Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects

Casali, Karina R.; Schaan, Beatriz D.; Montano, Nicola; Massierer, Daniela; M.F. Neto, Flávio; Teló, Gabriela H.; Ledur, Priscila S.; Reinheimer, Marilia; Sbruzzi, Graciele; Gus, Miguel

doi:10.5935/abc.20180020

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Original Articles, Hypertension • Arq. Bras. Cardiol. 110 (2) • Feb 2018 • https://doi.org/10.5935/abc.20180020 copy

Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet.

Objective:

The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects.

Methods:

Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05.

Results:

There was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations.

Conclusions:

Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

Keywords:
Hypertension; Diabetes Mellitus, Type 2; Autonomic Nervous System; Blood Pressure Monitoring, Ambulatory

Variables	Controls (n = 12)	Diabetic-hypertensive (n = 51)	p
Age (years)	51.6 ± 4.4	57.3 ± 8.1	0.011
Male gender	6 (50.0)	11 (20.8)	0.065
BMI (Kg/m²)	23.5 ± 2.3	30.5 ± 4.2	< 0.001
Office SBP (mmHg)	116.0 ± 8.2	139.2 ± 17.2	< 0.001
Office DBP (mmHg)	77.0 ± 5.0	80.9 ± 11.9	0.086
Duration of diabetes (years)	-	6.9 (3.0-10.0)
Fasting plasma glucose (mg/dL)	-	156.5 ± 55.1
HbA1c (%)	-	8.2 ± 2.0
Total cholesterol (mg/dl)	-	181. 2 ± 32.6
HDL cholesterol (mg/dl)	-	42.6 ± 13.2
Triglycerides (mg/dl)	-	180.5 (132.8 - 248.5)
Creatinine (mg/dl)	-	0.82 ± 0.2
Microalbuminuria (> 17 µg/min)	-	14 (27.4)

Variable	C (n = 12)		DH (n = 51)		P
Variable	At rest	Standing up	At rest	Standing up	Group	Condition	Interaction
Mean BP (mmHg)	114.6 ± 23.6	112.6 ± 18.2	129.4 ± 17.7	123.8 ± 21.6	0.019	0.494	0.147
Very short-term BPV (mmHg²)	21.57 ± 12.20	37.17 ± 16.12^* * p < 0.05 vs. rest condition;	25.27 ± 20.08	25.23 ± 23.04	0.504	0.058	0.047
LF component of BPV (mmHg²)	1.80 ± 1.13	13.84 ± 11.93	4.59 ± 6.02	9.26 ± 10.61	0.879	< 0.001	0.060
HF component of BPV (mmHg²)	1.40 ± 1.57	3.73 ± 3.02^* * p < 0.05 vs. rest condition;	3.44 ± 3.46^# # p < 0.05 vs. C; FBPM: Short-Term Blood Pressure. Two-way repeated measures ANOVA. Post hoc Student-Newman-Keuls.	2.25 ± 1.64^* * p < 0.05 vs. rest condition;	0.538	0.323	< 0.001
Mean HR (bpm)	66.2 ± 9.3	77.8 ± 8.7^* * p < 0.05 vs. rest condition;	70.8 ± 11.9	77.2 ± 13.9^* * p < 0.05 vs. rest condition;	0.419	< 0.001	0.016
HRV (s²)	1.47 ± 1.71	1.07 ± 0.78	0.73 ± 0.79	0.45 ± 0.42	0.005	0.010	0.658
LF component of HRV (nu)	40.77 ± 16.84	61.48 ± 16.90	31.08 ± 21.07^# # p < 0.05 vs. C; FBPM: Short-Term Blood Pressure. Two-way repeated measures ANOVA. Post hoc Student-Newman-Keuls.	40.69 ± 23.62	0.014	< 0.001	0.339
HF component of HRV (nu)	50.65 ± 14.79	30.07 ± 15.33	49.91 ± 22.35	36.19 ± 20.48	0.842	< 0.001	0.464
LF/HF index	0.99 ± 0.76	3.33 ± 3.16	1.09 ± 1.54	2.69 ± 4.13	0.902	0.001	0.744
Alpha index (ms/mmHg)	15.04 ± 9.75	6.43 ± 5.24^* * p < 0.05 vs. rest condition;	8.24 ± 7.70^# # p < 0.05 vs. C; FBPM: Short-Term Blood Pressure. Two-way repeated measures ANOVA. Post hoc Student-Newman-Keuls.	4.72 ± 3.89^* * p < 0.05 vs. rest condition;	< 0.001	< 0.001	0.003

