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[Visit-to-visit variability: Prognostic significance?]

Camille Ly1, Davide Agnoletti, Michel Safar

  • 1AP-HP, hôpital Hôtel-Dieu, université Paris-Descartes, centre de diagnostic et de thérapeutique, unité hypertension artérielle, prévention et thérapeutique cardiovasculaire, 75004 Paris, France.

Presse Medicale (Paris, France : 1983)
|April 14, 2012
PubMed

Insights

High blood pressure variability, not just average levels, is linked to stroke risk. This suggests new treatment strategies and trial designs are needed to account for blood pressure fluctuations.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Clinical Hypertension Research

Context:

  • Hypertension is a primary treatable risk factor for stroke.
  • Current hypertension management relies on average blood pressure readings.
  • Elevated readings are often dismissed as white coat hypertension or measurement noise.

Purpose:

  • To challenge the traditional view of hypertension management.
  • To investigate the association between blood pressure variability and stroke risk.
  • To explore the implications of episodic hypertension in clinical practice.

Summary:

  • Post-hoc analyses of three randomized trials and one meta-analysis indicate that visit-to-visit systolic blood pressure variability, residual variability in treated patients, and episodic hypertension are strongly associated with stroke risk.
  • These findings suggest that blood pressure variability may be a significant, previously underestimated, factor in vascular risk.
  • While not proving causation, the association opens new avenues for clinical practice and research.

Impact:

  • Suggests a paradigm shift in hypertension management, moving beyond average blood pressure to consider variability.
  • Highlights the need to incorporate blood pressure variability and episodic hypertension into future clinical trials.
  • May lead to revised treatment strategies for hypertension to mitigate stroke risk more effectively.

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