To the Editor In their provocative meta-analysis, Clark et al1 conclude, “Our results confirm prior work outlining BPV [blood pressure variability] to be a predictor of cardiovascular events and further extend these findings to indicate that BPV, in particular systolic BPV, manifests as a proatherosclerotic process.” We take issue with the suggestion that this is the principal sequence of events. At least as likely is the pathogenetic hypothesis that stiffening of the arterial tree leads to increased BPV. Indeed, ever since the elegant studies of Hallock and Benson in 1937,2 we know that aging increases arterial stiffness and that increased arterial stiffness gives rise to increased BPV.3
Messerli FH, Rimoldi SF, Bangalore S. Blood Pressure Variability and Arterial Stiffness—Chicken or Egg? JAMA Cardiol. Published online August 07, 2019. doi:10.1001/jamacardio.2019.2730
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