Fanelli Elvira, Picca Giulia, Airale Lorenzo, Astarita Anna, Mingrone Giulia, Catarinella Cinzia, Votta Simona, Colomba Anna, Cesareo Marco, Leone Dario, Paladino Arianna, Rabbia Franco, Bringhen Sara, Gay Francesca, Veglio Franco, Milan Alberto, Vallelonga Fabrizio
Division of Internal Medicine, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy.
Emergency Medicine Unit, Ospedale San Giovanni Bosco, Turin, Italy.
Hypertens Res. 2025 Apr;48(4):1554-1563. doi: 10.1038/s41440-024-02084-w. Epub 2025 Jan 22.
Blood pressure (BP) variability (BPV) is an independent predictor of cardiovascular (CV) events. The role of BPV in defining risk of cancer therapy-related cardiovascular toxicity (CTR-CVT) is currently unknown. The aims of this study were: (i) to evaluate BPV in a population of patients with Multiple Myeloma, undergoing proteasome inhibitors therapy; (ii) to assess the predictive value of BPV for CTR-CVT; (iii) to analyze clusters of subjects based on BPV. One hundred twenty-four patients underwent a baseline evaluation, including Ambulatory Blood Pressure Monitoring (ABPM), PWV, and Echocardiography. BPV was assessed through ABPM-based standard deviation (SD), weighted standard deviation (wSD), coefficient of variation (CoV), average real variability (ARV), and variability independent of the mean (VIM). Individuals who developed CTR-CVT had a higher baseline BPV. Furthermore, night-time BPV was associated with CTR-CVT, independently of age, smoking, BP, diabetes, dyslipidemia, and kidney function (night-time systolic CoV: adjusted OR 1.09 [1.01-1.21]; night-time systolic VIM: adjusted OR 1.18 [1.01-1.39]). Cut-offs for these BPV parameters were identified as predictors of CTR-CVT occurrence: 10.5 for night-time systolic CoV; 7.8 and 6.4 for systolic and diastolic night-time VIM. Clustering analysis identified subgroups of subjects characterized by the highest BPV, who had a greater prevalence of events, but no differences in other CV risk determinants. Short-term BPV is an independent predictor of CTR-CVT. BPV may enhance the precision of risk stratification in cancer patients, enabling identification of individuals at higher risk who would not be recognized, if traditional prognostic indicators were the sole applied criteria. On the left panel in the figure, the distribution of blood pressure variability (BPV) in the population according to cancer therapy-related cardiovascular toxicity occurrence; in the central panel, association of blood pressure variability with events and cutoffs values; in the right panel, clustering analysis results based on BPV levels. Histogram and radar plot represent events and BPV indexes distribution in the three clusters, respectively. ARV, average real variability; BPV, Blood Pressure Variability; CTR-CVT, cancer therapy-related cardiovascular toxicity; CoV, coefficient of variation; DBP, Diastolic blood pressure; SBP, Systolic blood pressure; SD, standard deviation; VIM, variability independent of the mean; wSD, weighted standard deviation.
血压（BP）变异性（BPV）是心血管（CV）事件的独立预测因素。BPV在定义癌症治疗相关心血管毒性（CTR-CVT）风险中的作用目前尚不清楚。本研究的目的是：（i）评估接受蛋白酶体抑制剂治疗的多发性骨髓瘤患者群体中的BPV；（ii）评估BPV对CTR-CVT的预测价值；（iii）基于BPV分析受试者聚类。124例患者接受了基线评估，包括动态血压监测（ABPM）、脉搏波速度（PWV）和超声心动图检查。通过基于ABPM的标准差（SD）、加权标准差（wSD）、变异系数（CoV）、平均实际变异性（ARV）和独立于均值的变异性（VIM）来评估BPV。发生CTR-CVT的个体基线BPV较高。此外，夜间BPV与CTR-CVT相关，独立于年龄、吸烟、血压、糖尿病、血脂异常和肾功能（夜间收缩压CoV：调整后比值比1.09 [1.01 - 1.21]；夜间收缩压VIM：调整后比值比1.18 [1.01 - 1.39]）。确定了这些BPV参数的临界值作为CTR-CVT发生的预测指标：夜间收缩压CoV为10.5；夜间收缩压和舒张压VIM分别为7.8和6.4。聚类分析确定了以最高BPV为特征的受试者亚组，这些亚组事件发生率更高，但在其他心血管风险决定因素方面无差异。短期BPV是CTR-CVT的独立预测因素。BPV可能提高癌症患者风险分层的准确性，能够识别出如果仅应用传统预后指标则无法识别的高风险个体。在图的左面板中，根据癌症治疗相关心血管毒性的发生情况，人群中血压变异性（BPV）的分布；在中间面板中，血压变异性与事件和临界值的关联；在右面板中，基于BPV水平的聚类分析结果。直方图和雷达图分别表示三个聚类中事件和BPV指标的分布。ARV，平均实际变异性；BPV，血压变异性；CTR-CVT，癌症治疗相关心血管毒性；CoV，变异系数；DBP，舒张压；SBP，收缩压；SD，标准差；VIM，独立于均值的变异性；wSD，加权标准差。
