Dataset Information

Does Antihypertensive Drug Class Affect Day-to-Day Variability of Self-Measured Home Blood Pressure? The HOMED-BP Study.

ABSTRACT:

Background

Recent literature suggests that blood pressure variability (BPV) predicts outcome beyond blood pressure level (BPL) and that antihypertensive drug classes differentially influence BPV. We compared calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockade for effects on changes in self-measured home BPL and BPV and for their prognostic significance in newly treated hypertensive patients.

Methods and results

We enrolled 2484 patients randomly allocated to first-line treatment with a calcium channel blocker (n=833), an angiotensin-converting enzyme inhibitor (n=821), or angiotensin receptor blockade (n=830). Home blood pressures in the morning and evening were measured for 5 days off treatment before randomization and for 5 days after 2 to 4 weeks of randomized drug treatment. We assessed BPL and BPV changes as estimated by variability independent of the mean and compared cardiovascular outcomes. Home BPL response in each group was significant (P?0.0001) but small in the angiotensin-converting enzyme inhibitor group (systolic/diastolic: 4.6/2.8 mm Hg) compared with the groups treated with a calcium channel blocker (systolic/diastolic: 8.3/3.9 mm Hg) and angiotensin receptor blockade (systolic/diastolic: 8.2/4.5 mm Hg). In multivariable adjusted analyses, changes in home variability independent of the mean did not differ among the 3 drug classes (P?0.054). Evening variability independent of the mean before treatment significantly predicted hard cardiovascular events independent of the corresponding home BPL (P?0.022), whereas BPV did not predict any cardiovascular outcome based on the morning measurement (P?0.056). Home BPV captured after monotherapy had no predictive power for cardiovascular outcome (P?0.22).

Conclusions

Self-measured home evening BPV estimated by variability independent of the mean had prognostic significance, whereas antihypertensive drug classes had no significant impact on BPV changes. Home BPL should remain the primary focus for risk stratification and treatment.

Clinical trial registration

URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000137.

SUBMITTER: Asayama K

PROVIDER: S-EPMC4943272 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Does Antihypertensive Drug Class Affect Day-to-Day Variability of Self-Measured Home Blood Pressure? The HOMED-BP Study.

Asayama Kei K Ohkubo Takayoshi T Hanazawa Tomohiro T Watabe Daisuke D Hosaka Miki M Satoh Michihiro M Yasui Daisaku D Staessen Jan A JA Imai Yutaka Y

Journal of the American Heart Association 20160323 3

<h4>Background</h4>Recent literature suggests that blood pressure variability (BPV) predicts outcome beyond blood pressure level (BPL) and that antihypertensive drug classes differentially influence BPV. We compared calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockade for effects on changes in self-measured home BPL and BPV and for their prognostic significance in newly treated hypertensive patients.<h4>Methods and results</h4>We enrolled 2484 pat ...[more]

PMID: 27009620

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Project description:PurposeThe aim was to use accelerometer data to describe day-to-day variability in physical activity in a single week, according to sociodemographic variables, in mid-aged Australian adults.MethodsData were from participants in the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study who took part in a 2014 sub-study (N = 612; Mean age 60.6 [SD 6.9; range 48-73]). Participants wore a triaxial accelerometer (ActiGraph wGT3X-BT) on their non-dominant wrist for seven days, and data were expressed as acceleration in gravitational equivalent units (1 mg = 0.001 g). These were, used to estimate daily acceleration (during waking hours) and daily time spent in moderate-vigorous physical activity (MVPA, defined as ≥ 100mg). Coefficient of variation (calculated as [standard deviation/mean of acceleration and MVPA across the seven measurement days] * 100%) was used to describe day-to-day variability.ResultsAverage values for both acceleration (24.1-24.8 mg/day) and MVPA (75.9-79.7 mins/day) were consistent across days of the week, suggesting little day-to-day variability (at the group level). However, over seven days, average individual day-to-day variability in acceleration was 18.8% (SD 9.3%; range 3.4-87.7%) and in MVPA was 35.4% (SD 15.6%; range 7.3-124.6%), indicating considerable day-to-day variability in some participants. While blue collar workers had the highest average acceleration (28.6 mg/day) and MVPA (102.5 mins/day), their day-to-day variability was low (18.3% for acceleration and 31.9% for MVPA). In contrast, variability in acceleration was highest in men, those in professional occupations and those with high income; and variability in MVPA was higher in men than in women.ConclusionResults show group-level estimates of average acceleration and MVPA in a single week conceal considerable day-to-day variation in how mid-age Australians accumulate their acceleration and MVPA on a daily basis. Overall, there was no clear relationship between overall volume of activity and variability. Future studies with larger sample sizes and longitudinal data are needed to build on the findings from this study and increase the generalisability of these findings to other population groups.

Dataset Information

Does Antihypertensive Drug Class Affect Day-to-Day Variability of Self-Measured Home Blood Pressure? The HOMED-BP Study.

Background

Methods and results

Conclusions

Clinical trial registration

Publications

Does Antihypertensive Drug Class Affect Day-to-Day Variability of Self-Measured Home Blood Pressure? The HOMED-BP Study.

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