The Adaptive Value and Clinical Significance of Allostatic Blood Pressure Variation

Author(s): Gary D. James*

Journal Name: Current Hypertension Reviews

Volume 15 , Issue 2 , 2019

Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


In recent years, there has been interest in evaluating the morbidity and mortality risk of circadian, diurnal, or nocturnal blood pressure variation. Variation is a normative property of blood pressure, necessary for survival. Like many physiological functions, blood pressure undergoes allostasis, meaning that the body does not defend a particular blood pressure value, but rather blood pressure maintains bodily stability through continual change that is initiated by constantly fluctuating internal and external environmental stimuli. Because of its allostatic and adaptive properties, the blood pressure response to unusual situations like a visit to the clinic can lead to misdiagnosis of hypertension. However, blood pressure variation is mostly ignored when evaluating hypertension, which is an arbitrary dichotomy. Whether variation is indicative of pathology should be determined by assessing its appropriateness for the circumstance, which requires quantification of the sources and extent of normative blood pressure responses to everyday living. These responses will vary among populations due to evolutionary genetic differences. The inconsistency of reports regarding aspects of ambulatory blood pressure variation as cardiovascular risk factors likely results from the fact that the measures used do not reflect the actual nature of blood pressure allostasis.

Keywords: Allostasis, blood pressure variability, ambulatory blood pressure, white coat hypertension, masked hypertension, human evolution.

