Treating Visit-to-Visit Blood Pressure Variability to Improve Prognosis

Blood pressure (BP) levels are linearly associated with cardiovascular risk, and hypertension is the most common modifiable risk factor for cardiovascular disease. Moreover, antihypertensive treatment-induced BP lowering has been associated with reduction in all outcomes (stroke, heart failure, coronary events, cardiovascular, and all-cause mortality). Apart from the established knowledge regarding the importance of hypertension and its effective treatment, during the last years, there has been an increasing interest in the possibility that BP variability (BPV) might carry an additional contribution to cardiovascular risk, on top of the impact of mean BP levels. BP fluctuates constantly and its variability not only may have diagnostic implications regarding the accurate assessment of hypertension but also seems to exert additional stress on the cardiovascular system over and above average BP levels. Different components of BPV have been identified, characterized by BP fluctuations between hours, days, or months/years, respectively, termed as short-, mid-, and longterm components. All these types of BPV have been shown to carry an independent prognostic value in terms of cardiovascular events and all-cause and cardiovascular mortality. Three interesting articles have been recently published in this journal regarding long-term visit-to-visit BPV (VVV). Tedla et al showed that an increased VVV among 1122 untreated individuals was predictive of arterial stiffness progression after 10 years of follow-up. The 2 remaining papers reported data on the prognostic value of systolic VVV coming from 2 major trials: the observational extension of the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) and the SPRINT (Systolic Blood Pressure Intervention Trial). However, it seems that at the present time, despite the accumulating evidence on the clinical relevance of VVV, the latter still remains a research tool failing to provide clinical application in practice.