ambulatory blood pressure monitoring and were classified as dipper or non-dipper based on nocturnal systolic blood pressure decline. Arterial stiffness was assessed using pulse wave velocity (PWV), and EASIX was calculated from lactate dehydrogenase, creatinine, and platelet count. Logistic regression analysis was performed to identify independent predictors of non-dipper status, while receiver operating characteristic analysis evaluated the diagnostic performance of EASIX, PWV, and their combination. Seventy-two patients were classified as non-dippers and 91 as dippers. Non-dipper patients had significantly higher EASIX scores (0.73 vs. 0.52, p < 0.001) and PWV values (7.92 vs. 7.05 m/s, p = 0.003). In multivariable analysis, EASIX (OR: 2.553, 95% CI: 1.568-4.156, p < 0.001) and PWV (OR: 1.358, 95% CI: 1.090-1.691, p = 0.006) remained independently associated with non-dipper status. The combined model demonstrated better discrimination (AUC: 0.755) than EASIX (0.723)

<h4>Background</h4>Blood pressure (BP) variability (BPV) is associated with cardiovascular risk beyond mean BP. Whether first-line antihypertensive regimens differentially affect BPV and cardiovascular outcomes remains uncertain.<h4>Methods</h4>We conducted a target trial emulation using pooled individual participant data from 2 randomized trials: ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) and SPRINT (Systolic Blood Pressure Intervention Trial). Propensity score matching was used for pairwise comparisons of RAS (renin-angiotensin system) inhibitors, calcium channel blockers (CCBs), and diuretics, as monotherapy or in combination. Follow-up was initiated at a predefined baseline medication assessment. The primary outcome was visit-to-visit systolic BPV, assessed using variation independent of the mean. Secondary outcomes included major adverse cardiovascular events and its individual components.<h4>Results</h4>The final cohort included 5779 participants (median of 12 BP measurements and median follow-up of 3.5 years), among whom 2754 were included in the matched analysis. CCB-based regimens were consistently associated with significantly lower systolic BPV compared with both RAS inhibitor-based and diuretic-based regimens. This association was consistent across monotherapy (CCB versus RAS: β=-1.341 [95% CI, -1.930 to -0.752]; <i>P</i><0.001) and combination therapies (CCB+diuretic versus RAS+diuretic: β=-1.299 [95% CI, -1.852 to -0.747]; <i>P<