MAIN RESULTS:

1. High visit-to-visit blood pressure variability can be important for cardiovascular risk.

2. Hypertensive patients who develop atrial fibrillation have larger visit-to-visit blood pressure variability.
3. Different antihypertensive drugs might have different clinical effect based on how they affect mean blood pressure and blood pressure variability.

THESIS DEFENCE:

Thesis: Systolic blood pressure variability and risk of cardiovascular events and death in hypertensive patients treated with angiotensin receptor blockers or calcium channel blockers
Candidate: Maria Hollund Mehlum
Time: March 2, 2020 at 13:15
Place: Oslo University Hospital Ullevål, Laboratoriebygget (Building 25): Red Auditorium
Link to university website

SUMMARY:

(1/2) Patients on antihypertensives are at increased risk of cardiovascular events and early death if they have large systolic blood pressure variability from one hospital visit to the next. Every 5 mmHg increase in standard deviation of systolic blood pressure was associated with 10% increased risk of death during follow-up. The increased risk was independent of mean blood pressure, and the association was strongest in younger patients and patients with lower mean systolic blood pressure.

The study uses data from the multinational Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial including 13,803 patients treated for high blood pressure and at increased cardiovascular risk. The median follow-up period was 4.2 years, and every patient included had at least three blood pressure measurements during this period. 1089 patients died and 1557 had a cardiovascular event during follow-up.

(3) Patients who developed atrial fibrillation during the course of the VALUE trial had higher blood pressure variability than patients without fibrillation. On the other hand, atrial fibrillation at baseline was not associated with blood pressure variability. 13,827 patients were included in this analysis.

(4) Valsartan and amlidopine influence mean blood pressure and blood pressure variability differently. These different effects are associated with differences in risk of myocardial infarction and stroke between the two drugs. The risk of heart failure was lower in patients on valsartan compared to patients on amlodipine.

REFERENCES:

(1) Mehlum, M. H., Liestøl, K., Kjeldsen, S. E., Julius, S., Hua, T. A., Rothwell, P. M., Mancia, G., Parati, G., Weber, M. A., & Berge, E. (2018). Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. European heart journal, 39(24), 2243-2251.

(2) Mehlum, M. H., Liestøl, K., Kjeldsen, S. E., & Berge, E. (2018). Response to letters from Torp-Pedersen and colleagues and de Courson and colleagues. European heart journal.

(3) Mehlum, M. H., Liestøl, K., Wyller, T. B., Hua, T. A., Rostrup, M., & Berge, E. (2019). Blood pressure variability in hypertensive patients with atrial fibrillation in the VALUE trial. Blood pressure, 28(2), 77-83.