Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Episodic hypertension and stroke risk

The Lancet has published the results of an analysis that has identified a correlation between stroke risk and variability or maximal in systolic blood pressure (SBP). This study has been reported in the general media (BBC).

The study noted that guidelines for the treatment and diagnosis of hypertension focus upon assessment of blood pressure over a time period, essentially providing an average over the time the readings are taken. This study aimed to assess stroke risk in comparison to visit-to-visit variability in SBP (expressed in standard deviations) or maximum SBP using data from the UK-TIA and ASCOT-BPLA studies.

The analysis founds that mean SBP, variability in SBP (as standard deviation, coefficient of variation and variation independent of the mean) all positively correlated with stroke risk. The correlations in variability remained after correction for mean SBP.

Additionally, it was noted that the association was strong individuals in the top decile of variability and this association grew stronger after correction for mean SBP, age, sex and other risk factors (Hazard Ratio [HR] 12.08, 95% CI 7.40-19.72, p<0.0001). Maximum SBP was also strongly correlated after correction for mean SBP (HR 15.01, 95% CI 6.56-34.38, p<0.0001).

The authors note that their findings do not prove causality and recommend that consideration be given to how visit-to-visit strong>variability in blood pressure might be integrated into clinical practice. Attention is also drawn to the "false reassurance of a few normal blood-pressure readings ".

Action: Clinicians should be aware of this study. While clinical guidelines are reviewed perhaps it would be prudent to give a little more weight to one-off high blood pressure readings.

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3 Comments to “Episodic hypertension and stroke risk”

  1. Helpful stuff. Blood pressure and hypertension have been interests of mine for a long time, and I think that a balanced holistic approach is overall the most promising. You have to eat healthy, exercise, and regularly watch your blood pressure and cholesterol levels, and then things should be not too hard. We have lots of info on all that on our site, everyone interested is welcome to take a look.

    Comment by Fern Rice — August 19, 2010 #
    Reply

  2. [...] first section discusses the results of a recent study published in the Lancet that identified variability in systolic blood pressure as an independent [...]

    Pingback by Prescribing Advice For GPs » MeReC Extra 45 — May 20, 2010 #
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  3. I doubt 24hours reading give a true insight of a patient's BP state. Scanning thrugh BP readings I could detect quite a number of false negative readings when it was expected to be high. Also there is a variability of clinic bp reading and amnulatory reading.

    Comment by Sikdar — March 30, 2010 #
    Reply

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