Post-medication high blood pressure variability and beta blocker or thiazide use were associated with increased adverse event risk, but medication effects were largely independent of patient BPV.
Cohort (n=25,268)
Does treatment with calcium channel blockers compared to other antihypertensives reduce long-term adverse outcomes associated with blood pressure variability in US veterans?
While calcium channel blockers may ameliorate blood pressure variability over time, this study does not support choosing them over other antihypertensive agents specifically to lessen blood pressure variability-associated risk.
BACKGROUND: Blood pressure variability (BPV) is associated with adverse events (AEs) independently of hypertension. It has been suggested that calcium channel blockers (CCBs) may reduce BPV, and thus be particularly valuable in hypertensives with high BPV. We sought to investigate how CCB affect BPV progression and whether long-term adverse effects of BPV differ after CCB treatment than after treatment with other antihypertensives. METHODS: We retrospectively analyzed 25,268 US veterans who had been followed for 3 years without hypertensive therapy, started on a single class of antihypertensive agents (thiazides, CCBs, ACE inhibitors, or beta blockers BBs), treated for 6 years, and then followed for 3 additional years. BPV was calculated as SD of systolic or diastolic blood pressures from at least 10 measurements over each 3-year period. A combined AE endpoint included hospitalization, coronary artery bypass grafting, carotid endarterectomy, angioplasty, amputation, arteriovenous fistula creation, and mortality was assessed in years 9-12. RESULTS: Post-medication high BPV and BB or thiazide use were associated with increased AE risk. Medication type also affected mean post-medication BPV. The effects of medications except for BBs on AE and mortality was independent of the patient BPV. CONCLUSIONS: The possible deleterious effects of thiazides should be considered within the context of the study population, who were mostly male and received only a single class of hypertensives. While CCB may ameliorate BPV over time, this study does not support choosing CCB over other agents specifically to lessen BPV-associated risk.
Basson et al. (Tue,) conducted a cohort in Hypertension (n=25,268). Calcium channel blockers (CCBs) vs. Thiazides, ACE inhibitors, or beta blockers was evaluated on Combined adverse event endpoint including hospitalization, coronary artery bypass grafting, carotid endarterectomy, angioplasty, amputation, arteriovenous fistula creation, and mortality. Post-medication high blood pressure variability and beta blocker or thiazide use were associated with increased adverse event risk, but medication effects were largely independent of patient BPV.