Episodic hypertension is a strong predictor of stroke risk

The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure.

In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.

Maximum SBP reached was also a strong predictor of stroke (HR 15).

Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

References:

Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet, Volume 375, Issue 9718, Pages 895 - 905, 13 March 2010.

Image source: BP device used for measuring arterial pressure. Wikipedia, GNU Free Documentation License.