Ps-p15-2: changes in home blood pressure variability during down-titration of antihypertensive drugs in patient with systolic home blood pressure below 120mmhg

Background: In the guideline recommendation for intensive blood pressure (BP) control, there has been a concern for the J-curve phenomenon so European guidelines recommended down-titration if systolic BP (SBP) lowered below 120 mmHg. But there is no studies for the changes in BP and BP variability with down-titration. Aim of the study is to test the hypothesis that BP variability could be increased with down-titration. Methods: In a retrospective study, 82 patients undergone down-titration in whom home BP monitoring (HBPM) before and after were available were analyzed during 2020.09.01∼2022.05.31. During this period, the guideline directed medical therapy was to down-titrate when home SBP was below 120 mmHg. When preclinic SBP below 120 mmHg, down-titration was performed when home SBP was less than 120 mmHg in the next visit or incidental home SBP less than 120 mmHg regardless of clinic SBP level. Minimal and maximal required numbers of readings in HBPM were 8 and 40. Average and standard deviation (SD) were compared before after down-titration. Results: Mean age was 66.2(34∼95) years and female readings were 44 (53.7%). Preclinic SBP was 122.4 + /-17.5 mmHg and clinic SBP was 121.9 +/-14.2 mmHg at baseline (BL). Clinic SBP at follow up (FU) was 126.4 +/-15.5 mmHg. History of cardiovascular diseases, diabetes and hyperlipidemia were present in 17%, 32.9%, and 69.5%, respectively. Numbers of AHMS were 1 in 26.8%, 2 in 30.5%, 3 in 32.9%, and 4 in 9.7%. The uses of renin angiotensin blockade, beta blocker, calcium antagonist, and diuretics were 84.1%, 36.5%, 75.6% and 29.3%, respectively. Home SBP was increased significantly (111.6 mmHg BL, 118.8mmHg FU, p < 0.0001). SD of home SBP did not increased significantly (3.5 mmHg BL, 3.4 mmHg FU, p = 0.85). Home diastolic BP (DBP) was also increased significantly (68.7 mmHg BL, 72.8 mmHg FU, p < 0.0001). SD of home DBP did not changed (2.2 mmHg BL, 1.6 mmHg, p = 0.55). Conclusion: When antihypertensive drug was down-titrated due to excessive lowering of systolic BP less than 120 mmHg, mean BPs were increased modestly without increase in BP variability. Current guideline directed down-titration should be safe without increasing BP variability.