Blood pressure variability and cardiovascular risk

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4190 (Published 10 August 2016) Cite this as: BMJ 2016;354:i4190
  1. Jeff Whittle, staff physician and professor1 2
  1. 1Primary Care, Clement J Zablocki VA Medical Center, Milwaukee, WI, 53295, USA
  2. 2Department of Medicine, Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
  1. Jeffrey.whittle{at}va.gov

Would intensifying treatment for higher risk patients improve outcomes?

Although elevated mean blood pressure increases the risk of untoward vascular outcomes, that risk is markedly affected by a range of patient characteristics beyond mean blood pressure. In this issue, Stevens and colleagues (doi:10.1136/bmj.i4098) use meta-analysis to synthesise evidence on the affect of variability in blood pressure on this risk.1 They find consistent evidence that increased variability across clinic visits over months to years is associated with an increased cardiovascular risk. They convincingly exclude confounding by several other known risk factors, such as age, sex, mean blood pressure, and established cardiovascular disease.2 3 Although they found fewer studies of variability measured over shorter time frames, the evidence suggested a similar effect of variability measured over hours and weeks.

How should this new information affect clinical practice? Firstly, we should accept that variability in blood pressure across clinic visits does not tell us much about drug adherence. Previous research has shown that variation in adherence makes only a small contribution to variability in blood pressure.4 Furthermore, the study reminds us of …

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