Fluctuation: Does Blood Pressure Variability Matter?
Effective drug treatment of hypertension for prevention of fatal and non-fatal cardiovascular disease passed its 50th anniversary two years ago1. Until recently, the most consistent observation among trials had been that stroke risk was directly related to the fall in blood pressure on treatment2. Older trials established the value of anti-hypertensive drug treatment (AHT) and generally recruited disease free participants at their outset. Recent trials have focused on less healthy participants. Recruitment has been extended to those with a prior stroke, recent myocardial infarction, coronary artery disease, chronic renal disease (with or without diabetes), heart failure, combined high-risk states and the elderly (old-old). The benefit of AHT is still related to the reduction in blood pressure3. Differences between drug classes for have been found in some, but not all trials; the differences are generally small, even if statistically significant. AHT is effective in reducing risk for those with a higher disease burden, but risk is never lowered to levels equal to those who have lower pressure without AHT and lack prior cardiovascular disease. The hands of the cardiovascular clock may slow, but never stop or reverse. It is a challenge to unmask traits that might account for the limited effectiveness of AHT in its present form.(SELECT FULL TEXT TO CONTINUE)
- Received June 14, 2012.
- Accepted June 19, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited