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Hypothesis Links Blood Pressure Variability to Stroke Risk in Hypertension

Stroke risks in hypertension seem more related to the variability of a patient's systolic pressure than to mean pressure, according to studies in the Lancet and Lancet Neurology.

One study, examining stroke risk in cohorts comprising some 25,000 hypertensives, found heightened risk in those with greater visit-to-visit variability in systolic pressure. Patients on the calcium-channel blocker amlodipine showed less pressure variability (and lower stroke risk) than those on the beta-blocker atenolol.

Another study examined risk in relation to pressure variability among patients who had a previous transient ischemic attack. It found variability and maximum systolic pressure to be strong predictors of risk.

A meta-analysis of drug-class effects found lower variability with calcium-channel blockers and non-loop diuretics, and increased variability with ACE inhibitors, angiotensin-receptor blockers, and beta blockers.

A Lancet Neurology commentator calls the results "compelling," and says they "might set the foundation for a major change in our practice."

LINK(S):

Lancet Neurology article (Free abstract; full text requires subscription)

Lancet cohort study (Free abstract; full text requires subscription)

Lancet meta-analysis (Free abstract; full text requires subscription)

Lancet review (Free abstract; full text requires subscription)

Lancet Neurology comment (Subscription required)

Lancet comment (Subscription required)

Published in Physician's First Watch March 12, 2010