Skip to main content
Top
Published in: Current Hypertension Reports 3/2015

01-03-2015 | Hypertension and Metabolic Syndrome (JR Sowers and A Whaley-Connell, Section Editors)

Visit-to-Visit Variability of Systolic Blood Pressure and Cardiovascular Disease

Authors: Wael F. Hussein, Tara I. Chang

Published in: Current Hypertension Reports | Issue 3/2015

Login to get access

Abstract

Visit-to-visit variability of blood pressure (VVV of BP) is gaining interest as a prognostic marker for stroke, cardiovascular disease, and all-cause mortality. In this review, we discuss different metrics used to define VVV of BP, explore the potential sources of this phenomenon including patient characteristics and antihypertensive medication classes, and discuss recent evidence of its relation with cardiovascular outcomes. Current evidence relies on secondary analyses of clinical trials or on observational studies, none of which was designed to examine VVV of BP specifically. More research is required to develop standardized definitions of VVV of BP, to confirm the value of VVV as a prognostic indicator, and to ascertain whether efforts to reduce VVV of BP in addition to mean BP will improve outcomes.
Literature
1.
go back to reference Pickering TG et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45(1):142–61.CrossRefPubMed Pickering TG et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45(1):142–61.CrossRefPubMed
2.
go back to reference Muntner P et al. Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care. J Hypertens. 2011;29(12):2332–8.CrossRefPubMed Muntner P et al. Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care. J Hypertens. 2011;29(12):2332–8.CrossRefPubMed
3.
go back to reference Franklin SS et al. Does the relation of blood pressure to coronary heart disease risk change with aging?: the Framingham Heart Study. Circulation. 2001;103(9):1245–9.CrossRefPubMed Franklin SS et al. Does the relation of blood pressure to coronary heart disease risk change with aging?: the Framingham Heart Study. Circulation. 2001;103(9):1245–9.CrossRefPubMed
4.
go back to reference Portaluppi F et al. Circadian rhythms and cardiovascular health. Sleep Med Rev. 2012;16(2):151–66.CrossRefPubMed Portaluppi F et al. Circadian rhythms and cardiovascular health. Sleep Med Rev. 2012;16(2):151–66.CrossRefPubMed
5.
go back to reference Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375(9718):938–48.CrossRefPubMed Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375(9718):938–48.CrossRefPubMed
6.
go back to reference Mena L et al. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005;23(3):505–11.CrossRefPubMed Mena L et al. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005;23(3):505–11.CrossRefPubMed
7.
go back to reference Rothwell PM et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375(9718):895–905.CrossRefPubMed Rothwell PM et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375(9718):895–905.CrossRefPubMed
8.
go back to reference Mancia G et al. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension. 2007;40:299–305.CrossRef Mancia G et al. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension. 2007;40:299–305.CrossRef
9.••
go back to reference Diaz, K.M., et al., Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis. Hypertension, 2014. Comprehensive systematic review of VVV of BP, with focus on differences in metrics and definitions used across studies. Highlights the need for standardized approaches when defining and calculating VVV: BP measurement protocol, number of visits, interval between visits and metrics used. Diaz, K.M., et al., Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis. Hypertension, 2014. Comprehensive systematic review of VVV of BP, with focus on differences in metrics and definitions used across studies. Highlights the need for standardized approaches when defining and calculating VVV: BP measurement protocol, number of visits, interval between visits and metrics used.
10.
go back to reference Chang TI et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens. 2014;28(1):18–24.CrossRefPubMed Chang TI et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens. 2014;28(1):18–24.CrossRefPubMed
11.
