Abstract 029: Antihypertensive Treatment and Short-Term Blood Pressure Variability

Abstract

Blood pressure variability (BPV) is recognized as an important prognostic contributor in hypertension. We asseseds differences in short-term BPV in treated patients depending on the number of drugs, drug-classes and combinations, and individual compounds. From the Spanish ABPM Registry, we selected 38188 treated patiens. BPV estimates were obtained from ABPM records, and included weighted, daytime and nighttime SD and average real variability (ARV). Comparisons (general linear models adjusted for age, gender, diabetes, dyslipidemia and CV disease) were carried out depending on the number of drugs (1, 2, 3, and more). In patients treated with monotherapy (13765), BPV estimates were compared depending on the drug classes, as well as on individual compounds inside each class. Additional comparisons were performed depending on the type of combination in patients treated with 2 (12716) and 3 drugs (7888). Systolic BPV increased from monotherapy to treatment with 4 or more drugs (p<0.001 for weighted, daytime, and nighttime SD, and ARV). Among those treated with monotherapy, BPV was increased in those treated with beta blockers, ACEi and ARB, when compared to diuretics or CCB. No differences were observed among diuretics (chlorthalidone, hydrochlorothiazide, indapamide, or loop diuretics). Among betablockers, BPV was increased in those treated with carvedilol, compared to bisoprolol and nevibolol. Among CCB, BPV was lower in treated with amlodipine, with respect to other dihydropyridines. No differences were observed among most frequent used ACEi or ARB. In patients treated with 2-drug combinations, BPV was lower in those treated with diuretic/CCB combinations, compared with other types. Moreover, in those treated with 3-drug combinations, those which included a CCB resulted in a lower BPV in comparison to those which did not include a CCB. Results regarding diastolic BPV were consistent with those observed with systolic BPV. We conclude that antihypertensive treatment is associated with differences in BPV. CCB, specifically amlodipine, used in monotherapy or in combination with other drugs, especially diuretics, is associated with lower short-term BPV. These results may help to explain some benefits of amlodipine observed in clinical trials.