Reducing visit-to-visit variability in systolic blood pressure for improving the progression of carotid atherosclerosis and endothelial dysfunction in patients with hypertension management

Background: visit-to-visit variability (vvv) in blood pressure (bp) creates challenges to hypertension control and was independent associated with increased all-cause mortality in hypertensive patients. the major goal of the present study was to investigate the association of vvv in systolic (s)bp with progression of carotid atherosclerosis and en-dothelial dysfunction in on-treated hypertensive patients. methods: overall,356 hypertensive patients were enrolled and completed the trial. clinic bp was measured at base-line and at 3 monthly thereafter. carotid artery ultrasound and endothelial function were evaluated at baseline and annually follow-up visit. vvv in bp was assessed by standard deviation (sd) and coefficient of variation (cv) of serial follow-up bp measurements. the patients were divided into low,middle,and high group by tertile of sd in sbp. results: decrease percentage of maximum intima-media thickness (imt) and stiffness index β and increase percent-age of brachial flow-mediated dilation (fmd) and nitric oxide (no) in lower groups were significant greater than in higher groups (p < 0.05). change percentage of stiffness index β and endothelin-1 positively,and change percentage of fmd and no negatively correlated with sd,cv,maximum,and delta of sbp (p < 0.05). sd and cv of sbp were risk factors for change percentage of imt,stiffness index β,fmd,no,and endothelin-1 independently of other influential factors,such as age,and mean sbp. conclusion: excessive vvv in sbp maybe increase carotid atherosclerosis and impair endothelial function in on-treated hypertensive patients. reducing vvv in sbp is benefit for patients with hypertension management.