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Systolic blood pressure variability is a strong predictor of stroke
The mechanisms by which raised blood pressure causes stroke and other vascular events are poorly understood. Although substantial variability in clinical blood pressure is often noted, episodic hypertension tends not to be treated. The prognostic value of visit-to-visit variability and episodic hypertension in the same setting has not been established. Therefore, in this study the risk of stroke in relation to visit-to-visit variability in blood pressure and maximum blood pressure was studied in patients who were participants in the UK-TIA (transient ischaemic attack) study and the Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA).
In patients in the UK-TIA study visit-to-visit variability in blood pressure was a strong predictor of subsequent stroke (HR 6.22 in the top variability decile over seven visits, p<0.0001). This effect was found to be independent of mean blood pressure, but dependent on the precision of measurement, and maximum blood pressure recorded at any stage was also found to be a strong predictor of stroke after adjustment for mean systolic blood pressure(HR 15.01 for top decile over seven visits, p<0.0001). In ASCOT-BPLA, residual visit-to-visit variability in systolic blood pressure on treatment was also found to be a strong predictor of both stroke and coronary events, independent of mean systolic blood pressure in the clinic or on ambulatory blood pressure monitoring (figure 1).