Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis

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.
Read the abstract at Annals of Internal Medicine

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014 – MMWR

Source: Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014 | MMWR

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.

Blood pressure variability and cardiovascular disease: systematic review and meta-analysis – The BMJ

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.

Source: Blood pressure variability and cardiovascular disease: systematic review and meta-analysis | The BMJ

Blood Pressure and Complications in DM2 and no Previous CVD – The BMJ

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.

Source: Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study | The BMJ