Key result
Calcium channel blockers or diuretics reduced day-to-day home systolic blood pressure variability by 4.0% compared to a 7.8% increase with RAS inhibitors after TIA or minor stroke.
Why the study?
Do calcium channel blockers and diuretics reduce day-to-day home systolic blood pressure variability compared to renin-angiotensin system inhibitors in patients with recent TIA or minor stroke?
Observational (n=500)
Do calcium channel blockers and diuretics reduce day-to-day home systolic blood pressure variability compared to renin-angiotensin system inhibitors in patients with recent TIA or minor stroke?
Absolute Event Rate: -4% vs 7.8%
p-value: p=0.015
In patients with recent TIA or minor stroke, calcium channel blockers and diuretics effectively reduce day-to-day home systolic blood pressure variability and maximum SBP, particularly in the morning, compared to RAS inhibitors.
May support preferring CCBs or diuretics over RAS inhibitors post-TIA; leaves open outcome impact pending RCTs.
BACKGROUND AND PURPOSE: Visit-to-visit variability in systolic blood pressure (SBP) is associated with an increased risk of stroke and was reduced in randomized trials by calcium channel blockers and diuretics but not by renin-angiotensin system inhibitors. However, time of day effects could not be determined. Day-to-day variability on home BP readings predicts stroke risk and potentially offers a practical method of monitoring response to variability-directed treatment. METHODS: SBP mean, maximum, and variability (coefficient of variation=SD/mean) were determined in 500 consecutive transient ischemic attack or minor stroke patients on 1-month home BP monitoring (3 BPs, 3× daily). Hypertension was treated to a standard protocol. Differences in SBP variability from 3 to 10 days before to 8 to 15 days after starting or increasing calcium channel blockers/diuretics versus renin-angiotensin system inhibitors versus both were compared by general linear models, adjusted for risk factors and baseline BP. RESULTS: Among 288 eligible interventions, variability in SBP was reduced after increased treatment with calcium channel blockers/diuretics versus both versus renin-angiotensin system inhibitors (-4.0 versus 6.9 versus 7.8%; P=0.015), primarily because of effects on maximum SBP (-4.6 versus -1.0 versus -1.0%; P=0.001), with no differences in effect on mean SBP. Class differences were greatest for early-morning SBP variability (3.6 versus 17.0 versus 38.3; P=0.002) and maximum (-4.8 versus -2.0 versus -0.7; P=0.001), with no effect on midmorning (P=0.29), evening (P=0.65), or diurnal variability (P=0.92). CONCLUSIONS: After transient ischemic attack or minor stroke, calcium channel blockers and diuretics reduced variability and maximum home SBP, primarily because of effects on morning readings. Home BP readings enable monitoring of response to SBP variability-directed treatment in patients with recent cerebrovascular events.
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Webb et al. (2014) conducted an observational in TIA or minor stroke (n=500). Calcium channel blockers and/or diuretics vs. Renin-angiotensin system inhibitors (RASi) was evaluated on Change in day-to-day systolic blood pressure variability (p=0.015). Calcium channel blockers or diuretics reduced day-to-day home systolic blood pressure variability by 4.0% compared to a 7.8% increase with RAS inhibitors after TIA or minor stroke.
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