Determinants of short-term blood pressure variability – the value of arterial stiffness

Keywords: arterial hypertension, blood pressure variability, arterial stiffness, ambulatory arterial stiffness index


Abstract. Increased blood pressure variability is a significant parameter that affects the prognosis in patients with arterial hypertension, and is an independent predictor of cardiovascular events and mortality. The arterial elasticity is an important factor in maintaining a constant average blood pressure for adequate blood supply to inner organs against the background of dynamic blood pressure fluctuations. A decrease in the elastic properties of the arteries, and therefore, an increase in the arterial stiffness can be one of the potential mechanisms for the blood pressure variability violation. Objective. The aim of the study was to evaluate the possible relationships between arterial stiffness indicators and blood pressure variability indices in patients with hypertension based on the results of ambulatory blood pressure monitoring. Patients and methods. The results of ambulatory blood pressure monitoring of 172 patients with hypertension were analyzed. Arterial stiffness was assessed using the ambulatory arterial stiffness index - symmetric and asymmetric. SD, SDw, CV, SV, ARV, and BPVR indices were calculated to assess blood pressure variability. Analysis of the obtained results was carried out using Microsoft Excel 2010 and the STATISTICA version 10.0 software. Differences between groups were assessed by the Mann-Whitney method, correlations among blood pressure variability indices and ambulatory arterial stiffness indices were evaluated using Spearman`s rank correlation analysis. Significance was set at p ˂ 0.05. The results. Awake asymmetric ambulatory arterial stiffness index was significantly higher than asleep one, no statistically significant difference between asleep and 24-hour asymmetric ambulatory arterial stiffness index was established. The asleep symmetric ambulatory arterial stiffness index did not significantly differ from the awake one and was significantly higher than the 24-hour one. In comparison with asymmetric, for symmetric ambulatory arterial stiffness index statistically significant relationships were established for a greater number of blood pressure variability indices. In all statistically significant cases, the direction of the established relationship with arterial stiffness was only direct for the systolic blood pressure variability indices. Variability of diastolic blood pressure had a clear inverse relationship with arterial stiffness. Conclusions. The presence of pathogenetic interrelationships between arterial stiffness and blood pressure variability have been proven in the present study. The obtained results allow to state that arterial elasticity is an important component of blood pressure variability.


Download data is not yet available.

Author Biographies

Olena Kanishcheva, V. N. Karazin Kharkiv National University

MD, Assistant professor, Internal Medicine Department, School of Medicine, V. N. Karazin Kharkiv National University, 4, Maidan Svobody, Kharkiv, Ukraine, 61022

Oleksandr Bilchenko, Kharkiv National Medical University

PhD, Doctor of Medical Science, Professor, Head of the Department of Therapy № 1, Educational and Scientific Institute of Postgraduate Education, Kharkiv National Medical University, 4, Nauky Avenue, Kharkiv, Ukraine, 61022


Zhou B, Perel P, Mensah GA, Ezzati. M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat. Rev. Cardiol. 2021, 18, 785, DOI:

Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J. Hypertens. 2020,38,982–1004, DOI:

Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension; 2018; 39. DOI:

Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. In Proceedings of the Journal of Clinical Hypertension; Blackwell Publishing Inc., 2018; 20: 1133–1137. DOI:

Malik EZ, Abdulhadi B, Mezue KN, Lerma EV, Rangaswami J. Clinical hypertension: Blood pressure variability. Disease-a-Month 2018,64:5–13. DOI:

Takahash, O, Glasziou PP, Perera R, Shimbo T, Fukui T. Blood pressure re-screening for healthy adults: What is the best measure and interval. J. Hum. Hypertens. 2012; 26: 540–546, DOI:

Barnett MP, Bangalore S. Cardiovascular Risk Factors: It’s Time to Focus on Variability! J. Lipid Atheroscler. 2020; 9: 255. DOI:

