PP.03.31

Objective: Blood pressure variability (BPV) has been proven to correlate with an increased risk of cardiovascular (CV) events even in controlled hypertension. Different BPV indicators have been tested to correlate with increased CV risk, however none, except for dipping profile, have become a standard of measure well enough to enter the guidelines. Average real variability (ARV) of daytime SBP and not high SD has been proven to associate with increased risk of CV events and has been recently proposed as a more reliable representation of BPV than SD as it is less sensitive to the low sampling frequency of ABPM. Incidence of CV events is higher in patients with a lesser drop in nocturnal BP, however data on a possible increased CV risk in extreme dippers are inconsistent thus far. Our aim was to compare novel BPV indicators between the two extremes of the dipping profile and thus prove their importance in the evaluation of the high risk hypertensive patient.Design and method: We included hypertensive patients referred to our department for uncontrolled hypertension between 2012–2014, with a minimum of 40 successful daytime and 8 successful night-time readings on ABPM monitoring (Meditech-05 ABPM, recordings at 15 min intervals during day-time and 30 min intervals during night-time). Exclusion criteria were presence of secondary HTN, eGFR (glomerular filtration rate) < 30 ml/min/1.73m2. Extreme dippers – patients with a nocturnal dip > 20%; risers – patients with an nocturnal dip < 0%. Other BPV indicators calculated: standard deviation (SD) of mean 24 h BP, BP load, average weighted SD and average real variability. Results: In our study average SBP, daytime and night-time SBP SD and ARV did not differ significantly between the two extreme groups, as opposed to classical indicators such as SBP load and weighted SD. Conclusions: At least in the clinical setting of an emergency hospital, hypertensive patients may show distinctive CV risk profiles, with normal average BP values but high BPV. In these patients, the guideline definition of controlled hypertension becomes an understatement and, thus, drug therapy in their case should respect the patients’ chronobiology.