Trial reportHypertension (Dallas, Tex. : 1979)2016
The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.
Open access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
In one paragraph
Trial report in Hypertension (Dallas, Tex. : 1979), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 1 of them a synthesis that pooled it.
0numbers the graph read from it
0cells of the map it votes in
52citing papers in PubMed, 1 pooled it
9.2field-weighted citation impact, top 2% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
52 citing papers in PubMed, 1 synthesis or guideline pooled it, 95 citations in OpenAlex.
- Prognostic value of blood pressure variability in patients with heart failure: a systematic review and meta-analysis.Journal of human hypertension · 2026Pooled it
- Blood Pressure Visit Intensification in Treatment (BP-Visit) Findings: a Pragmatic Stepped Wedge Cluster Randomized Trial.Journal of general internal medicine · 2022Trial
- Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly.Hypertension (Dallas, Tex. : 1979) · 2020Trial
- Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial).Hypertension (Dallas, Tex. : 1979) · 2017Trial
- Systolic Blood Pressure Variability and Outcomes in Atrial Fibrillation: A Nationwide Population Study in Korea.Journal of Korean medical science · 2026Article
- Association Between Symptoms of Anxiety and Depression and Blood Pressure Variability in Older Outpatients.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026Observational
- The impact of blood pressure variability and African Caribbean ethnicity on the progression of diabetic kidney disease in type 1 diabetes.Diabetologia · 2026Article
- Visit-to-visit blood pressure variability and dementia risk after considering antihypertensive treatment: real-world data from the Japanese National Health Insurance.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Long-Term Blood Pressure Variability and Physical Performance in Older Adults.Journal of clinical hypertension (Greenwich, Conn.) · 2025Observational
- Impact of Variability in Blood Pressure and Heart Rate on Beta-Blocker Adherence.Journal of clinical hypertension (Greenwich, Conn.) · 2025Article
- Article
- The effect of visit-to-visit blood pressure variability on cognitive function: state-of the-art.Cerebral circulation - cognition and behavior · 2025Article
- Factors associated with inadequate blood pressure control among hypertensive individuals living in a Quilombola Community: a cross-setional study, Brazil, 2017-2018.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2025Article
- Impact of blood pressure and medication adherence on clinical outcomes in patients with hypertension.Frontiers in medicine · 2025Article
- Association of systolic blood pressure target and variability with long-term clinical outcomes in patients undergoing percutaneous coronary intervention.Clinical hypertension · 2025Article
- Cardiovascular Precision Medicine and Remote Intervention Trial Rationale and Design.Journal of clinical medicine · 2024Article
- Exploring the link between blood pressure variability and atrial fibrillation: current insights and future directions.Journal of human hypertension · 2024Review
- Gray matter volume mediates the association of long-term blood pressure variability with cognitive function in an adult population.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- Systolic blood pressure visit-to-visit variability and outcomes in Asian patients with atrial fibrillation.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Article
- Temporal and Bidirectional Association Between Blood Pressure Variability and Arterial Stiffness: Cross-Lagged Cohort Study.JMIR public health and surveillance · 2023Article
Corrections and comments
- Commented on by
Authors and funding
10 authors at 4 institutions in 1 country.
Ian M KronishFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.). ik2293@cumc.columbia.edu.
Amy I LynchFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Suzanne OparilFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Jeff WhittleFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Barry R DavisFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Lara M SimpsonFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Marie Krousel-WoodFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
William C CushmanFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Tara I ChangFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Paul MuntnerFrom the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Department of Epidemiology (A.I.L., P.M.) and Division of Cardiology (S.O.), University of Alabama at Birmingham; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston (B.R.D., L.M.S.); Department of Medicine, Tulane University School of Medicine, Department of Epidemiology, Tulane University School of Public Health, and Tropical Medicine, Research Division, Ochsner Health System (M.K.-W.); Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); and Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.I.C.).
Columbia University Irving Medical Center · USUniversity of Alabama at Birmingham · USVeterans Health Administration · USOchsner Health System · US
Funding
Tracking & Evaluation CoreU54GM104940 · NIGMS · LSU PENNINGTON BIOMEDICAL RESEARCH CTR · PI Peter Todd Katzmarzyk · 2012 to 2026
$69.1MClinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2MUniversity of Alabama at Birmingham's Diabetes Research CenterP30DK079626 · NIDDK · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Stuart J Frank · 2013 to 2026
$19.5MCLINICAL TRIALS CENTER FOR ALLHAT-N01HC35130-268035130N01HC035130 · HC · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · 1993 to 2005
$6.3MModel Based Approach to Improving Hypertension Control in PopulationsR01HL130500 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI MORAN, ANDREW EDWARD · 2016 to 2019
$2.4MPTSD, Medication Adherence, and Prognosis after Acute Coronary SyndromesR01HL123368 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI DAVIDSON, KARINA W., KRONISH, IAN MATTHEW · 2014 to 2017
$1.6MVisit-to-visit variability of blood pressure and CVD and renal outcomesR01HL110993 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI MUNTNER, PAUL · 2012 to 2014
$1.1MTowards optimizing care for cardiovascular disease in chronic kidney diseaseK23DK095914 · NIDDK · STANFORD UNIVERSITY · PI CHANG, TARA I-HSIN · 2013 to 2017
$908kUncontrolled hypertension - the role of medication adherence and clinical inertiaK23HL098359 · NHLBI · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI KRONISH, IAN MATTHEW · 2010 to 2014
$688kNCATS NIH HHS UL1 TR000040NHLBI NIH HHS HHSN268201100036CNHLBI NIH HHS K23 HL098359NHLBI NIH HHS N01 HC035130NHLBI NIH HHS R01 HL110993NHLBI NIH HHS R01 HL123368NHLBI NIH HHS R01 HL130500NIDDK NIH HHS K23 DK095914NIDDK NIH HHS P30 DK079626NIGMS NIH HHS U54 GM104940
Abstract
Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80% of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95% confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95% confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.
Indexed as
Drug MonitoringAdrenergic alpha-AntagonistsAgedAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBlood Pressure DeterminationCalcium Channel BlockersDouble-Blind MethodElectrocardiographyFemaleFollow-Up StudiesHumansHypertensionHypolipidemic AgentsLinear ModelsMaleAdrenergic alpha-AntagonistsAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsCalcium Channel BlockersHypolipidemic Agentsblood pressurecardiovascular diseasehypertensionmedication adherenceprognosis
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