Key result
Antihypertensive drug classes (calcium channel blockers, ACE inhibitors, and ARBs) had no significant differential impact on changes in home blood pressure variability (P≥0.054).
Why the study?
Does antihypertensive drug class affect day-to-day variability of self-measured home blood pressure in newly treated hypertensive patients?
RCT (n=2,484)
randomly allocated
Does antihypertensive drug class affect day-to-day variability of self-measured home blood pressure in newly treated hypertensive patients?
p-value: p=≥0.054
Antihypertensive drug classes do not differentially affect home blood pressure variability, reinforcing that absolute blood pressure levels should remain the primary focus for risk stratification and treatment.
No antihypertensive class differentially affects home BP variability; confirms absolute BP reduction as the primary focus for clinicians and researchers.
BACKGROUND: Recent literature suggests that blood pressure variability (BPV) predicts outcome beyond blood pressure level (BPL) and that antihypertensive drug classes differentially influence BPV. We compared calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockade for effects on changes in self-measured home BPL and BPV and for their prognostic significance in newly treated hypertensive patients. METHODS AND RESULTS: We enrolled 2484 patients randomly allocated to first-line treatment with a calcium channel blocker (n=833), an angiotensin-converting enzyme inhibitor (n=821), or angiotensin receptor blockade (n=830). Home blood pressures in the morning and evening were measured for 5 days off treatment before randomization and for 5 days after 2 to 4 weeks of randomized drug treatment. We assessed BPL and BPV changes as estimated by variability independent of the mean and compared cardiovascular outcomes. Home BPL response in each group was significant (P≤0.0001) but small in the angiotensin-converting enzyme inhibitor group (systolic/diastolic: 4.6/2.8 mm Hg) compared with the groups treated with a calcium channel blocker (systolic/diastolic: 8.3/3.9 mm Hg) and angiotensin receptor blockade (systolic/diastolic: 8.2/4.5 mm Hg). In multivariable adjusted analyses, changes in home variability independent of the mean did not differ among the 3 drug classes (P≥0.054). Evening variability independent of the mean before treatment significantly predicted hard cardiovascular events independent of the corresponding home BPL (P≤0.022), whereas BPV did not predict any cardiovascular outcome based on the morning measurement (P≥0.056). Home BPV captured after monotherapy had no predictive power for cardiovascular outcome (P≥0.22). CONCLUSIONS: Self-measured home evening BPV estimated by variability independent of the mean had prognostic significance, whereas antihypertensive drug classes had no significant impact on BPV changes. Home BPL should remain the primary focus for risk stratification and treatment. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000137.
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Asayama et al. (2016) conducted an RCT in hypertension (n=2,484). Calcium channel blocker, ACE inhibitor, or angiotensin receptor blocker vs. Active comparators (3-arm trial) was evaluated on changes in home blood pressure variability independent of the mean (p=≥0.054). Antihypertensive drug classes (calcium channel blockers, ACE inhibitors, and ARBs) had no significant differential impact on changes in home blood pressure variability (P≥0.054).
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