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Adjudication committee
- First opponent: Neurology Consultant Alastair Webb, Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom
- Second opponent: Professor Renata Cífcová, Center for Cardiovascular Prevention, Charles University, Czech Republic
- Third member and chair of the evaluation committee: Professor II Mona Elisabeth Skjelland, Institute of Clinical Medicine, University of Oslo
Chair of defence
Professor II Henrik Schirmer, Institute of Clinical Medicine, University of Oslo
Principal Supervisor
Professor Eivind Berge†, Department of Cardiology, Oslo University Hospital, Ullevål
Summary
Although antihypertensive treatment reduces cardiovascular risk, patients on treatment continue to have excessive risk.
We studied whether high systolic blood pressure variability from one visit to the next (visit-to-visit), independently of baseline cardiovascular risk, conferred increased risk of cardiovascular events and death in patients on antihypertensive treatment. We also assessed if different risks of cardiovascular events in patients treated with valsartan versus amlodipine were attributable to the drugs` different effects on mean blood pressure and blood pressure variability.
We used data from the VALUE trial, a randomised-controlled, double-blinded study of valsartan versus amlodipine in 15.245 hypertensive patients at increased cardiovascular risk. We assessed visit-to-visit blood pressure variability during 4.2 years (mean), and related variability to risk of cardiovascular events and death, in subgroups and comparing treatment groups, using Cox regression models.
High visit-to-visit systolic blood pressure variability was associated with an increased risk of cardiovascular events and death, independently of mean blood pressure or cardiovascular risk. The risk associated with blood pressure variability was higher in patients <68 years and in those with lower mean blood pressure during follow-up. Variability was similar in patients with or without baseline atrial fibrillation, but higher in those with atrial fibrillation during follow-up. Differences in risks of myocardial infarction and stroke were related to the drugs’ different effect on blood pressure mean and variability, while risk of heart failure was lower with valsartan treatment, independently of blood pressure profile.
The findings presented in this thesis indicate that high blood pressure variability can be important for cardiovascular risk and that antihypertensive drugs might have different clinical effect based on their effect on both mean blood pressure and blood pressure variability.
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