Sega R, Corrao G, Bombelli M, Beltrame L, Facchetti R, Grassi G, et al. Blood pressure variability and organ damage in a general population: results from the PAMELA study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertens. (Dallas, Tex. 1979). 2002; 39: 710–714. DOI:

Mehlu, MH, Liestøl K, Kjeldsen SE, Julius S, Hua TA, Rothwell PM, et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. Eur. Heart J. 2018;39:2243–2251. DOI:

Zawadzki MJ, Small AK, Gerin W. Ambulatory blood pressure variability: A conceptual review. Blood Press. Monit. 2017;22:53–58. DOI:

Parati G, Torlasco C, Pengo M, Bilo G, Ochoa JE. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens. Res. 2020; 43: 609–620. DOI:

Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial Stiffness and Cardiovascular Risk in Hypertension. Circ. Res. 2021; 128: 864–886. DOI:

Zhou TL, Henry RMA, Stehouwer CDA, Van Sloten TT, Reesink KD, Kroon AA. Blood pressure variability, arterial stiffness, and arterial remodeling the Maastricht study. Hypertension 2018; 72: 1002–1010. DOI:

Zanoli L, Lentini P, Briet M, Castellino P, House AA, London GM, et al. Arterial Stiffness in the Heart Disease of CKD. J. Am. Soc. Nephrol. 2019;30:918–928. DOI:

Boos CJ,Thiri-Toon L, Steadman CD, Khambekar S, Jordan A, Carpenter JP. The Relationship Between Ambulatory Arterial Stiffness Index and Cardiovascular Outcomes in Women. Cardiol. Res. 2021; 12: 161–168. DOI:

Boos CJ, Toon LT, Almahdi H. The relationship between ambulatory arterial stiffness, inflammation, blood pressure dipping and cardiovascular outcomes. BMC Cardiovasc. Disord. 2021; 21. DOI:

Vallée A. Arterial Stiffness and the Canonical WNT/β-catenin Pathway. Curr. Hypertens. Rep. 2022; 24: 499–507. DOI:

Namba T, Masaki N, Takase B, Adachi T. Arterial Stiffness Assessed by Cardio-Ankle Vascular Index. Int. J. Mol. Sci. 2019; 20. DOI:

Tanaka H. Various Indices of Arterial Stiffness: Are They Closely Related or Distinctly Different? Pulse (Basel, Switzerland) 2018; 5: 1–6. DOI:

Obata Y, Barodka V, Berkowitz DE, Gottschalk A, Hogue CW, Steppan J. Relationship between the ambulatory arterial stiffness index and the lower limit of cerebral autoregulation during cardiac surgery. J. Am. Heart Assoc. 2018; 7: 1–10. DOI:

Gavish B, Ben-Dov IZ, Bursztyn M. Linear relationship between systolic and diastolic blood pressure monitored over 24 h: assessment and correlates. J. Hypertens. 2008; 26: 199–209. DOI:

Kips JG, Vermeersch SJ, Reymond P, Boutouyrie P, Stergiopulos N, Laurent S. et al. Ambulatory arterial stiffness index does not accurately assess arterial stiffness. J. Hypertens. 2012; 30: 574–580. DOI:

Kollias A, Stergiou GS, Dolan,E, O’Brien E. Ambulatory arterial stiffness index: A systematic review and meta-analysis. Atherosclerosis 2012; 224: 291–301.


Bhandari V, Sharma K, Shah P, Khan E, Desai HD, Vora T, et al. Predictors of Arterial Stiffness Amongst the 24-Hour Ambulatory Blood Pressure Variables in Hypertensive Patients. Cureus 2020;12. DOI:

Efe FK, Tek M. Increased ambulatory arterial stiffness index and blood pressure load in normotensive obese patients. Afr. Health Sci. 2021; 21: 1185–1190. DOI:

Hermida RC, Smolensky MH, Ayala DE, Portaluppi F, Crespo JJ, Fabbian F, et al. 2013 Ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals (summary). Joint recommendations from the Internati. Clin. e Investig. en Arterioscler. 2013; 25: 74–82. DOI:

