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Visit-to-visit blood pressure variability in the European Lacidipine Study on Atherosclerosis : methodological aspects and effects of antihypertensive treatment . BACKGROUND Recent studies have reported that in patients under antihypertensive treatment visit-to-visit ( or long-term ) variability of clinic BP within a given patient has an independent prognostic significance . Partly based on between-patient dispersion of BP values during treatment ( interindividual variability ) it has also been reported that long-term clinic BP variability is greater for β-blocker than for calcium antagonist and other types of treatment . GOALS To measure visit-to-visit intraindividual variations of both clinic and 24-h mean BP in the hypertensive patients of the European Lacidipine Study on Atherosclerosis ( ELSA ) trial treated for 4 years with either atenolol or lacidipine , and to check whether interindividual clinic and 24-h BP variabilities during treatment can really be considered a surrogate of intraindividual variabilities in exploring differences between β-blocker and calcium antagonist treatments . METHODS Long-term intraindividual BP variability was defined as the coefficient of variation of the average systolic or diastolic values of clinic and 24-h BP measured at each visit throughout the treatment period . Patients in whom at least seven clinic ( 6-month intervals ) or at least three ( yearly intervals ) 24-h values were available from the end of the drug titration phase to the end of the study were considered . RESULTS Visit-to-visit 24-h SBP/DBP variabilities were 20-25 % smaller than , and loosely correlated with clinic BP variability ( r ( 2 ) < 0.022 ) . There was also a very limited relationship ( r ( 2 ) < 0.026 ) between visit-to-visit and within 24-h ambulatory BP variabilities , the latter being two to three times greater than the former . Visit-to-visit intraindividual clinic SBP variability was only slightly lower on calcium antagonist than on β-blocker treatment but little or no between-treatment difference was found for visit-to-visit clinic DBP and ambulatory SBP/DBP particularly in patients under monotherapy throughout the study . Interindividual BP variability was markedly greater than the intra-individiual one of which it did not precisely reflect the treatment-induced changes . CONCLUSION In mild-to-moderate hypertensive patients , visit-to-visit BP variability does not differ substantially between β-blocker and calcium antagonist treatment . Major discrepancies exist between visit-to-visit BP variability as quantified by 24-h vs. clinic BP , making investigation of which of these indices is clinically more relevant important . Interindividual BP variability during treatment shows marked quantitative differences with intraindividual BP variability questioning whether its use can accurately reflect individual BP variations from one visit to another .
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Intervention_Control
antihypertensive treatment
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Outcome_Physical
blood pressure variability
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Outcome_Physical
variability of clinic BP
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Outcome_Physical
long-term clinic BP variability
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Participant_Condition
patients under antihypertensive treatment visit-to-visit ( or long-term ) variability of clinic BP