title: Response of day-to-day home blood pressure variability by antihypertensive drug class after transient ischemic attack or nondisabling stroke.
abstract: OBJECTIVE
  Visit-to-visit variability in systolic blood pressure (SBP) is associated with an increased risk of stroke and was reduced in randomized trials by calcium channel blockers and diuretics but not by renin-angiotensin system inhibitors. However, time of day effects could not be determined. Day-to-day variability on home BP readings predicts stroke risk and potentially offers a practical method of monitoring response to variability-directed treatment.
  
  
  METHODS
  SBP mean, maximum, and variability (coefficient of variation=SD/mean) were determined in 500 consecutive transient ischemic attack or minor stroke patients on 1-month home BP monitoring (3 BPs, 3× daily). Hypertension was treated to a standard protocol. Differences in SBP variability from 3 to 10 days before to 8 to 15 days after starting or increasing calcium channel blockers/diuretics versus renin-angiotensin system inhibitors versus both were compared by general linear models, adjusted for risk factors and baseline BP.
  
  
  RESULTS
  Among 288 eligible interventions, variability in SBP was reduced after increased treatment with calcium channel blockers/diuretics versus both versus renin-angiotensin system inhibitors (-4.0 versus 6.9 versus 7.8%; P=0.015), primarily because of effects on maximum SBP (-4.6 versus -1.0 versus -1.0%; P=0.001), with no differences in effect on mean SBP. Class differences were greatest for early-morning SBP variability (3.6 versus 17.0 versus 38.3; P=0.002) and maximum (-4.8 versus -2.0 versus -0.7; P=0.001), with no effect on midmorning (P=0.29), evening (P=0.65), or diurnal variability (P=0.92).
  
  
  CONCLUSIONS
  After transient ischemic attack or minor stroke, calcium channel blockers and diuretics reduced variability and maximum home SBP, primarily because of effects on morning readings. Home BP readings enable monitoring of response to SBP variability-directed treatment in patients with recent cerebrovascular events.
authors.affiliation: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom.
authors.forename: Alastair J S
authors.initials: AJ
authors.lastname: Webb
authors.affiliation: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Wilson
authors.affiliation: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lovett
authors.affiliation: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Paul
authors.affiliation: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.affiliation: From the Stroke Prevention Research Unit, Oxford University, Oxford, United Kingdom. peter.rothwell@ndcn.ox.ac.uk.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
keywords: antihypertensive agents; home blood pressure monitoring; stroke