Office blood pressure variability as a predictor of brain infarction in elderly hypertensive patients

Large 24-h blood pressure (BP) variability and an excessive drop in BP duri ng nighttime are associated with a higher risk of cardiovascular events. Da ta are lacking regarding the prognostic significance of variability in BP m easured during office visits. We analyzed the relationship between office B P variability and the risk of brain infarction in elderly patients receivin g antihypertensive therapy. Patients who experienced their first-ever strok e at the age of 60 years or over were registered in the study. At least 2 s ex- and age-matched control patients were registered for each case patient. Office BP at each clinic visit and known cardiovascular risk factors were recorded. The BP variability was defined as the variation coefficient (VC) of office BP. In this report, we analyze the data of brain infarction patie nts. The VC of both systolic and diastolic BPs was significantly higher in the brain infarction patients than in the control patients. Higher office B P variability was associated with a higher risk of brain infarction after a djustment for EP level and other confounding factors. Regarding diastolic B P, the association of brain infarction with the maximal value for the diffe rence of office BPs taken at any consecutive two visits (Max-dBP) or the di fference between the highest and lowest values of office BP (BP-range) reco rded during a 1-year period prior to the event was also significant. In con clusion, a retrospective case-control study suggested that office BP variab ility was an independent predictor of brain infarction. Either the Max-dBP or the BP-range may be surrogate indices of diastolic BP variability.