The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure.In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.
Maximum SBP reached was also a strong predictor of stroke (HR 15).
Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.
Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.
References:
Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet, Volume 375, Issue 9718, Pages 895 - 905, 13 March 2010.
Image source: BP device used for measuring arterial pressure. Wikipedia, GNU Free Documentation License.