go back to reference Gao S et al. Redefined blood pressure variability measure and its association with mortality in elderly primary care patients. Hypertension. 2014;64(1):45–52.CrossRefPubMed Gao S et al. Redefined blood pressure variability measure and its association with mortality in elderly primary care patients. Hypertension. 2014;64(1):45–52.CrossRefPubMed
12.
go back to reference Lau KK et al. Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct. Eur J Neurol. 2014;21(2):319–25.CrossRefPubMed Lau KK et al. Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct. Eur J Neurol. 2014;21(2):319–25.CrossRefPubMed
13.
go back to reference Hsieh YT et al. Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: a 5.5-year prospective analysis. Eur J Clin Invest. 2012;42(3):245–53.CrossRefPubMed Hsieh YT et al. Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: a 5.5-year prospective analysis. Eur J Clin Invest. 2012;42(3):245–53.CrossRefPubMed
14.
go back to reference Muntner P et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011;57(2):160–6.CrossRefPubMed Muntner P et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011;57(2):160–6.CrossRefPubMed
15.
go back to reference Nagai M et al. Visit-to-visit blood pressure variability in the elderly: associations with cognitive impairment and carotid artery remodeling. Atherosclerosis. 2014;233(1):19–26.CrossRefPubMed Nagai M et al. Visit-to-visit blood pressure variability in the elderly: associations with cognitive impairment and carotid artery remodeling. Atherosclerosis. 2014;233(1):19–26.CrossRefPubMed
16.
go back to reference Lau KK et al. Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases–relationships and comparisons with vascular markers of atherosclerosis. Atherosclerosis. 2014;235(1):230–5.CrossRefPubMed Lau KK et al. Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases–relationships and comparisons with vascular markers of atherosclerosis. Atherosclerosis. 2014;235(1):230–5.CrossRefPubMed
17.
go back to reference Levitan EB et al. Blood pressure measurement device, number and timing of visits, and intra-individual visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich). 2012;14(11):744–50.CrossRef Levitan EB et al. Blood pressure measurement device, number and timing of visits, and intra-individual visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich). 2012;14(11):744–50.CrossRef
18.
19.
go back to reference Di Iorio B et al. Blood pressure variability and outcomes in chronic kidney disease. Nephrol Dial Transplant. 2012;27(12):4404–10.CrossRefPubMed Di Iorio B et al. Blood pressure variability and outcomes in chronic kidney disease. Nephrol Dial Transplant. 2012;27(12):4404–10.CrossRefPubMed
20.
go back to reference Hata J et al. Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: the ADVANCE trial. Circulation. 2013;128(12):1325–34.CrossRefPubMed Hata J et al. Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: the ADVANCE trial. Circulation. 2013;128(12):1325–34.CrossRefPubMed
21.
go back to reference Mancia G et al. Visit-to-visit blood pressure variability, carotid atherosclerosis, and cardiovascular events in the European Lacidipine Study on Atherosclerosis/Clinical Perspective. Circulation. 2012;126(5):569–78.CrossRefPubMed Mancia G et al. Visit-to-visit blood pressure variability, carotid atherosclerosis, and cardiovascular events in the European Lacidipine Study on Atherosclerosis/Clinical Perspective. Circulation. 2012;126(5):569–78.CrossRefPubMed
22.
go back to reference Okada H et al. Visit-to-visit blood pressure variability is a novel risk factor for the development and progression of diabetic nephropathy in patients with type 2 diabetes. Diabetes Care. 2013;36(7):1908–12.CrossRefPubMedCentralPubMed Okada H et al. Visit-to-visit blood pressure variability is a novel risk factor for the development and progression of diabetic nephropathy in patients with type 2 diabetes. Diabetes Care. 2013;36(7):1908–12.CrossRefPubMedCentralPubMed
23.
go back to reference Di Iorio B et al. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk. J Nephrol. 2013;26(1):173–82.CrossRefPubMed Di Iorio B et al. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk. J Nephrol. 2013;26(1):173–82.CrossRefPubMed
24.
go back to reference Kawai, T., et al., The impact of visit-to-visit variability in blood pressure on renal function. Hypertens Res, 2011. Kawai, T., et al., The impact of visit-to-visit variability in blood pressure on renal function. Hypertens Res, 2011.
