Dihydropyridine CCB lowers visit-to-visit BP variability

Regular use of a dihydropyridine calcium channel blocker (CCB) results in a 2-mm Hg decrease in visit-to-visit blood pressure variability (vvBPV), according to the results of a post hoc analysis of the SPRINT trial.

“Prior research has suggested that dihydropyridine CCBs may reduce vvBPV, which we attempted to verify in a high-quality dataset with robust statistical methodology,” the authors said.

In this post hoc analysis, the authors included participants on a dihydropyridine CCB either 0 or 100 percent of follow-up visits. They also estimated the average treatment effect of the treated (ATET) after augmented inverse-probability-weighting (AIPW) matching.

The primary outcome, vvBPV, was defined as residual standard deviation (rSD) of systolic blood pressure (BP) from month 6 until study completion.

A total of 9,361 participants were enrolled in SPRINT, of whom 5,020 (mean age 67.4 years, 34.5 percent men, 65.9 percent White) were included in the current analysis. Of these, 1,959 were on a dihydropyridine CCB and 3,061 were not. Nearly half of the participants (49.4 percent) were randomly assigned to intensive BP control, with an rSD of 10.1 mm Hg.

Amlodipine accounted for more than 95 percent of dihydropyridine CCB use.

ATET estimation on a dihydropyridine CCB was an rSD that was 2.05-mm Hg lower (95 percent confidence interval, ‒3.19 to ‒0.91) after AIPW matching of demographics and other antihypertensive medications. Other antihypertensive drug classes did not reduce vvBPV, and several even increased it.

“The implication of this hypothesis-generating finding in a high-quality dataset is that future trials to reduce vvBPV could consider using dihydropyridine CCBs,” the authors said.

“Increased vvBPV has negative effects on multiple organ systems,” they noted.