Effects of renal denervation on short-term blood pressure variability: lack of meta-analytic evidence

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Evidence from observational studies and post-hoc analysis of randomized clinical trials have indicated a strong independent association between increased blood pressure (BP) variability and cardiovascular outcomes in hypertension. Prospective studies including the Pressioni Arteriose Monitorate e Loro Associazioni study [1,2] have shown that short-term BP variability over a 24-h period independently predicts the development and progression of cardiac, vascular and renal damage, cardiovascular events and mortality. However, BP variability using SD reflects the fluctuation of the BP values, and the magnitude of the SD rise proportionally increases with the mean BP, indicating that ambulatory BP variability does not significantly contribute to risk stratification over and beyond 24-h BP [3]. A report from the International Database of Ambulatory Blood Pressure in relation to Cardiovascular Outcomes included 11 785 patients randomly recruited from 11 populations has described the shortcomings of previous BP variability studies and conclusively established that short-term reading-to-reading BP variability over the 24 h predicted the outcomes [4]. Taken together, these findings strongly support the relevance of BP variability over the 24 h for patients risk stratification and research, and highlights the prognostic use of mean ambulatory BP in clinical practice.

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