25.
go back to reference Hastie CE et al. Long-term and ultra long-term blood pressure variability during follow-up and mortality in 14,522 patients with hypertension. Hypertension. 2013;62(4):698–705.CrossRefPubMed Hastie CE et al. Long-term and ultra long-term blood pressure variability during follow-up and mortality in 14,522 patients with hypertension. Hypertension. 2013;62(4):698–705.CrossRefPubMed
26.
go back to reference Okada H et al. Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes. Atherosclerosis. 2012;220(1):155–9.CrossRefPubMed Okada H et al. Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes. Atherosclerosis. 2012;220(1):155–9.CrossRefPubMed
27.
go back to reference Okada H et al. Visit-to-visit variability in systolic blood pressure is a novel risk factor for the progression of coronary artery calcification. Hypertens Res. 2013;36(11):996–9.CrossRefPubMed Okada H et al. Visit-to-visit variability in systolic blood pressure is a novel risk factor for the progression of coronary artery calcification. Hypertens Res. 2013;36(11):996–9.CrossRefPubMed
28.
go back to reference Masugata H et al. Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients. Hypertens Res. 2011;34(7):846–50.CrossRefPubMed Masugata H et al. Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients. Hypertens Res. 2011;34(7):846–50.CrossRefPubMed
29.
go back to reference Nguyen NT et al. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008;207(6):928–34.CrossRefPubMed Nguyen NT et al. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008;207(6):928–34.CrossRefPubMed
30.
31.
go back to reference Faramawi MF et al. Metabolic syndrome is associated with visit-to-visit systolic blood pressure variability in the US adults. Hypertens Res. 2014;37(9):875–9.CrossRefPubMed Faramawi MF et al. Metabolic syndrome is associated with visit-to-visit systolic blood pressure variability in the US adults. Hypertens Res. 2014;37(9):875–9.CrossRefPubMed
32.
go back to reference U.S. Renal Data System, USRDS 2013 Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States, NIDDK, National Institutes of Health, Editor 2013: Bethesda, MD. U.S. Renal Data System, USRDS 2013 Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States, NIDDK, National Institutes of Health, Editor 2013: Bethesda, MD.
33.
go back to reference McMullan, C.J., et al., Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial. Am J Kidney Dis, 2014. McMullan, C.J., et al., Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial. Am J Kidney Dis, 2014.
34.
go back to reference Mallamaci F et al. Long-term visit-to-visit office blood pressure variability increases the risk of adverse cardiovascular outcomes in patients with chronic kidney disease. Kidney Int. 2013;84(2):381–9.CrossRefPubMed Mallamaci F et al. Long-term visit-to-visit office blood pressure variability increases the risk of adverse cardiovascular outcomes in patients with chronic kidney disease. Kidney Int. 2013;84(2):381–9.CrossRefPubMed
35.
go back to reference Selvarajah V et al. Pre-dialysis systolic blood pressure-variability is independently associated with all-cause mortality in incident haemodialysis patients. PLoS ONE. 2014;9(1):e86514.CrossRefPubMedCentralPubMed Selvarajah V et al. Pre-dialysis systolic blood pressure-variability is independently associated with all-cause mortality in incident haemodialysis patients. PLoS ONE. 2014;9(1):e86514.CrossRefPubMedCentralPubMed
36.
go back to reference Shafi, T., et al., Predialysis systolic BP variability and outcomes in hemodialysis patients. Journal of the American Society of Nephrology, 2014. Shafi, T., et al., Predialysis systolic BP variability and outcomes in hemodialysis patients. Journal of the American Society of Nephrology, 2014.
37.
go back to reference Rossignol P et al. Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSIDIAL. Hypertension. 2012;60(2):339–46.CrossRefPubMed Rossignol P et al. Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSIDIAL. Hypertension. 2012;60(2):339–46.CrossRefPubMed
39.
