Which antihypertensive? Beta blockers risky

Webb et al.  Lancet 2010 375:905-915

Idea  BP variability is worse than absolute measurement of a high BP.  Certain drugs such as Beta blockers are associated with high variability and therefore higher risk, whereas Calcium channel blockers have less variability in BP and are therefore better for stroke prevention.  ACE inhibitors trend bad, ARBs slightly better.

lifestyle choices and stroke prevention risk

Chiuve et al. Circulation 2008; 118:947-954

43,685 men Health professionals followup study

71,243 women Nurses health study

Five factors:

1.  Not smoking

2.  healthy diet

3.  30 minutes per day vigorous activity

4.  Weight BMI< 25

5.  one alcoholic drink per day for women, 1-2 for men

80 percent reduction in risk, dose dependent on how many followed.

Partly related to secondary effects of above on blood pressure.  Amount of BP reduction per lifestyle aspect adopted

10 kg weight reduction= 5-20 mm HG

DASH eating plan 8-14 mm

dietary sodium restriction  5-8

physical activity 4-9 mm

moderate alcohol consumtpion 2-4 mm

Chobanian JAMA 2003; 289:2560

Every 10 mm   reduction in BP leads to a 31 % stroke risk

Lawes et al. Stroke 2004; 35:776