CCB-based regimens were associated with significantly lower visit-to-visit systolic blood pressure variability compared with RAS inhibitors (β=-1.341; 95% CI -1.930 to -0.752; P<0.001).
Cohort (n=5,779)
Yes
Do CCB-based regimens reduce visit-to-visit systolic blood pressure variability compared to RAS inhibitor-based or diuretic-based regimens in high-risk hypertensive patients?
CCB-based regimens lower visit-to-visit systolic blood pressure variability more than RAS inhibitors or diuretics, but this reduction does not translate to a detectable difference in cardiovascular outcomes.
Mean Difference: -1.341 (95% CI -1.93–-0.752)
p-value: p=<0.001
Background: Blood pressure variability (BPV) is associated with cardiovascular risk beyond mean blood pressure (BP). Whether first-line antihypertensive regimens differentially affect BPV and cardiovascular outcomes remains uncertain. Methods: We conducted a target trial emulation using pooled individual participant data from two randomised trials: ACCORD-BP and SPRINT. Propensity score matching was used for pairwise comparisons of renin–angiotensin system (RAS) inhibitors, calcium channel blockers (CCBs), and diuretics, as monotherapy or in combination. Follow-up was initiated at a predefined baseline medication assessment. The primary outcome was visit-to-visit systolic BPV, assessed using variation independent of the mean (VIM). Secondary outcomes included major adverse cardiovascular events (MACE) and its individual components. Results: The final cohort included 5,779 participants (median of 12 BP measurements and median follow-up of 3.5 years), among whom 2,754 were included in the matched analysis. CCB-based regimens were consistently associated with significantly lower systolic BPV compared with both RAS inhibitor-based and diuretic-based regimens. This association was consistent across monotherapy (CCB vs RAS: β=-1.341, 95% CI -1.930 to -0.752, P<0.001) and combination therapies (CCB+diuretic vs RAS+diuretic: β=-1.299, 95% CI -1.852 to -0.747, P<0.001). In contrast, RAS inhibitor–based and diuretic-based regimens demonstrated comparable BPV profiles. 215 (3.7%) MACE events were observed in the overall cohort. No significant differences in MACE or individual components were observed across comparisons. Conclusions: Among high-risk hypertensive patients receiving target-driven BP management, CCB-based regimens were associated with lower visit-to-visit systolic BPV compared with RAS inhibitor–based and diuretic-based regimens. However, these differences were not accompanied by detectable differences in cardiovascular outcomes.
Qiao et al. (Tue,) conducted a cohort in Hypertension (n=5,779). Calcium channel blockers (CCBs) vs. Renin-angiotensin system (RAS) inhibitors and diuretics was evaluated on Visit-to-visit systolic BPV, assessed using variation independent of the mean (VIM) (β -1.341, 95% CI -1.930 to -0.752, p=<0.001). CCB-based regimens were associated with significantly lower visit-to-visit systolic blood pressure variability compared with RAS inhibitors (β=-1.341; 95% CI -1.930 to -0.752; P<0.001).