	24-hour			Daytime			Nighttime
	Time-rate	Coefficient of variation	Standard deviation	Time-rate	Coefficient of variation	Standard deviation	Time-rate	Coefficient of variation	Standard deviation
AT REST
Total BPV R	0.236	-0.042	-0.007	-0.247	-0.585	-0.315	0.555	0.210	0.301
(P)	0.461	0.897	0.983	0.439	0.046	0.319	0.061	0.513	0.341
LF component BPV R	0.373	0.538	0.608	0.370	0.445	0.559	0.021	0.343	0.438
(P)	0.233	0.071	0.036	0.236	0.147	0.059	0.948	0.276	0.155
Alpha index R	-0.127	-0.357	-0.322	-0.483	-0.592	-0.524	0.290	-0.056	0.063
(P)	0.695	0.255	0.308	0.111	0.043	0.080	0.361	0.863	0.846
AFTER SYMPATHETIC ACTIVATION (Standing‑up maneuver)
Total BPV R	0.418	0.350	0.427	0.138	-0.172	0.084	0.180	0.392	0.424
(P)	0.176	0.265	0.167	0.670	0.594	0.795	0.575	0.208	0.170
LF component BPV R	0.591	0.322	0.385	0.649	0.329	0.413	-0.074	0.315	0.263
(P)	0.043	0.308	0.217	0.022	0.296	0.183	0.819	0.319	0.409
Alpha index R	-0.116	-0.392	-0.322	-0.346	-0.312	-0.322	0.191	-0.503	-0.270
(P)	0.720	0.208	0.308	0.271	0.324	0.308	0.552	0.095	0.397
DELTA INDEXES (AT REST/AFTER SYMPATHETIC ACTIVATION)
Delta_HRV R	-0.056	-0.070	-0.105	0.353	0.081	-0.042	-0.541	-0.168	-0.340
(P)	0.862	0.829	0.746	0.261	0.803	0.897	0.070	0.602	0.280
Delta_LF/HF R	0.636	0.000	0.217	0.857	0.385	0.392	-0.233	-0.126	0.088
(P)	0.026	1.000	0.499	0.000	0.216	0.208	0.466	0.697	0.787
Delta LF_BPV R	0.299	-0.091	-0.077	0.282	0.011	-0.035	-0.170	-0.035	-0.217
(P)	0.346	0.779	0.812	0.374	0.974	0.914	0.598	0.914	0.498

	24-hour			Daytime			Nighttime
	Time-rate	Coefficient of variation	Standard deviation	Time-rate	Coefficient of variation	Standard deviation	Time-rate	Coefficient of variation	Standard deviation
AT REST
Total BPV R	0.03	0.280	0.240	0.210	0.261	0.286	-0.036	0.026	0.103
(P)	0.486	0.046	0.090	0.152	0.064	0.042	0.807	0.857	0.471
LF component BPV R	0.330	0.356	0.347	0.332	0.185	0.259	0.234	0.278	0.337
(P)	0.022	0.010	0.013	0.021	0.194	0.066	0.110	0.048	0.016
Alpha index R	-0.371	-0.250	-0.264	-0.420	-0.171	-0.222	-0.158	-0.151	-0.220
(P)	0.009	0.076	0.062	0.003	0.229	0.117	0.283	0.289	0.122
AFTER SYMPATHETIC ACTIVATION (Standing‑up maneuver)
Total BPV R	0.192	0.403	0.413	0.269	0.447	0.486	0.033	0.029	0.176
(P)	0.191	0.003	0.003	0.065	0.001	0.000	0.826	0.841	0.218
LF component BPV R	0.140	0.274	0.283	0.156	0.166	0.245	0.042	0.090	0.134
(P)	0.341	0.052	0.044	0.290	0.244	0.083	0.777	0.532	0.349
Alpha index R	-0.359	-0.206	-0.263	-0.405	-0.098	-0.192	-0.172	-0.306	-0.336
(P)	0.012	0.146	0.063	0.004	0.493	0.177	0.243	0.029	0.016
DELTA INDEXES (AT REST/AFTER SYMPATHETIC ACTIVATION)
Delta_HRV R	0.054	0.018	-0.011	-0.003	-0.045	-0.058	0.055	0.106	0.059
(P)	0.714	0.901	0.938	0.985	0.754	0.688	0.711	0.460	0.679
Delta_LF/HF R	-0.015	-0.152	-0.099	-0.037	-0.215	-0.190	0.088	0.097	0.083
(P)	0.922	0.291	0.492	0.807	0.134	0.186	0.557	0.501	0.568
Delta LF_BPV R	-0.162	-0.105	-0.077	-0.210	-0.093	-0.070	-0.069	-0.070	-0.097
(P)	0.271	0.464	0.590	0.152	0.515	0.623	0.643	0.623	0.500

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