Variable Blood Pressure a New Stroke Risk Factor?

Big ups and downs in readings may call for specific treatments, experts say

By Ed Edelson
HealthDay Reporter

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THURSDAY, March 11 (HealthDay News) -- Challenging established medical wisdom about blood pressure and stroke, new British research suggests that extremely variable blood pressure, and not just high blood pressure, can greatly increase a person's risk of stroke.

"Some people have very stable hypertension, in which case simple hypertension is all that matters, but variability and episodic hypertension is very common and matters much more than mean blood pressure in some patients," said Dr. Peter Rothwell, a professor of neurology at the University of Oxford and lead author of four papers in the March 13 issues of The Lancet and The Lancet Neurology.

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One paper looked at high blood pressure and blood pressure variability in four groups of 2,000 people, each of who had minor strokes called transient ischemic attacks (TIAs), or "mini-strokes." These are warning signs of stroke risk.

They found that people with the greatest variation in systolic blood pressure (the higher of the 120/80 readings) over seven visits to their doctor were six times more likely to have a major stroke. People with the highest blood pressure readings were 15 times more likely to have a stroke.

"Under-diagnosis and under-treatment of hypertension is a major, seemingly intractable problem in all health-care systems," Rothwell said. "The new research shows that part of the problem is likely to have been under-recognition of the impact of variability in blood pressure on diagnosis in routine clinical practice in primary care. It shows that doctors have to make diagnoses on the basis of blood pressure measurements that vary substantially from visit to visit."

The message for doctors is that they have to change the way they view high blood pressure, he said.

"All current clinical guidelines encourage doctors to ignore variability and occasional high readings and to rely exclusively on the average blood pressure from multiple visits or 24-hour monitoring," Rothwell said. "The new research shows that increased variability in blood pressure, a high maximum blood pressure and episodic hypertension are associated with high risks of stroke and other vascular events, and emphasize that any comfort taken from the fact blood pressure is sometimes normal is false."

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