Pickering TG. Ambulatory monitoring and blood pressure variability. London: Science Press 1991.
Parati G, Mutti E, Omboni S, Mancia G. How to deal with blood pressure variability.In: Brunner H, B. Waeber B, Eds. Ambulatory blood pressure recording, New York: Raven Press, Ltd. 1992: pp. 71-99.
James GD. Understanding blood pressure variation and variability: Biological importance and clinical significance. Adv Exp Med Biol 2017; 956: 3-19.
Pickering G. Hyperpiesis: High blood-pressure without evident cause: Essential hypertension. Br Med J 1965; 2: 959-68.
James PA, Oparil S, Carter BL, et al. Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). J Am Med Assoc 2014; 311(5): 507-20.
Whelton PK, Carey RM, Wilbert S, et al. 2017 ACC/AHA/AAPA/ ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71: e13-e115.
Sterling P. Principles of allostasis: Optimal design, predictive regulation, pathophysiology, and rational therapeutics. In: Schulkin J, Ed. Allostasis, homeostasis, and the costs of physiological adaptation. Cambridge: Cambridge University Press 2004; pp. 17-64.
Paskalev D, Kircheva A, Krivoshiev S. A centenary of auscultatory blood pressure measurement: A tribute to Nikolai Korotkoff. Kidney Blood Press Res 2005; 2: 259-63.
Joint Recommendations of the American Heart Association and Cardiac Society of Great Britain and Ireland. Standardization of blood pressure readings. Am Heart J 1939; 18: 95-101.
Rowell LB. Human circulation: Regulation during physical stress. New York: Oxford University Press 1986.
Ayman D, Goldshine AD. Blood pressure determinations by patients with essential hypertension: The difference between clinic and home readings before treatment. Am J Med Sci 1940; 200: 465-74.
Levy RL, Hillman CC, Stroud WD, White PD. Transient hypertension: Its significance in terms of later development of sustained hypertension and cardiovascular-renal disease. J Am Med Assn 1944; 126: 829-33.
Rogers WF, Palmer RS. Transient hypertension as a military risk: Its relation to essential hypertension. N Engl J Med 1944; 230: 39-42.
Shapiro A, Meyers T, Reier MF, Ferris EB. Comparison of blood pressure response to Veriloid and to the doctor. Psychosom Med 1954; 16: 478-88.
Comstock GW. An epidemiological study of blood pressure levels in a biracial community in the southern United States. Am J Hyg 1957; 65: 271-315.
Pickering G. Hyperpiesis: High blood-pressure without evident cause: Essential hypertension. Brit Med J 1965; 2: 1021-6.
Kain HK, Hinman AT, Sokolow M. Arterial blood pressure measurements with a portable recorder in hypertensive patients: Variability and correlation with ‘casual’ pressure. Circulation 1964; 30: 882-92.
Hinman AT, Engel BT, Bickford AF. Portable blood pressure recorder: accuracy and preliminary use in evaluating intra-daily variation in pressure. Am Heart J 1962; 63: 663-8.
Sokolow M, Werdegar D, Kain HK, Hinman AT. Relationship between level of blood pressure measured casually and by portable recorders and severity of complications in essential hypertension. Circulation 1966; 34: 279-98.
Richardson DW, Honour AJ, Fenton GW, Stott FH, Pickering GW. Variation in pressure throughout the day and night. Clin Sci 1964; 26: 445-60.
Bevan AT, Honor AJ, Stott FH. Direct arterial pressure recording in unrestricted man. Clin Sci 1969; 36: 329-44.
James GD. Ambulatory blood pressure variation: Allostasis and adaptation. Autonom Neuro Basic Clin 2013; 177: 87-94.
James GD. Evaluation of journals, diaries, and indexes of worksite and environmental stress. In: White WH, Ed. Clinical hypertension and vascular disease: Blood pressure monitoring in cardiovascular medicine and therapeutics. 2nd ed. Totowa, N.J: The Humana Press 2007; pp. 39-58.
Flores JS. Blood pressure variability: A novel and important risk factor. Can J Cardiol 2013; 29: 557-63.
Palatini P, Reboldi G, Beilin LJ, et al. Added predictive value of night-time blood pressure variability for cardiovascular events and mortality: The Ambulatory Blood Pressure International Study. Hypertension 2014; 64: 487-93.
Asayama K, Fang-Fei W, Hara A, Hansen TW, Li Y, Staessen JA. Prognosis in relation to blood pressure variability; con side of the argument. Hypertension 2015; 65: 1170-9.
Parati G, Ochoa JE, Lombardi C, Bilo G. Blood pressure variability: Assessment, predictive value, and potential as a therapeutic target. Curr Hypertens Rep 2015; 17: 23.
Cannon WB. The wisdom of the body New York; The Norton Library, Norton WW & Company, reprint 1963. 1939.
Sterling P, Eyer J. Allostasis: A new paradigm to explain arousal pathology. In: Fisher J, Reason J, Eds. Handbook of life stress. New York: John Wiley 1988; pp. 629-49.
Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A. Alerting reaction and rise in pressure during management by physician and nurse. Hypertension 1987; 9: 209-15.
Jhalani J, Goyala T, Clemow L, Schwartz JE, Pickering TG, Gerin W. Anxiety and outcome expectations predict the white-coat effect. Blood Press Monit 2005; 10: 317-9.
Longo D, Dorigatti F, Palatini P. Masked hypertension in adults. Blood Press Monit 2005; 10: 307-10.
James GD. Continuous blood pressure variation: Hidden adaptability. In: Sievert LL, Brown DE, Eds. Biological measures of human experience across the lifespan: Making visible the invisible. New York: Springer, Inc. 2016; pp. 143-69.
Pickering TG, James GD, Boddie C, Harshfield GA, Blank SG, Laragh JH. How common is white coat hypertension? J Am Med Assoc 1988; 259: 225-8.
Stergiou G, Palatini P, Asmar R, et al. Blood pressure measurement and hypertension diagnosis in the 2017 US guidelines: First things first. Hypertension 2018; 71: 963-5.
Zanstra YJ, Johnston DW. Cardiovascular reactivity in real life settings: Measurement, mechanisms and meaning. Biol Psychol 2011; 86: 98-105.
Hansen TW, Thijs L, Li Y, et al. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension 2010; 55: 1049-57.
Taylor KS, Heneghan CJ, Stevens RJ, Adams EC, Nunan D, Ward A. Heterogeneity of prognostic studies of 24-hour blood pressure variability: Systematic review and meta-analysis. PLoS One 2015; 10(5): e0126375.
James GD, Pickering TG, Schlussel YR, Clark LA, Denby L, Pregibon D. Measures of reproducibility of blood pressure variability measured by noninvasive ambulatory blood pressure monitors. J Ambul Monit 1990; 3(2): 139-47.
