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ASCOT-BPLA: BP variability more dangerous than high BP
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American College of Cardiology 59th Annual Scientific Sessions
ATLANTA – Patients with BP variability may be at higher risk than those with high BP and less variability, according to new study results.
"These findings have major clinical implications for the management of patients with high BP," Peter Sever, MD, professor of clinical pharmacology and therapeutics and co-director of the International Centre for Circulatory Health at Imperial College in London, said during a presentation here on Sunday.
Researchers for ASCOT-BPLA randomly assigned 19,257 patients with hypertension to either amlodipine/perindopril, or atenolol/bendroflumethiazide treatments, with a follow up of 5.5 years.
According to the results, standard deviations in systolic BP were significant predictors of adverse reactions such as stroke and coronary events. Age, sex and mean systolic BP were adjusted for, yielding a hazard ratio of 4.06 (95% CI, 2.17-7.60) for stroke in the top decile of between-visit SD in the atenolol group and 3.80 (95% CI, 1.67-8.65) in the amlodipine group. A HR of 1.99 (95% CI, 1.25-3.18) was reported for coronary events in the atenolol group vs. 2.85 (95% CI, 1.56-5.21) in the amlodipine group. The between-visit standard variation was higher in the atenolol group (13.42) compared with amlodipine group (10.99; P<.0001).
The reduction in risk for stroke (HR=0.78; amlodipine, 0.67; atenolol, 0.90) and coronary events (HR=0.85; amlodipine, 0.77; atenolol, 0.94) was eliminated after researchers adjusted for within-visit and between-visit variability.
“[Past studies] have shown that for almost all beta blockers there is an increase in BP variability, and across all of the classes of drugs there is a constant finding that calcium antagonists are associated with less variability”, Sever said. “What that means in terms of clinic practice it is probably too early to say, but one of the take-home messages is that if you are on treatment, you are better off with a higher pressure and less variability, than a lower pressure and more variability — and that is worrying.” – by Matthew Brannon
For more information:
- Sever PS. ACC/i2 Featured Clinical Research. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
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