Response of day-to-day home blood pressure variability by antihypertensive drug class after transient ischemic attack or nondisabling stroke.
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...
| Publicado en: | Stroke (00392499) Vol. 45; no. 10; pp. 2967 - 2974 |
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| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Oct2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107802120&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107802120 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00392499 1FT jtl: Stroke (00392499) issn: 00392499 maglogo: N pubinfo: dt: Oct2014 vid: 45 iid: 10 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 107802120 107802120 NLM25147330 2012742065 10.1161/STROKEAHA.114.005982 NLM25147330 107802120 ppf: 2967 ppct: 7 formats: tig: atl: Response of day-to-day home blood pressure variability by antihypertensive drug class after transient ischemic attack or nondisabling stroke. aug: au: Webb, Alastair J S Wilson, Michelle Lovett, Nicola Paul, Nicola Fischer, Urs Rothwell, Peter M affil: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom. sug: subj: Antihypertensive Agents Therapeutic Use Blood Pressure Drug Effects Blood Pressure Monitoring, Ambulatory Methods Calcium Channel Blockers Therapeutic Use Cerebral Ischemia, Transient Prevention and Control Stroke Prevention and Control Aged Diuretics Therapeutic Use Female Male Middle Age Time Factors Funding Source Human Aged: 65+ years Middle Aged: 45-64 years Female Male ab: 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. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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