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Published on: September 26, 2018
Long-term blood pressure variability: an emerging cardiovascular risk factor
Allis Lai1, Lawrence Lam1, Akshita Raminemi1
1Medical Student.
Insights
High systolic blood pressure variability predicts cardiovascular events, even with controlled blood pressure. Certain medications like amlodipine and thiazide diuretics can effectively reduce this variability.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- Long-term systolic blood pressure variability (SBPV) is a significant predictor of cardiovascular outcomes.
- High SBPV increases cardiovascular risk, even in patients with well-controlled blood pressure (<140/90 mmHg).
Purpose of the Study:
- To highlight the prognostic significance of systolic blood pressure variability.
- To discuss methods of measuring SBPV and potential alternatives.
- To identify antihypertensive medications that effectively reduce SBPV.
Main Methods:
- Analysis of data from clinical trials and observational studies.
- Derivation of SBPV using standard deviation of visit-to-visit clinic blood pressure measurements.
- Review of evidence on antihypertensive drug effects on SBPV.
Main Results:
- SBPV is an independent predictor of cardiovascular outcomes, irrespective of average systolic pressure levels.
- Values exceeding 12 for SBPV indicate high risk.
- Ongoing research is exploring home blood pressure monitoring for SBPV assessment.
Conclusions:
- Long-acting calcium-channel blockers (e.g., amlodipine) and thiazide-like diuretics are the primary antihypertensive drug classes shown to reduce long-term SBPV.
- These medications should be prioritized for patients exhibiting high SBPV.
Abstract:
Clinical trials and observational studies have demonstrated that long-term systolic blood pressure variability derived from repeated measurements of visit-to-visit clinic blood pressure is an important predictor of cardiovascular outcomes, independent of average levels of systolic pressure. Even in patients with well-controlled blood pressure (<140/90 mmHg), high systolic blood pressure variability confers an increased risk of cardiovascular events. Systolic blood pressure variability is currently derived from several measurements of visit-to-visit clinic blood pressure and expressed as the standard deviation of systolic pressure. Values in excess of 12 are indicative of high systolic blood pressure variability. Ongoing studies aim to determine whether home blood pressure monitoring may be an alternative way of measuring blood pressure variability. Evidence from several clinical trials shows that long-acting calcium-channel blockers, such as amlodipine, and thiazide-like diuretics are the only antihypertensive drugs that reduce longterm systolic blood pressure variability, and should be used preferentially in patients with high variability.
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