Variable Blood Pressure Linked To Stroke Risk

Patients whose pressure is up and down may gain reassurance from it not always being too high. But, according to a new analysis, this may be false reassurance.

Professor Peter Rothwell of John Radcliffe Hospital, Oxford, UK, explains: "Variability in blood pressure is dismissed as uninformative and 'random', only noteworthy as an obstacle in the measurement of the true underlying blood pressure."
His team carried out a study of more than 8,000 patients who had high blood pressure or a previous heart attack.

They report in the Lancet: "Visit-to-visit variability in systolic blood pressure and maximum systolic blood pressure are strong predictors of stroke, independent of mean systolic blood pressure."

Current guidelines say that patients with only occasional high readings do not require treatment.

.But Professor Rothwell believes that episodic hypertension "should no longer be ignored".

Commenting on the study, experts from Umea University Hospital in Sweden, write: "Rothwell and co-workers make a strong argument for also measuring blood-pressure variability because it supplements blood pressure very well as a risk factor."

But they add that guidelines should not be updated until results from clinical trials can be clearly translated into every day practice.
Professor Peter Weissberg of the British Heart Foundation commented: "These researchers suggest that measuring blood pressure variability - rather than single recordings of blood pressure - may be important.

"They suggest that the reason why calcium channel blockers are best at preventing heart attack and stroke may be their ability to regulate blood pressure variability.

"Current practice is not wrong, but this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use."

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