go back to reference Menni C et al. Heritability analyses show visit-to-visit blood pressure variability reflects different pathological phenotypes in younger and older adults: evidence from UK twins. J Hypertens. 2013;31(12):2356–61.CrossRefPubMed Menni C et al. Heritability analyses show visit-to-visit blood pressure variability reflects different pathological phenotypes in younger and older adults: evidence from UK twins. J Hypertens. 2013;31(12):2356–61.CrossRefPubMed
40.
go back to reference Diaz KM et al. Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in African Americans. Hypertens Res. 2012;35(1):55–61.CrossRefPubMedCentralPubMed Diaz KM et al. Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in African Americans. Hypertens Res. 2012;35(1):55–61.CrossRefPubMedCentralPubMed
41.
go back to reference Rothwell PM et al. Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9(5):469–80.CrossRefPubMed Rothwell PM et al. Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9(5):469–80.CrossRefPubMed
42.
go back to reference Shimbo D et al. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative. Hypertension. 2012;60(3):625–30.CrossRefPubMedCentralPubMed Shimbo D et al. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative. Hypertension. 2012;60(3):625–30.CrossRefPubMedCentralPubMed
43.
go back to reference Chowdhury EK et al. Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients. J Hypertens. 2014;32(3):525–33.CrossRefPubMed Chowdhury EK et al. Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients. J Hypertens. 2014;32(3):525–33.CrossRefPubMed
44.
go back to reference Suchy-Dicey AM et al. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens. 2013;26(10):1210–7.CrossRefPubMedCentralPubMed Suchy-Dicey AM et al. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens. 2013;26(10):1210–7.CrossRefPubMedCentralPubMed
45.
go back to reference Lau, K.K., et al., Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischemic stroke. Am J Hypertens, 2014. Lau, K.K., et al., Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischemic stroke. Am J Hypertens, 2014.
46.
go back to reference Kostis JB et al. Visit-to-visit blood pressure variability and cardiovascular death in the systolic hypertension in the elderly program. J Clin Hypertens (Greenwich). 2014;16(1):34–40.CrossRef Kostis JB et al. Visit-to-visit blood pressure variability and cardiovascular death in the systolic hypertension in the elderly program. J Clin Hypertens (Greenwich). 2014;16(1):34–40.CrossRef
47.
go back to reference Blacher, J., et al., Blood pressure variability: cardiovascular risk integrator or independent risk factor? J Hum Hypertens, 2014. Blacher, J., et al., Blood pressure variability: cardiovascular risk integrator or independent risk factor? J Hum Hypertens, 2014.
48.
go back to reference Echt DS et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. N Engl J Med. 1991;324(12):781–8.CrossRefPubMed Echt DS et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. N Engl J Med. 1991;324(12):781–8.CrossRefPubMed
49.•
go back to reference Muntner P et al. Association between antihypertensive medication adherence and visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich). 2013;15(2):112–7. One of the few studies to examine the association between VVV of BP and adherence to antihypertensive therapy. Used data from a large managed care organization on 1391 patients with hypertension to show that a significant degree of variability existed even among patients with high degree of medication adherence. Poor adherence was associated with higher VVV of BP, but only a small proportion of the variability was explained by non-adherence to BP medications.CrossRef Muntner P et al. Association between antihypertensive medication adherence and visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich). 2013;15(2):112–7. One of the few studies to examine the association between VVV of BP and adherence to antihypertensive therapy. Used data from a large managed care organization on 1391 patients with hypertension to show that a significant degree of variability existed even among patients with high degree of medication adherence. Poor adherence was associated with higher VVV of BP, but only a small proportion of the variability was explained by non-adherence to BP medications.CrossRef
50.