James GD, Cates EM, Pickering TG, Laragh JH. Parity and perceived job stress elevate blood pressure in young normotensive working women. Am J Hypertens 1989; 2: 637-9.
Ice GH, James GD, Crews DE. Blood pressure variation in the institutionalized elderly. Coll Antropol 2003; 27: 47-55.
Ice GH, James GD. Human biology and stress. In: Stinson S, Bogin B, O’Rourke D, Eds. Human biology: An evolutionary and biocultural perspective. 2nd Edition (pp. 459-512). New York: Wiley-Blackwell Publishing 2012; pp. 459-512.
James GD, Bovbjerg DH, Hill LA. Daily environmental differences in blood pressure and heart rate variability in healthy premenopausal women. Am J Hum Biol 215(27): 136-8.
Cochran WG. Sampling techniques. New York: John Wiley & Sons 1977.
James GD. Blood pressure response to the daily stressors of urban environments: methodology, basic concepts, and significance. Yrbk Phys Anthropol 1991; 34: 189-210.
Gerin W, James GD. Psychosocial determinants of hypertension: Laboratory and field models. Blood Press Monit 2010; 15: 93-9.
James GD, Pecker MS, Pickering TG, et al. Extreme changes in dietary sodium effect the daily variability and level of blood pressure in borderline hypertensive patients. Am J Hum Biol 1994; 6: 283-91.
Modesti PA, Moriabito M, Bertolozzi I. et al. Weather-related changes in 24-hour blood pressure profile: Effects of age and implications for hypertension management. Hypertension 2006; 47: 155-61.
James GD, Yee LS, Harshfield GA, Blank S, Pickering TG. Sex differences in factors affecting the daily variation of blood pressure. Soc Sci Med 1988; 26: 1019-23.
Schwartz JE, Warren K, Pickering TG. Mood, location and physical position as predictors of ambulatory blood pressure and heart rate: application of a multilevel random effects model. Ann Behav Med 1994; 16: 210-20.
Kamarck TW, Schiffman SM, Smithline L, et al. Effects of task strain, social conflict, on ambulatory cardiovascular activity: Life consequences of recurring stress in a multiethnic adult sample. Health Psychol 1998; 17: 17-29.
Brondolo E, Karlin W, Alexander K, Bubrow A, Schwartz J. Workday communication and ambulatory blood pressure: Implications for the reactivity hypothesis. Psychophysiology 1999; 36: 86-94.
Gump BB, Polk DE, Kamarck TW, Shiffman S. Partner interactions are associated with reduced blood pressure in the natural environment: Ambulatory blood pressure monitoring evidence from a healthy, multiethnic adult sample. Psychosom Med 2001; 63: 423-33.
Kamarck TW, Janicki DL, Shiffman S, et al. Psychosocial demands and ambulatory blood pressure: A field assessment approach. Physiol Behav 2002; 77: 699-704.
Brown DE, James GD, Nordloh L. Comparison of factors affecting daily variation of blood pressure in Filipino-American and Caucasian nurses in Hawaii. Am J Phys Anthropol 1998; 106: 373-83.
Kamarck TW, Schwartz JE, Janiki DL, Schiffman S, Raynor DA. Correspondence between laboratory and ambulatory measures of cardiovascular reactivity: A multilevel modeling approach. Psychophysiology 2003; 40: 675-83.
James GD. Measuring changes in the cardiovascular system: Ambulatory blood pressure. In: Ice GH, James GD, Eds. Measuring stress in humans: A practical guide for the field. Cambridge: Cambridge University Press 2007; pp. 158-80.
Pickering TG, Gerin W. Cardiovascular reactivity in the laboratory and the role of behavioral factors in hypertension: A critical review. Ann Behav Med 1990; 12: 3-16.
Linden W, Gerin W, Davidson K. Cardiovascular reactivity: Status quo and a research agenda for the new millennium. Psychosom Med 2003; 65: 5-8.
Van Berge-Landry HM, Bovbjerg DH, James GD. The relationship between waking-sleep blood pressure and catecholamine changes in African American and European American women. Blood Pres Monit 208; 13: 257-62.
James GD. Climate-related morphological variation and physiological adaptations in Homo Sapiens. In: Larsen CS, Ed. A companion to biological anthropology. Malden, MA: Wiley-Blackwell 2010; pp. 153-66.
James GD, Baker PT. Human population biology and blood pressure: Evolutionary and ecological considerations and interpretations of population studies. In: Laragh JH, Brenner BM, Eds. Hypertension: Pathophysiology, diagnosis and management. New York: Raven Press, Ltd. 1995; pp. 115-26.
Hanna JM, Brown DA. Human heat tolerance: Biological and cultural adaptations. Yrbk Phys Anthropol 1979; 22: 163-86.
Young JH, Chang YC, Kim JD, et al. Differential susceptibility to hypertension is due to selection during the out-of-Africa expansion. PLoS Genet 2005; 1(6): e82.
Steegmann AG. Human adaptation to cold. In: Damon A, Ed. Physiological anthropology. New York: Oxford University Press 1975; pp. 130-66.
Beall CM, Jablonski NG, Steegmann AT. Human adaptation to climate: Temperature, ultraviolet radiation, and altitude. In: Stinson S, Bogin B, O’Rourke D, Eds. Human biology: An evolutionary and biocultural perspective. 2nd ed. New York: Wiley-Blackwell Publishing 2012; pp. 177-250.
Anderson NB, Lane LD, Muranaka M, Williams RB Jr, Houseworth SJ. Racial differences in blood pressure and forearm vascular responses to the cold face stimulus. Psychosom Med 1988; 50: 57-63.
Treiber FA, Musante L, Braden D, et al. Racial differences in hemodynamic responses to the cold face stimulus in children and adults. Psychosom Med 1990; 52: 286-96.
Kelsey RM, Alpert BS, Patterson SM, Barnard M. Racial differences in hemodynamic responses to environmental thermal stress among adolescents. Circulation 2000; 101: 2284-9.
Mills PJ, Dimsdale JE, Ziegler MG, Nelesen RA. Racial differences in epinephrine and beta 2-adrenergic receptors. Hypertension 1995; 25: 88-91.
Parati G, Ochoa JE, Bilo G. Moving beyond office blood pressure to achieve a personalized and more precise hypertension management. Which way to go? Hypertension 2017; 70: e20-31.
James GD, Moucha OP, Pickering TG. The normal hourly variation of blood pressure in women: average patterns and the effect of work stress. J Hum Hypertens 1991; 5: 505-9.

open access plus

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 28 May, 2019
Page: [93 - 104]
Pages: 12
DOI: 10.2174/1573402115666190301144316

Article Metrics

PDF: 56