Academic journal article Iranian Journal of Public Health

Reducing Visit-to-Visit Variability in Systolic Blood Pressure for Improving the Progression of Carotid Atherosclerosis and Endothelial Dysfunction in Patients with Hypertension Management

Academic journal article Iranian Journal of Public Health

Reducing Visit-to-Visit Variability in Systolic Blood Pressure for Improving the Progression of Carotid Atherosclerosis and Endothelial Dysfunction in Patients with Hypertension Management

Article excerpt

Introduction

It is well known that hypertension has become a major public health problem which needs to be urgently addressed in the world. Commonly, aver-age blood pressure (BP) level is widely recom-mended by clinical guidelines to be a key compo-nent in the management of CVD (1-2). However, recent evidences have shown that the protective effect of antihypertension depends on not only reductions in average BP levels but also visit-to-visit variability (VVV) in BP (3-7). VVV in systolic (S) BP has a strong predictor for cardiovascular events, stoke, and renal dysfunction in patients with on-treated hypertension and in patients with a previous transient ischemic attack, independent of mean BP (3). Moreover, it is also associated with increased all-cause mortality independently of age, sex, and average SBP levels (6). Therefore, VVV in BP may be another critical goal besides average BP lowering in management of hyperten-sive patients.

VVV in SBP has been verified to be consistent within individuals over time and can be well re-producible (8). It was correlated with 24-h ABP variability in the Anglo-Scandinavian Cardiac Out-comes Trial Blood Pressure Lowering Arm (AS-COT-BPLA) study (3). ABP variability is inde-pendently related to arterial stiffness (9), endothe-lial function (10). From these standpoints, we hy-pothesized that VVV in BP might be also associ-ated with atherosclerosis and endothelial function. However, to the best of our knowledge, the asso-ciation of VVV in BP with the progression of ath-erosclerosis and endothelial dysfunction is also obscured. To elucidate the hypothesis maybe sig-nificantly reduce the cardiovascular morbidity and mortality. It will be benefit for the majority of hy-pertensive patients and reduce the health burden of family and society. Accordingly, at least in some extent, management of VVV in BP will pro-mote the settlement of issues related to public health.

In the present study, our major goal was to inves-tigate the relationship of between VVV in SBP and the progression of carotid atherosclerosis and stiffness and endothelial dysfunction in on-treated essential hypertensive patients.

Materials and Methods

Study Design and Patients

This study was conducted as part of the Chinese Hypertension Intervention Efficacy (CHIEF) study. The design and methods of CHIEF have been reported previously (11-12). From May 2008 and October 2012, we initially recruited 372 hy-pertensive patients from clinics in rural area of Shandong, China. The mean age was 54.04 ± 7.10 years (range 50-79 years) and there were 191 males and 181 females. Hypertension was diagnosed when the clinic BP was ≥ 140/90mm Hg on at least three occasions, or when there was a previ-ous diagnosis of hypertension with current antihy-pertensive medication use. After potentially eligi-ble patients were washed-out from any previous antihypertensive treatment over a period of 2 weeks, they were randomized to either of the two regiments once daily: amlodipine plus hydrochlo-rothiazide and amlodipine plus telmisartan. In or-der to achieve a BP goal (less than 140/90 mm Hg), the daily doses were titrated from 12.5 mg to 25 mg for hydrochlorothiazide and from 40 mg to 80 mg for telmisartan after 2 weeks. If clinic BP was still uncontrolled after 2 additional weeks, the dosage of amlodipine was increased to 5 mg daily. If clinic BP goal still did not reached, other anti-hypertensive agents including ACE inhibitor, α- or β-adrenoceptor blockers could be added at 2 months at the discretion of the investigator's opinion. All patients were monitored closely dur-ing the washout period, and an agreement was made that if any potential problem occurred, the antihypertensive treatment would be re-instated, and the patient was removed from the study. Pa-tients were excluded if they were with any of the following conditions: secondary hypertension; ma-jor cardiovascular event; diabetes mellitus, ad-vanced renal dysfunction; advanced hepatic or renal diseases; malignant tumor; gout; pregnancy; difficulty providing informed consent, or any oth-er clinical conditions unsuitable for this trial. …

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