Jan 2026· International Journal of Hypertension· Vol 2026· 0 citations· 23 references
Medicine
TL;DR
In this cross‐sectional observational cohort, antihypertensive medication classes showed context‐dependent associations with BP variability, which were minimal for home BP but more pronounced for office BP, partially independent of the white‐coat effect.
Abstract
Objective Blood pressure (BP) variability provides prognostic information beyond mean BP. However, the class‐specific associations of antihypertensive medications with BP variability remain uncertain, and few studies have directly contrasted home and office BP variability within the same patients while accounting for the white‐coat effect. Methods In a multicenter prospective registry, patients with hypertension and adequate measurements (≥ 10 home and ≥ 5 office readings) were analyzed. The primary outcomes were systolic and diastolic average real variability (ARV) of home and office BP. Associations of renin–angiotensin system inhibitors, beta‐blockers, dihydropyridine calcium channel blockers (DHP‐CCBs), and diuretics with BP variability were estimated using inverse probability of treatment weighting (IPTW) and doubly robust models. The white‐coat effect was further adjusted using both a continuous office‐home mean difference and a guideline‐based white‐coat definition. A true‐monotherapy subcohort sensitivity analysis and class‐by‐class interaction tests were additionally performed. Results Among 495 participants, home ARV differed minimally by antihypertensive class; a small beta‐blocker‐associated increase in home systolic BP (SBP)‐ARV was attenuated with additional adjustment. In contrast, office BP ARV was higher with DHP‐CCBs and diuretics, although the beta‐blocker association was weakened after further adjustment. Following white‐coat effect adjustment, home BP ARV remained neutral across drug classes, whereas DHP‐CCB remained associated with higher office SBP‐ARV and diuretics with higher office diastolic BP ARV. DHP‐CCBs were also associated with a lower probability of office BP control. Home BP control rates did not differ significantly by antihypertensive class. Conclusions In this cross‐sectional observational cohort, antihypertensive medication classes showed context‐dependent associations with BP variability, which were minimal for home BP but more pronounced for office BP, partially independent of the white‐coat effect. Given potential residual confounding by indication, these hypothesis‐generating findings warrant prospective confirmation.
Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality, with a disproportionate burden in low- and middle-income countries, including Nigeria. Questions remain regarding real-world prescribing patterns, blood pressure responses, and follow-up control rates among patients receiving combination antihypertensive therapy in Nigerian private clinical settings.
Aim: To evaluate antihypertensive prescribing patterns, blood pressure changes, control rates, and documented treatment-related adverse events among patients with hypertension managed at a private multispecialist hospital in Lagos, Nigeria.
Methods: A retrospective observational study was conducted among 563 adults with hypertension who had baseline and second-visit blood pressure measurements; 286 also had third-visit measurements. Demographic characteristics, comorbidities, treatment regimens, and blood pressure outcomes were analysed. Paired-samples t-tests were used to compare mean systolic and diastolic blood pressures across visits, while independent-samples t-tests and chi-square tests were used to compare patients who completed and did not complete follow-up. A p-value <0.05 was considered statistically significant.
Results: The cohort had a mean age of 60.23 ± 14.12 years and was predominantly male (57.73%). Significant reductions in systolic blood pressure were observed, with mean decreases of 21.09 mmHg and 28.53 mmHg at the second and third visits, respectively (p < 0.001). Among patients with available follow-up blood pressure measurements, mean systolic blood pressure decreased significantly from baseline to the second visit and from baseline to the third visit. Blood pressure control was achieved in 219/563 patients at the second visit and 172/286 patients at the third visit.
Conclusion: Antihypertensive therapy, particularly commonly used combination regimens, was associated with significant reductions in blood pressure and improved control rates across follow-up visits in this private Nigerian clinical setting. Prospective studies are needed to confirm the effectiveness, adherence benefits, and safety of fixed-dose combination therapy in broader Nigerian populations.
Tosin Majekodunmi, Moses C. Nnamdi, E. Ezeh et al.· Journal of Advances in Medic...· 0 citations
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each, supporting shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
Frances M Wang, Hannah V Col, F. L. Kwapong et al.· American Journal of Hyperten...· 0 citations
Short‐term blood pressure variability (BPV) and circadian BP abnormalities are important cardiovascular risk predictors of mean BP levels, but their combined prognostic significance in essential hypertension remains incompletely understood. To evaluate the independent and combined prognostic value of 24‐hour BPV and circadian BP patterns for predicting major adverse cardiovascular events (MACE) in patients with essential hypertension. This retrospective cohort study included 500 adults with essential hypertension who underwent 24‐hour ambulatory BP monitoring. Short‐term BPV was assessed using the standard deviation of 24‐hour systolic BP. Circadian patterns were classified as dipper, non‐dipper, or reverse dipper based on nighttime systolic BP decline. The primary outcome was MACE, including myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox proportional hazards regression models were used to evaluate associations with outcomes. During a median follow‐up of 4.2 years, 128 patients (25.6%) experienced MACE. High BPV was associated with a significantly greater incidence of MACE than low BPV (34.2% vs. 17.1%, p < 0.001) and remained an independent predictor (adjusted HR 1.89, 95% CI 1.32–2.71, p < 0.001). Reverse dipping was also associated with increased risk. Patients with both elevated BPV and abnormal circadian patterns had the highest risk. Elevated short‐term BPV and abnormal circadian BP patterns are independent predictors of MACE in essential hypertension. Their coexistence identifies a particularly high‐risk phenotype. ABPM‐based dynamic BP assessment may improve cardiovascular risk stratification beyond mean BP levels.
