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Variability of blood pressure and risk of stroke

Author : Pierre Allain Date : 2010-4-2

The team of Peter M Rothwell published in the Lancet of March 13, 2010 three articles concerning the variability of blood pressure and the risk of stroke.

The first article shows that the risk of stroke is more related to the visit-to-visit variability of systolic blood pressure and to the highest systolic blood pressure observed than to the mean arterial pressure (taking into account all blood pressure measurements made during successive visits, the intervals between visits ranging from one to six months).

The second article shows that among the different classes of antihypertensive drugs, the class that best reduces visit-to-visit variability in blood pressure and the risk of stroke is the class of calcium-channel blockers, such as amlodipine, and to a lesser extent thiazide diuretics, such as chlorthalidone. Beta-blockers appear to be less effective in reducing the variability of blood pressure. This finding does not apply to the prevention of myocardial infarction or heart failure, in which calcium-channel blockers seem less effective than the other antihypertensive classes.

The third article is a set of interesting considerations about blood pressure. The outstanding fact is that calcium-channel blockers seem the antihypertensive best suited for preventing the risk of stroke. But I must recall that it was recently shown that the risk of atrial fibrillation was higher in hypertensive patients treated with calcium-channel blockers than in those treated with other classes of antihypertensive drugs and atrial fibrillation is a cause of stroke.


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