Visit-to-Visit Blood Pressure Variability, Carotid Atherosclerosis and Cardiovascular Events in the European Lacidipine Study on Atherosclerosis
Background—In high cardiovascular risk treated hypertensive patients the incidence of cardiovascular events has been reported to relate to visit-to-visit blood pressure (BP) variability. We investigated whether visit-to-visit BP variability is prognostically important in mild-to-moderate treated hypertensives in whom treatment aims at avoiding events but also at preventing or delaying progression of organ damage.
Methods and Results—We analysed the pooled data from the European Lacidipine study on atherosclerosis (ELSA), a randomized, double blind 4 year trial on the effect of lacidipine or atenolol on echographic carotid intima-media thickness (IMT). Visit-to-visit BP variability was assessed by the coefficient of variation (CV) or the standard deviation (SD) of the mean on-treatment systolic (S) BP obtained respectively at 6 (clinic BP) and 12 (24h BP) months intervals (1521 and 1264 patients, respectively). In a multivariable linear regression model mean on-treatment clinic or 24-h SBP, but not SBP CV or SD, were associated with end-of-treatment carotid IMT. IMT increased progressively from lowest to highest quartile of mean on-treatment clinic or 24-h SBP (adjusted P for trend 0.046 and 0.048), but not along similar quartiles of SBP CV or SD. In a multivariable logistic regression model also mean BP but not variability was associated with cardiovascular outcomes.
Conclusions—In the mild-to-moderate hypertensive patients carotid IMT and cardiovascular outcomes were related to the mean clinic or ambulatory SBP achieved by treatment but not to on-treatment visit-to-visit clinic or 24-h BP variability. Thus when BP is modestly elevated, inconsistency of BP control between visits plays a less important prognostic role than long-term average BP levels.
- Received March 26, 2012.
- Accepted May 29, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited