CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
234
AFRICA
over the age of 80 years with a systolic
blood pressure of > 160 mmHg. Patients
were eligible for the trial if the systolic
blood pressure was > 160 mmHg but not
if the standing systolic blood pressure
was < 140 mmHg. In this study, target
blood pressure was < 150/80 mmHg.
Active treatment with indapamide-based
therapy was associated with a significant
reduction in total mortality (25%),
cardiovascular mortality (35%), stroke
mortality (60%) and heart failure (50%).
The JATOS trial, published in
Hypertension Research
in 2008,
confirmed that a systolic blood pressure
of < 140 mmHg was associated with
more deaths in those over the age of 75
years. It was finally concluded that the
target blood pressure in the very elderly
is 150/80 mmHg. Currently, there are
no data on the optimal blood pressure
goal in patients with mild hypertension
(140–160/< 90 mmHg) as trials have only
recruited patients with a systolic blood
pressure > 160 mmHg.
Blood pressure variability
This refers to visit–visit variability, within-
visit variability, as well as variability over
a longer period of time such as a week
or a month. The greater the variability in
blood pressure, the higher the risk. No
specific number was given for the cut-off
measure which predicted higher versus
lower variability.
A good technique to assess variability
entailed home blood pressure monitoring
with three successive measurements a
day, over a period of seven days. The
greater the variability in readings, the
higher the risk.
Recent data published in the
Lancet
in
2010 confirmed that visit–visit variability
in systolic blood pressure is a strong
predictor of stroke, independent of mean
systolic blood pressure. Increased residual
variability in systolic blood pressure
in patients with treated hypertension is
associated with a high risk of vascular
events.
To most effectively prevent stroke,
blood pressure-lowering drugs should
reduce mean blood pressure without
increasing variability. Ideally they should
do both.
Dr Naomi Rapeport,
Specialist physician, Milpark Hospital,
Johannesburg
Dr Shirley Middlemost
,
Cardiologist, Hermanus MediClinic,
Western Cape
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