Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults

Abstract

Background and Purpose-The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged ≥65 years. Methods-The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPV reg ). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPV reg , covariates, and delayed entry bias. Results-There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05-2.40; P=0.03). Conclusions-The angiotensin receptor blocker and β-blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke. .).The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

Twenty-four-hour blood pressure variability plays a detrimental role in the neurological outcome of hemorrhagic stroke

“…2–4 Blood pressure variability (BPV), a natural characteristic of blood pressure (BP), is the result of complex interactions between extrinsic environmental and behavioral factors and intrinsic cardiovascular regulatory mechanisms (neural central, neural reflex, and humoral influences). BPV is correlated with the risk of stroke, 5 and BPV is especially detrimental to the occurrence of hemorrhagic stroke. However, the clinical implications of markedly elevated BPV in the setting of acute hemorrhagic stroke are incompletely understood.…”

Visit-to-visit Variability of Blood Pressure and Risk of Stroke: Results of the Kailuan Cohort Study

“…Over a median follow-up of 12 years, Schutte et al 24 found that SBP variability did not predict any fatal or nonfatal cardiovascular events, including stroke. In another study, Tully et al 25 also showed that there was no association between SBP variability and the incidence of stroke in people aged ≥65 years. Given these controversial results, we conducted an analysis to explore the relationship between SBP variability and the risk of stroke in a large-scale Chinese general population.…”

Efficacy of Surgical Revascularizations in Young and Middle-aged Patients with Symptomatic Middle Cerebral Arterial Occlusion

“…Antihypertensive drugs have been reported to be effective on preventing SIE. (23) Among different classes, Tully et al (24) reported that angiotensin receptor blocker (ARB) and beta-blocker were associated with ischemic stroke. Oppositely, Tziomalos et al (25) reported that ARB was more effective on SIE preventing than any other classes.…”