Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality

Background: Information is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long-term mortality in an elderly hypertensive population. Methods and Results: We used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24-hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow-up). Weighted day-night systolic BPV was calculated for both baseline and follow-up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day-night systolic BPV between baseline and follow-up. Having constant stable: high BPV was associated with an increase in all-cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow-up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group. Conclusions: Our results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow-up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long-term mortality

Hypertension guidelines: more challenges highlighted by Europe

The release of a new set of major international guidelines from an authoritative group commissioned jointly by the European Society of Cardiology and the European Society of Hypertension (ESH/ESC guidelines)1 is cause for reflection both on the changing scene in hypertension and on the application of guidelines to improve outcomes in people with hypertension in their community.&lt;p&gt;&lt;/p&gt; At 76 pages long and supported by 735 references, this is a useful resource, but the question is: to whom? Guidelines should enable practitioners to follow best practice, establish standards of care, and provide balance in the face of many and varied influences experienced by busy clinicians. If it is the purpose of guidelines to enable practitioners, especially those at the front line of patient care, to follow best practice guided by the best available evidence, then these are too long and discursive to be used for everyday practice. A pocket guide is likely to become available in due course and clinicians might use this in their practice if it is user-friendly and can be easily found among the multitude of other disease-based guidelines made available to them.&lt;p&gt;&lt;/p&gt

Australian Health Research Alliance: national priorities in data-driven health care improvement

Abstract not available.Helena J Teede, Alison Johnson, Jim Buttery, Cheryl A Jones, Douglas IR Boyle, Garry LR Jennings, Tim Sha