Qin Ma, Shao-Hong Wang, Hua Chen· The Journal of Clinical Hype...· 0 citations
BACKGROUND AND OBJECTIVES
Blood pressure variability (BPV) has been recognized as a cardiovascular risk factor beyond mean blood pressure, but its role in ischemic stroke among patients receiving hemodialysis remains incompletely defined, particularly across stroke subtypes. We evaluated the association between visit-to-visit BPV and incident ischemic stroke in a multicenter hemodialysis cohort.
DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS
In this prospective cohort study, 1,136 patients undergoing maintenance hemodialysis were enrolled from 12 centers. Pre-dialysis blood pressure measurements were collected over a standardized 12-week baseline period (approximately 36 readings per patient). BPV was quantified using the coefficient of variation (CV) and analyzed per 10% greater CV and by tertiles. The primary outcome was incident ischemic stroke, including large artery atherosclerosis (LAA) and small vessel occlusion (SVO). Fine-Gray competing risk models were used to estimate subdistribution hazard ratios (sHRs), adjusting for demographics, blood pressure, comorbidities, medication, and dialysis-related factors.
RESULTS
During a median follow-up of 54 months, 144 patients developed ischemic stroke. Higher systolic BPV was independently associated with greater stroke risk (sHR per 10% greater CV, 1.74; 95% confidence interval [CI], 1.10-2.76, P=0.02) in the clinically adjusted model, with consistent findings in extended analyses. In subtype-specific analyses, systolic BPV was significantly associated with LAA and showed a directionally consistent but attenuated association with SVO after extended adjustment. In contrast, diastolic BPV showed weaker associations that were not statistically significant after multivariable adjustment.
CONCLUSIONS
Higher systolic BPV was independently associated with ischemic stroke in patients receiving hemodialysis, with the most consistent subtype-specific association observed for large artery atherosclerosis. These findings suggest that systolic BPV may serve as a clinically accessible marker of cerebrovascular risk beyond mean blood pressure in this high-risk population.
Mu-Yang Hsieh, Li-Kai Tsai, Ru-Yin Hsu et al.· American Society of Nephrolo...· 0 citations
Elevated MAP was consistently associated with CVD risk in individuals with diabetes, while PP variability offered additional prognostic information, and integrated monitoring of MAP levels and PP variability may help refine vascular risk stratification, pending external validation.
Ling-Jie Kong, Liu Xu, Yinghong Shi et al.· BMC Endocrine Disorders· 0 citations
Background: Uncertainty persists regarding the dose–response association between exercise exposure and blood pressure (BP) control in chronic kidney disease (CKD). This dose–response network meta-analysis examined whether different exercise modalities and model-estimated metabolic-equivalent exposure levels were associated with changes in systolic BP (SBP) and diastolic BP (DBP). Methods: Exercise dose was estimated as metabolic equivalents of task minutes per week (MET-min/week) from reported session duration, frequency, and intensity. Primary outcomes were changes in SBP and DBP, with exploratory subgroup analyses by dialysis status, baseline BP, and intervention duration. Results: The analysis included 26 randomized controlled trials (1218 participants). Aerobic exercise was associated with lower SBP, with the greatest model-estimated reduction at 880 MET-min/week (MD, −7.73 mm Hg). Resistance and mind–body exercise also showed model-estimated reductions, whereas combined aerobic-resistance training was not statistically significant. Dose–response estimates differed by dialysis status and intervention length, but several subgroup estimates were based on sparse data and wide uncertainty. Evidence certainty ranged from very low to high (CINeMA). Conclusions: Exercise interventions may be associated with BP reduction in CKD, but the identified MET-min/week ranges should be interpreted as exploratory, model-derived estimates rather than validated therapeutic thresholds. Better reported randomized trials are needed to confirm dose ranges, safety, adherence, and tolerability in dialysis and non-dialysis CKD populations.
Dongze Li, Kaiming Chen, Shi-Bo Kong et al.· Life· 0 citations
