Variability in blood pressure and arterial hypertension

Česká verzia

Authors: J. Widimský jr.
Authors place of work: Centrum pro hypertenzi III. interní kliniky 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in the journal: Vnitř Lék 2011; 57(3): 320-324
Category: 60th birthday of prof. Mudr. Jiřího Vítovce, CSc, FESC

Summary

Blood pressure variability in hypertension is an independent risk factor of cardiovascular complications, especially of stroke. Antihypertensive drugs/classes with powerful antihypertensive effect and suppression of blood pressure variability might have additional impact on the cardiovascular risk in clinical practice. Current evidence suggests that calcium channel blockers (CCB) decrease blood pressure variability more than all other antihypertensive classes. Combination of CCB with ACE-inhibitors suppresses blood pressure variability more than diuretics plus beta-blockers. Within-visit blood pressure variability (measured as coeficient of standard deviation) seems to be relatively simple and strong predictor of stroke and cardiovascular events.

Key words:
arterial hypertension – blood pressure variability – stroke

Zdroje

1. Widimský jr J, Cífková R, Špinar J et al. Doporučení diagnostických a léčebných postupů u arteriální hypertenze – verze 2007. Doporučení České společnosti pro hypertenzi. Cor Vasa 2008; 50: K5–K22.

2. Mancia G, De Backer G, Dominiczak A et al. Management of Arterial Hypertension of the European Society of Hypertension. European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Guidelines Committee. J Hypertens 2007; 25: 1105–1187.

3. Lawes CMM, Vander Hoorn S, Rodgers A. International Society of Hypertension. Global burden of blood pressure-related disease, 2001. Lancet 2008; 371: 1513–1518.

4. Verdecchia P, Gentile G, Angeli F et al. Influence of blood pressure reduction on composite cardiovascular endpoints in clinical trials. J Hypertens 2010; 28: 1356–1365.

5. Dahlöf B, Sever PS, Poulter NE et al. ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366: 895–906.

6. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.

7. Kaplan NM. Kaplan’s Clinical Hypertension. 9th ed. Lippincott Williams & Wilkins 2006: 1–518.

8. Parati G, Di Rienzo M, Ulian L et al. Clinical relevance of blood pressure variability. J Hypertens 1998; 16 (Suppl): S25–S33.

9. Muntner P, Shimbo D, Tonelli M et al. The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population: Findings From NHANES III, 1988 to 1994. Hypertension 2011; 57: 160–166.

10. Cahan A, Ben-Dov IZ, Mekler J et al. The role of blood pressure variability in misdiagnosed clinic hypertension. Hypertens Res 2011; 34: 187–192.

11. Rothwell PM, Howard SC, Dolan E et al. ASCOT-BPLA and MRC Trial Investigators. Effect of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol 2010; 9: 469–480.

12. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992; 304: 405–412.

13. Webb AJ, Fischer U, Mehta Z et al. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet 2010; 375: 906–915.

14. Jamerson K, Weber MA, Bakris GL et al. ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417–2428.

15. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895-905.