Limitation: Paucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity. Conclusion: Untreated WCH, but not treated WCE, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension.
Conclusions and Implications for Public Health Practice:
More than one in four Medicare Part D beneficiaries using anti-hypertensives were non-adherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for non-adherence.
Results – 41 papers representing 19 observational cohort studies and 17 clinical trial cohorts, comprising 46 separate analyses were identified. Long term variability in blood pressure was studied in 24 papers, mid-term in four, and short-term in 15 (two studied both long term and short term variability). Results from 23 analyses were excluded from main analyses owing to high risks of confounding. Increased long term variability in systolic blood pressure was associated with risk of all cause mortality (hazard ratio 1.15, 95% confidence interval 1.09 to 1.22), cardiovascular disease mortality (1.18, 1.09 to 1.28), cardiovascular disease events (1.18, 1.07 to 1.30), coronary heart disease (1.10, 1.04 to 1.16), and stroke (1.15, 1.04 to 1.27). Increased mid-term and short term variability in daytime systolic blood pressure were also associated with all cause mortality (1.15, 1.06 to 1.26 and 1.10, 1.04 to 1.16, respectively).
Conclusions – Long term variability in blood pressure is associated with cardiovascular and mortality outcomes, over and above the effect of mean blood pressure. Associations are similar in magnitude to those of cholesterol measures with cardiovascular disease. Limited data for mid-term and short term variability showed similar associations. Future work should focus on the clinical implications of assessment of variability in blood pressure and avoid the common confounding pitfalls observed to date.
Conclusions: Lower systolic blood pressure than currently recommended is associated with significantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than anti-hypertensive treatment.
“When we see something that surprises us and flies in the face of what is understood, it requires another look — maybe a different cohort, larger numbers, longer follow-up,”
Surprised? As long as we continue to focus on pharmaceuticals as the answer, no one should be surprised.
Hypertension is increasingly contributing to U.S. mortality, a national death-certificate study showed.
Note that this large genetic analysis demonstrated that individuals with genes linked to lower vitamin D levels are more likely to have hypertension mediated by low vitamin D, strengthening the argument for a causal link.
Be aware that the absolute effect of vitamin D levels on blood pressure was negligible, even though statistically significant.
Over 60% of the people surveyed believed sea salt was healthier than stable salt.
Over 75% of the people surveyed knew wine was good for the heart but only 30% knew the recommended limits on intake.
Just remember – less is more.
You can’t beet this.