Antihypertensive drug side effects was associated with drug adherence but only excessive urination and decrease in sexual drive significantly predicted lower adherence. These symptoms could be used as markers to screen out patients at high risk of non-adherence.

Experimental studies conducted on animal and human endothelium suggested that higher systolic blood pressure (SBP) variability reduces bioavailability of nitric oxide and increases vascular smooth muscle cell proliferation. These vascular wall changes could stiffen the arterial wall. Using data from the Multi-Ethnic Study of Atherosclerosis, we investigated the association between long-term SBP variability and ten-year percent change in arterial stiffness among 1122 individuals (mean age 57 years, 46% Males at baseline) who were not taking anti-hypertensive medications. Within-individual standard deviation (SD), variability independent of the mean (VIM), and coefficient of variation (CV) of SBP across 5 visits were used to capture long-term SBP variability. Carotid arterial stiffness was measured using distensibility coefficient (DC) and Young’s elastic modulus (YEM) at baseline and after a mean of 9.5 years of follow-up (visit 5). In a multivariate linear regression model, individuals in the 5th quintile as compared to those in the 1st quintile of SD, VIM, and CV of SBP had a 9.8% (95% CI: −17.0%, −2.7%), 6.4% (95% CI: −13.2%, 0.4%), and 8.7% (95% CI: −15.4%, −1.9%) higher decline in DC and a 27.5% (95% CI: 15.8%, 39.3%), 25.8% (95% CI: 14.7%, 36.9%), and 27.9% (95% CI: 16.8%, 39.1%) higher progression in YEM, respectively, after ten years of follow-up. Linear trends in the decline of DC and progression of YEM were observed across the quintiles of SBP variability indices. These findings suggest that higher long-term SBP variability may be a risk factor for arterial stiffness progression independent of mean BP.

This study questions the classic view that DBP is more able to identify future CVD events than SBP in all individuals younger than 50 years. In young adulthood, SBP in black individuals and DBP in white individuals were the most robust indicators of future CVD. In middle-age, SBP in both races identified risk of incident CVD.

The aims of this study are to assess the relationships of visit-to-visit blood pressure (BP) variability in young adulthood to hippocampal volume and integrity at middle age. We used data over eight examinations spanning 25 years collected in the Coronary Artery Risk Development in Young Adults (CARDIA) Study of black and white adults (age 18–30 years) started in 1985–1986. Visit-to-visit BP variability was defined as by standard deviation (SDBP) and average real variability (ARVBP, defined as the absolute differences of BP between successive BP measurements). Hippocampal tissue volume standardized by intracranial volume (%) and integrity assessed by fractional anisotropy (FA) were measured by 3-Tesla MRI at the Year 25 examination (n=545, mean age 51 years; 54% women; and 34% African Americans). Mean systolic BP (SBP)/diastolic BP (DBP) levels were 110/69 mmHg at Year 0 (baseline), 117/73 mmHg at Year 25, and ARVSBP and SDSBP were 7.7 and 7.9 mmHg, respectively. In multivariable-adjusted linear models, higher ARVSBP was associated with lower hippocampal volume (unstandardized regression coefficient [standard error] with 1 SD higher ARVSBP: −0.006 [0.003]), and higher SDSBP with lower hippocampal FA (−0.02 [0.01]; all P<0.05), independent of cumulative exposure to SBP during follow-up. Conversely, cumulative exposure to SBP and DBP was not associated with hippocampal volume. There was no interaction by sex or race between ARVSBP or SDSBP with hippocampal volume or integrity. In conclusion, visit-to-visit BP variability during young adulthood may be useful in assessing the potential risk for reductions in hippocampal volume and integrity in midlife.