Zhang H, Hu W, Wang Y, Liu J, You L, Dong Q, et al. The relationship between ambulatory arterial stiffness index and left ventricular diastolic dysfunction in HFpEF: a prospective observational study. BMC Cardiovasc. Disord. 2022; 22. DOI:

Kikuya M, Asayama K, Ohkubo T. Blood pressure variability and arterial stiffness parameters derived from ambulatory blood pressure monitoring. Kardiol. Pol. (Polish Hear. Journal) 2019; 77: 509–514. DOI:

Guo ZN, Qu Y, Reziya H, Liu J, Yan XL, Zhang P, et al. Which Parameters of Beat-to-Beat Blood Pressure Best Predict Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage? Front. Aging Neurosci. 2020; 12. DOI:

Fan Y, Hou C, Peng L, Gao X, Xu Y. Twenty-Four-Hour Ambulatory Blood Pressure Variability Associated With Cerebral Small Vessel Disease MRI Burden and Its Progression in Inpatients With Cerebrovascular Disease. Front. Neurol. 2020; 11. DOI:

Xia Y, Wu D, Gao Z, Liu X, Chen Q, Ren L, Wu W. Association between beat-to-beat blood pressure variability and vascular elasticity in normal young adults during the cold pressor test. Med. (United States) 2017;96. DOI:

Mena LJ, Felix VG, Melgarejo JD, Maestre GE. 24-Hour blood pressure variability assessed by average real variability: A systematic review and meta-analysis. J. Am. Heart Assoc. 2017; 6: 1–10. DOI:

Wang J, Jiang B, Song L, Yang C, Wu Y, Chen S, et al. Correlation between visit-to-visit and short-term blood pressure variability calculated using different methods and glomerular filtration rate. J. Hum. Hypertens. 2017; 31: 132–137. DOI:

Schober P, Schwarte LA. Correlation coefficients: Appropriate use and interpretation. Anesth. Analg. 2018;126:1763–1768. DOI:

Lacolley P, Regnault V, Laurent S. Mechanisms of Arterial Stiffening: From Mechanotransduction to Epigenetics. Arterioscler. Thromb. Vasc. Biol. 2020; 40: 1055–1062. DOI:

Dumor K, Shoemaker-Moyle M, Nistala R, Whaley-Connell A. Arterial Stiffness in Hypertension: an Update. Curr. Hypertens. Rep. 2018;20. DOI:

Van Bortel LM, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, Cockcroft J, et al. Clinical applications of arterial stiffness, task force III: Recommendations for user procedures. Am. J. Hypertens. 2002; 15: 445–452. DOI:

Bahrainwala J, Patel A, Diaz KM, Veerabhadrappa P, Cohen DL, Cucchiara A, Townsend RR. Ambulatory Arterial Stiffness Index and circadian blood pressure variability. J. Am. Soc. Hypertens. 2015;9:705–710, DOI:

Qin T, Jiang H, Jiao Y, Ke Y, Sun N, Wang J, Zhu J. Ambulatory arterial stiffness index correlates with ambulatory pulse pressure but not dipping status in patients with grade 1/grade 2 essential hypertension. J. Int. Med. Res. 2014; 42: 1323–1334. DOI:

Chen YK, Ni ZX, Li W, Xiao WM, Liu YL, Liang WC, Qu JF. Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study. J. Stroke Cerebrovasc. Dis. 2021:30. DOI:

Yang K, Zhu X, Feng Y, Shen F, Chen J, Fu N, Sun J, Fu Y. Abnormal blood pressure circadian rhythms are relevant to cerebral infarction and Leukoaraiosis in hypertensive patients. BMC Neurol. 2020;20. DOI:

How to Cite
Olena Kanishcheva, & Oleksandr Bilchenko. (2023). Determinants of short-term blood pressure variability – the value of arterial stiffness. The Journal of V. N. Karazin Kharkiv National University, Series "Medicine", (46), 12-21.