go back to reference Diaz KM et al. The effects of weight loss and salt reduction on visit-to-visit blood pressure variability: results from a multicenter randomized controlled trial. J Hypertens. 2014;32(4):840–8.CrossRefPubMedCentralPubMed Diaz KM et al. The effects of weight loss and salt reduction on visit-to-visit blood pressure variability: results from a multicenter randomized controlled trial. J Hypertens. 2014;32(4):840–8.CrossRefPubMedCentralPubMed
51.
go back to reference Webb AJ et al. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010;375(9718):906–15.CrossRefPubMed Webb AJ et al. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010;375(9718):906–15.CrossRefPubMed
52.
go back to reference Muntner P et al. Effect of chlorthalidone, amlodipine, and lisinopril on visit-to-visit variability of blood pressure: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. J Clin Hypertens (Greenwich). 2014;16(5):323–30.CrossRef Muntner P et al. Effect of chlorthalidone, amlodipine, and lisinopril on visit-to-visit variability of blood pressure: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. J Clin Hypertens (Greenwich). 2014;16(5):323–30.CrossRef
53.
go back to reference Mancia G et al. Visit-to-visit blood pressure variability in the European Lacidipine Study on Atherosclerosis: methodological aspects and effects of antihypertensive treatment. J Hypertens. 2012;30(6):1241–51.CrossRefPubMed Mancia G et al. Visit-to-visit blood pressure variability in the European Lacidipine Study on Atherosclerosis: methodological aspects and effects of antihypertensive treatment. J Hypertens. 2012;30(6):1241–51.CrossRefPubMed
54.•
go back to reference Wang JG, Yan P, Jeffers BW. Effects of amlodipine and other classes of antihypertensive drugs on long-term blood pressure variability: evidence from randomized controlled trials. J Am Soc Hypertens. 2014;8(5):340–9. Meta-analysis that analyzed the association of antihypertensive class with VVV of BP using individual data from 47,558 patients from five studies. Study showed that amlodipine (versus all active comparators) associated with of −1.23 mmHg (p = 0.008) lower VVV of BP (measured as standard deviation).CrossRefPubMed Wang JG, Yan P, Jeffers BW. Effects of amlodipine and other classes of antihypertensive drugs on long-term blood pressure variability: evidence from randomized controlled trials. J Am Soc Hypertens. 2014;8(5):340–9. Meta-analysis that analyzed the association of antihypertensive class with VVV of BP using individual data from 47,558 patients from five studies. Study showed that amlodipine (versus all active comparators) associated with of −1.23 mmHg (p = 0.008) lower VVV of BP (measured as standard deviation).CrossRefPubMed
55.
go back to reference Smith TR et al. Medication class effects on visit-to-visit variability of blood pressure measurements: analysis of electronic health record data in the “real world”. J Clin Hypertens (Greenwich). 2013;15(9):655–62.CrossRef Smith TR et al. Medication class effects on visit-to-visit variability of blood pressure measurements: analysis of electronic health record data in the “real world”. J Clin Hypertens (Greenwich). 2013;15(9):655–62.CrossRef
Metadata
Title
Visit-to-Visit Variability of Systolic Blood Pressure and Cardiovascular Disease
Authors
Wael F. Hussein
Tara I. Chang
Publication date
01-03-2015
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 3/2015
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-014-0527-8

Other articles of this Issue 3/2015

Current Hypertension Reports 3/2015 Go to the issue

Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)

Thiazide Diuretics in Chronic Kidney Disease

Secondary Hypertension: Nervous System Mechanisms (J Bisognano, Section Editor)

Renal Denervation in Heart Failure

Hypertension and Metabolic Syndrome (JR Sowers and A Whaley-Connell, Section Editors)

The Western Diet and Chronic Kidney Disease

Secondary Hypertension: Nervous System Mechanisms (J Bisognano, Section Editor)

The Baroreflex in Hypertension

Hypertension and Metabolic Syndrome (JR Sowers and A Whaley-Connell, Section Editors)

Understanding the Importance of Race/Ethnicity in the Care of the Hypertensive Patient

Hypertension and Metabolic Syndrome (JR Sowers and A Whaley-Connell, Section Editors)

Natriuretic Peptides as a Novel Target in Resistant Hypertension

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine