In Reply Messerli et al raise an important point regarding the pathophysiology underlying the association of blood pressure variability (BPV) with atheroma progression, suggesting that arterial stiffening may be the culprit of increased BPV. Indeed, we agree, as stated in our Discussion section, “Atheroma progression in the coronary arteries and/or other vascular beds may be the inciting event leading to higher BPV.”1 Moreover, in our Discussion section, we suggest that therapies to curb atheroma progression and induce regression, such as statins, may be a potential intervention among those with higher BPV. Further studies are required to evaluate underlying mechanisms and therapeutic implications of the observed association between BPV, coronary atheroma progression, and adverse cardiovascular outcomes.
Clark D, Puri R. Blood Pressure Variability and Arterial Stiffness—Chicken or Egg?—Reply. JAMA Cardiol. Published online August 07, 2019. doi:10.1001/jamacardio.2019.2735
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