Winter-induced BP spikes coincide with faltering control in aggressively treated patients
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Key takeaways:
- Despite intensive BP lowering, patients with hypertension experienced significant increases in BP during winter.
- Rates of BP control were higher during summer months.
Winter-induced elevations in BP were persistent among patients with hypertension despite treatment with up to three classes of antihypertensive medications, with an approximately 7% drop in BP control, researchers reported.
A secondary analysis of the ACCOMPLISH trial to assess seasonal changes in BP among hypertensive patients was published in the Journal of the American Heart Association.
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“It is well established that blood pressure (BP) levels increase during winter (5.6/3.3 mm Hg higher than summer),” Robert D. Brook, MD, FAHA, FNLA, FSVM, professor and director of cardiovascular disease prevention at Wayne State University, and colleagues wrote. “Nonetheless, a number of issues require clarification to better inform clinical practice including if treatment aspects (eg, number of drugs, tighter BP control, specific regimens) or patient characteristics modify winter-induced BP elevations.”
To this end, Brook and colleagues utilized data from the ACCOMPLISH trial to evaluate the effect of winter-induced BP elevations — defined as change in BP from December to February compared with June to August — on BP level and rate of control. Control was defined as BP less than 140/90 mm Hg.
ACCOMPLISH was a randomized, double-blind trial for which researchers compared the primary endpoint of first CV event or CV death among patients with hypertension assigned to the ACE inhibitor benazepril plus the calcium channel blocker amlodipine or benazepril plus the thiazide-type diuretic hydrochlorothiazide.
The present study included 8,150 ACCOMPLISH participants from 400 sites across the U.S.
Each participant had in-office BP measurements taken at 1, 2, 3, 6 and 12 months and every 6 months thereafter, resulting in 79,082 BP readings for the present analysis.
On average, participants were taking 3.3 antihypertensive medications, with 77.1% being prescribed additional drugs beyond benazepril plus amlodipine or benazepril plus hydrochlorothiazide.
Between months 6 and 42, the average BP was 129.7/72.3 mm Hg and 88.7% of participants achieved BP control.
After adjusting for multiple testing, the researchers observed that both systolic and diastolic BP were significantly higher during all other months compared with July (P < .0001). The differences in average BP during July compared with June and August were not significant.
Rates of BP control were also lower during all other months compared with July, except for August.
Moreover, systolic BP levels were on average 2.6 mm Hg higher during December and control rates were 7.2% lower.
The researchers observed no significant effect by age, sex, race, BMI, treatment intensity, drug regimen or achieved systolic BP on winter-induced BP elevation.
“We show for the first time that the BP-raising effects of winter persist among rigorously treated patients in a clinical trial. There was no evidence that the magnitude of winter-induced BP elevations differs by personal characteristics. This suggests that most patients may be at risk,” the researchers wrote. “Even tight systolic BP control to < 130 mm Hg (current goal) failed to protect patients. ... It has been suggested that scrupulous BP monitoring and up-titration of drug therapy during winter may be a rational management strategy. Our results support this recommendation.”
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