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A large pooled analysis found that calcium channel blockers (CCBs) reduce visit-to-visit blood pressure swings more effectively than RAS inhibitors or diuretics in high-risk hypertensive patients. Despite this advantage, no significant difference in major cardiovascular events was observed between drug classes. The findings, drawn from the ACCORD-BP and SPRINT trials, raise questions about whether blood pressure variability is a meaningful treatment target.
A new target trial emulation study pooling data from two major randomized trials — ACCORD-BP and SPRINT — found that calcium channel blocker (CCB)-based antihypertensive regimens were consistently associated with lower visit-to-visit systolic blood pressure variability (BPV) compared to regimens based on renin-angiotensin system (RAS) inhibitors or diuretics. Importantly, this was true even though all groups achieved similar average blood pressure levels, suggesting CCBs offer a stabilizing effect beyond simple pressure reduction.
The findings were presented at the World Stroke Congress 2026 in Seoul. Among 2,754 matched participants (mean age 65.9 years), CCB-based therapy showed significantly lower BPV both as monotherapy and in combination — yet no meaningful difference in major adverse cardiovascular events (MACE) was detected across treatment strategies.
Key Takeaways
Why it matters: While CCBs appear to smooth out blood pressure fluctuations better than other first-line agents, the lack of a corresponding cardiovascular benefit challenges the assumption that lower BPV directly translates to better outcomes — a key consideration for clinicians choosing antihypertensive regimens.
