Visit to visit Systolic BP variability may help predict cardiovascular outcomes

A recent study published in the European Heart Journal highlights the critical role of visit-to-visit systolic blood pressure variability (BPV) as a predictor of cardiovascular (CV) outcomes. This study was conducted as an extension of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm (ASCOT-BPLA) in the UK, which spanned over two decades to evaluate the long-term impact of blood pressure (BP) control and variability.

The findings suggest that BPV significantly influences CV events, independent of mean systolic blood pressure (SBP) and emphasizes its importance even in individuals with well-controlled BP. The study closely followed 8,580 hypertensive participants that underscore the necessity of addressing BP variability along with mean SBP for effective cardiovascular risk management.

During the follow-up period of 21 years, the participants on amlodipine-based treatment expressed a reduced risk of stroke, total CV events, total coronary events and atrial fibrillation when compared to those on atenolol-based treatment. The outcomes of this study challenge the previous assumptions about the primary determinants of CV risk by highlighting the significance of considering BPV as the factor to assess cardiovascular health. The results suggest that interventions that target BPV may offer substantial benefits in reducing the incidence of CV events in strokes and atrial fibrillation.

This research underlines the need for personalized treatment strategies that not only focus on achieving target SBP levels but also address BPV to optimize cardiovascular outcomes. This finds significant implications for clinical practice that help emphasizing the importance of comprehensive BP management in reducing the burden of cardiovascular disease.

Reference:

Gupta, A., Whiteley, W. N., Godec, T., Rostamian, S., Ariti, C., Mackay, J., Whitehouse, A., Janani, L., Poulter, N. R., Sever, P. S., Aldegather, J., Collier, D., Delles, C., Dyker, A., Eaton, M., Heller, S., Hildick-Smith, D., Kristinsson, A., … Lip, G. (2024). Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial. In European Heart Journal. Oxford University Press (OUP). https://doi.org/10.1093/eurheartj/ehad814