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Blood Pressure Variability and Outcomes Across Antihypertensive Regimens.

Yue Qiao¹, Zihan Sun², Eric L Harshfield²

¹Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.Q., W.Z.).

Hypertension (Dallas, Tex. : 1979)

|June 25, 2026

Summary

Calcium channel blockers (CCBs) reduced blood pressure variability (BPV) more than other first-line antihypertensives in high-risk patients. However, this reduction in BPV did not translate to improved cardiovascular outcomes.

Keywords:

blood pressure calcium channel blockers cardiovascular diseases diuretics propensity score

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Area of Science:

Cardiology
Pharmacology
Clinical Trials

Background:

Blood pressure variability (BPV) is a significant cardiovascular risk factor, independent of mean blood pressure.
The differential impact of first-line antihypertensive regimens on BPV and cardiovascular outcomes remains unclear.

Purpose of the Study:

To compare the effects of renin-angiotensin system (RAS) inhibitors, calcium channel blockers (CCBs), and diuretics on BPV.
To assess whether these antihypertensive regimens influence major adverse cardiovascular events (MACE).

Main Methods:

Pooled individual participant data from ACCORD-BP and SPRINT trials were analyzed.
Propensity score matching was used to compare regimens (monotherapy and combination).
Visit-to-visit systolic BPV (variation independent of the mean) and MACE were the primary and secondary outcomes, respectively.

Main Results:

CCB-based regimens were associated with significantly lower systolic BPV compared to RAS inhibitor-based and diuretic-based regimens.
This effect was consistent for both monotherapy and combination therapies.
No significant differences in MACE were observed across the compared antihypertensive regimens.

Conclusions:

In high-risk hypertensive patients, CCB-based regimens effectively reduce systolic BPV compared to RAS inhibitor-based and diuretic-based regimens.
Despite reducing BPV, CCB-based regimens did not demonstrate a significant difference in cardiovascular outcomes compared to other regimens.