Key result
Initiating antihypertensive treatment in autumn/winter compared to spring/summer was associated with a lower clinic blood pressure control rate at 8 weeks (52.5% vs 74.9%, P<0.001).
Why the study?
To investigate seasonal variation in ambulatory blood pressure control in hypertensive patients undergoing clinic blood pressure-guided antihypertensive treatment.
Does the season of treatment initiation (autumn/winter vs. spring/summer) affect ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided therapy?
Cohort (n=501)
Does the season of treatment initiation (autumn/winter vs. spring/summer) affect ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided therapy?
Absolute Event Rate: 52.5% vs 74.9%
p-value: p=< 0.001
Clinic blood pressure-guided antihypertensive treatment requires higher medication dosages in cold seasons, which may lead to over-treatment of nighttime blood pressure in winter and under-treatment in summer.
May warrant seasonal dosing caution with clinic BP-guided therapy; leaves open ambulatory BP effects and need for prospective confirmation.
BACKGROUND: We investigated seasonal variation in ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided antihypertensive treatment. METHODS: The study participants were hypertensive patients enrolled in an 8-week therapeutic study. Antihypertensive treatment was initiated with long-acting dihydropyridine calcium channel blockers amlodipine 5 mg/day or the gastrointestinal therapeutic system (GITS) formulation of nifedipine 30 mg/day, with the possible up-titration to amlodipine 10 mg/day or nifedipine-GITS 60 mg/day at 4 weeks of follow-up. RESULTS: The proportion of up-titration to higher dosages of antihypertensive drugs at 4 weeks of follow-up was higher in patients who commenced treatment in autumn/winter ( n = 302) than those who commenced treatment in spring/summer ( n = 199, 24.5 vs. 12.0%, P < 0.001). The control rate of clinic blood pressure, however, was lower in autumn/winter than in spring/summer at 4 (56.7 vs. 70.7%, P = 0.003) and 8 weeks of follow-up (52.5 vs. 74.9%, P < 0.001). At 8 weeks, patients who commenced treatment in autumn/winter, compared with those who commenced treatment in spring/summer, had a significantly ( P ≤0.03) smaller daytime (mean between-season difference -3.2/-2.8 mmHg) but greater nighttime SBP/DBP reduction (3.6/1.6 mmHg). Accordingly, at 8 weeks, the prevalence of nondippers was significantly ( P < 0.001) higher in spring/summer than in autumn/winter for both SBP (54.8 vs. 30.0%) and DBP (53.4 vs. 28.8%). CONCLUSION: Clinic blood pressure-guided antihypertensive treatment requires a higher dosage of medication in cold than warm seasons, which may have led to over- and under-treatment of nighttime blood pressure, respectively.
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Ye et al. (2024) conducted a cohort in Hypertension (n=501). Treatment initiation in autumn/winter vs. Treatment initiation in spring/summer was evaluated on Control rate of clinic blood pressure at 8 weeks (p=< 0.001). Initiating antihypertensive treatment in autumn/winter compared to spring/summer was associated with a lower clinic blood pressure control rate at 8 weeks (52.5% vs 74.9%, P<0.001).
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