CLINICAL APPLICATIONS OF VISIT TO VISIT BLOOD PRESSURE VARIABILITY

Abstract

Since the introduction of visit to visit blood pressure variability (VVBPV) for cardiovascular outcome, it has long been awaited for prospective intervention trial to reduce VVBPV for evidence based medicine. But because of several hurdles, most importantly, pending measure to reduce VVBPV, such trial may not be available in the near future. It means that current understanding on the VVBPV is not casual but related to the cardiovascular outcome.

Waiting for more sound evidence, which can be remained in a clinician's mind struggling not to be indifferent for potential benefit? Firstly, the most important potential confounder in spite of the strict statistical analyses to be published may be the mean blood pressure. Secondly, the population candidate for monitoring VVBPV needs to be understood. In general, the higher the risk, the more the value of considering the VVBPV. Thirdly, understanding the biological confounders for VVBPV such as arterial stiffness, low grade systemic inflammation, and sympathetic over-reactivity may inspire the clinician and/or patient the importance of the well-known lifestyle modification such as physical activity. Lastly, therapeutic aspects previously drawing less attention such as the class of drug with less inter-individual blood pressure variability, the relationship between the class of a drug and the volume status, adherence in general, the clinic protocol for the timing of drug intake with or without exercise and office visit, and the general conditions which can affect the volume status and thereby blood pressure level.

Even without evidence of direct intervention on VVBPV, by monitoring and understanding VVPBV, a clinician can be developed to a new level of blood pressure management which is not only simply prescribing antihypertensive drugs but also more comprehensive understanding of the patient factors closely related to the blood pressure.