Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA)

Background Baseline data from the European Lacidipine Study on Atherosclero sis (ELSA) have shown that carotid intima-media thickness (IMT) is not rela ted to diastolic blood pressure (BP), but that it is related to clinic syst olic (S) or pulse pressure (PP) and more so to their 24 h average values. T he aim of the present study was to determine whether IMT independently rela tes to additional information obtained through ambulatory BP, in particular to SBP or PP variability. Methods and results In 1663 hypertensive patients, after a wash-out period from antihypertensive treatment (mean age 56.2 +/- 7.65 years), IMT was ass essed from 12 different carotid sites. Ambulatory BP measurements were perf ormed every 15 min (day) and every 20 min (night). IMT values were positive ly related to 24 h, day and night average SBP and PP. There was some relati onship of IMT with day-night or clinic-day SBP and PP differences. The most important finding, however, was that IMT values were related with 24 h SBP or PP standard deviation (P < 0.001), a measure of overall SBP or PP varia bility. The relationship was seen also by multiple regression analysis, the standard deviation for SBP or PP only following age and 24 h average SBP o r PP in accounting for IMT values. Conclusions This is the first demonstration from a large database that not only average 24 h PP and SBP values, but also 24 h BP fluctuations, are ass ociated with, and possibly determinants of, the alterations of large artery structure in hypertension. (C) 2001 Lippincott Williams & Wilkins.