Downloaded from https://journals.lww.com/bpmonitoring by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3hIW04IhZ9AsEGenpJufxAlSM7swAGONOBvun1ld1cBojY4MWd7fvBg== on 03/03/2020 Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Brief report 1 1359-5237 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MBP.0000000000000435 A cohort-based comprehensive characterization of different patterns of very short-term, within-visit, blood pressure variability Theodore G. Papaioannou a , Athanase D. Protogerou b , Kimon S. Stamatelopoulos c , Krystallenia I. Alexandraki d , Dimitrios Vrachatis a , Antonios Argyris b , Vasilios Papaioannou e , Manolis Vavuranakis a,f , Christodoulos Stefanadis g and Dimitrios Tousoulis a Aim To characterize different patterns of variability of three repeated within-visit blood pressure (BP) readings and to determine the prevalence of specific variation trends in systolic (SBP), diastolic (DBP) blood pressure and pulse pressure (PP). Methods Data from 53 737 subjects from the National Health and Nutrition Examination Survey were analyzed. In each subject, three consecutive BP measurements were performed with a minimum time-interval of at least 30 s. We propose three patterns of within-visit BP variability (separately for SBP, DBP and PP): (1) increasing trend (BP 3 > BP 2 > BP 1 ); (2) decreasing trend (BP 1 > BP 2 > BP 3 ) and (3) no trend (BP 3 ≈ BP 2 ≈ BP 1 ). A threshold of minimum change (ΔP > 3 mmHg) between BP 1 -BP 2 and BP 2 -BP 3 was also applied as a prerequisite for the definition of these trends. Results An increasing trend was observed among three consecutive measurements of SBP, DBP and PP in 7.4, 10.4 and 10.2%, respectively. When a minimum threshold of 3 mmHg was set the respective increasing trends were observed in 1.8, 2.9 and 4.4%, respectively. There was a higher prevalence of decreasing trend within three consecutive SBP, DBP and PP readings: 17, 13.1 and 16.2%, respectively, whereas using a threshold of ΔP >3 mmHg the respective prevalence was 6.3, 4.1 and 7.7%. A maximum absolute difference >10 mmHg within triplicate of SBP/DBP/PP readings was observed in 12.9, 13 and 29.4%, respectively. In the era of personalized medicine, these patterns are well worth further investigation concerning their pathophysiologic and clinical relevance. Blood Press Monit XXX: 000–000 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Blood Pressure Monitoring 2020, XXX:000–000 Keywords: arterial pressure, hemodynamics, sphygmomanometer a First Department of Cardiology, Biomedical Engineering Unit, Hippokration Hospital, b Department of Pathophysiology, Cardiovascular Prevention and Research Unit, c Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, d First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, e Intensive Care Unit, Alexandroupolis General Hospital, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, f Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece and g Cardiovascular Medicine Section, School of Medicine, Yale University, New Haven, Connecticut, USA Correspondence to Theodore G. Papaioannou, PhD, First Department of Cardiology, Biomedical Engineering Unit, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vas. Sophias Ave, Athens 115 28, Greece Tel: +30 213 2088286; fax: +30 213 2088676; e-mail: thepap@med.uoa.gr Received 16 October 2019 Accepted 4 December 2019 Introduction Measures of blood pressure (BP) at the offce, clinic or at home are typically used for the evaluation of an individ- ual’s risk for BP-related cardiovascular events, diagnosis of hypertension and consequently guidance of antihy- pertensive treatment. Moreover, BP variability is being increasingly recognized as another essential parameter in risk prediction for cardiovascular events and mortal- ity [1]. Although diurnal and visit-to-visit BP variabil- ity has been extensively investigated [2], less is known concerning patterns of very short-term, within-visit, BP variability. Several epidemiologic and clinical studies have shown that differences exist between consecutive BP readings [3,4], due to the inherent beat-to-beat BP variation or/ and due to measurement errors. To increase the accuracy and precision in BP measurement, European guidelines for the management of arterial hypertension recommend that three sequential offce BP measurements should be performed, whereas additional recordings are required if the frst two readings of systolic BP differ by >10 mmHg [5]. Similarly, the respective American and Canadian hypertension guidelines recommend that two or more BP readings should be made [6,7]. The aim of this study was a novel comprehensive in-depth approach to characterize patterns of variability of three repeated BP readings within a single visit and particularly to determine the prevalence of specifc vari- ation trends in systolic (SBP) and diastolic (DBP) blood pressure as well as pulse pressure (PP).