Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke
Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke
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DOI：
10.1016/s1474-4422(10)70066-1
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发表时间：
2010-05-01
期刊：
影响因子：
48
通讯作者：
Sever, Peter S.
中科院分区：
文献类型：
--
作者：
Rothwell, Peter M.;Howard, Sally C.;Sever, Peter S.
一些随机试验的分析表明，钙通道阻滞剂降低卒中风险的作用超过了仅基于平均血压的预期，而β受体阻滞剂的效果低于预期。我们的目的是研究这些药物对血压变异性的影响是否可以解释这些差异对中风风险的影响。（ASCOT-BPLA）在19257例高血压和其他血管危险因素患者中比较了以氨氯地平为基础的方案与以阿替洛尔为基础的方案，医学研究理事会（MRC）试验比较了阿替洛尔-4396例65-74岁高血压患者中，以利尿剂为基础的方案与安慰剂相比。我们将两项试验中随访期间血压的访视间变异性表示为标准差（SD）和与平均血压不相关的转换。结果ASCOT-BPLA组收缩压（SBP）SD在所有随访时均低于阿替洛尔组（P < 0.05），而ASCOT-BPLA组收缩压（SBP）SD在所有随访时均低于阿替洛尔组（P < 0.05），且ASCOT-BPLA组收缩压SD在所有随访时均低于阿替洛尔组（P < 0.05）。
Background Analyses of some randomised trials show that calcium-channel blockers reduce the risk of stroke more than expected on the basis of mean blood pressure alone and that beta blockers are less effective than expected. We aimed to investigate whether the effects of these drugs on variability in blood pressure might explain these disparities in effect on stroke risk.Methods The Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA) compared amlodipine-based regimens with atenolol-based regimens in 19 257 patients with hypertension and other vascular risk factors and the Medical Research Council (MRC) trial compared atenolol-based and diuretic-based regimens versus placebo in 4396 hypertensive patients aged 65-74 years. We expressed visit-to-visit variability of blood pressure during follow-up in the two trials as standard deviation (SD) and as transformations uncorrelated with mean blood pressure. For ASCOT-BPLA, we also studied within-visit variability and variability on 24 h ambulatory blood-pressure monitoring (ABPM).Results In ASCOT-BPLA, group systolic blood pressure (SBP) SD was lower in the amlodipine group than in the atenolol group at all follow-up visits (p