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Multicenter Study
. 2025 May;27(5):e70065.
doi: 10.1111/jch.70065.

Impact of Variability in Blood Pressure and Heart Rate on Beta-Blocker Adherence

Yan Li  1 , Jia-Yin Sun  2 , Qian-Yun Guo  2 , Hong-Ya Han  2 , De-An Jia  2 , Zhi-Ming Zhou  2 , Zhi-Jian Wang  2 , Ying-Xin Zhao  2 , Yu-Jie Zhou  1   2 , Shi-Wei Yang  1   2
Affiliations
Multicenter Study

Impact of Variability in Blood Pressure and Heart Rate on Beta-Blocker Adherence

Yan Li et al. J Clin Hypertens (Greenwich). 2025 May.

Abstract

Adherence to antihypertensive medications is essential for blood pressure (BP) control, influencing long-term outcomes in hypertensive patients. This study examines the association between visit-to-visit variability in BP and heart rate (HR) and its effect on adherence to beta-blocker therapy among outpatients. Conducted across 160 hospitals in China from January 1, 2011, to December 31, 2011, this study included 9225 hypertensive outpatients prescribed metoprolol succinate. BP and HR variability were assessed over three visits (baseline, 1-month, and 2-month follow-up) using standard deviation (SD) and mean-independent parameters. Nonadherence was defined as medication discontinuation or treatment regimen changes by the 2-month follow-up. Among the 9037 patients analyzed, the mean age was 58.85 years (±12.54), and 52.9% were male. Visit-to-visit variability in the rate-pressure product (RPP; SBP×HR) was a significant predictor of nonadherence, with an odds ratio (OR) of 1.26 (95% confidence interval [CI]: 1.04-1.53, p < 0.05) for the top-decile SD of RPP, independent of mean RPP. Variability in diastolic blood pressure (DBP) and pulse pressure (PP) were also associated with nonadherence, with ORs of 1.65 (95% CI: 1.35-2.00, p < 0.001) for DBP and 1.66 (95% CI: 1.39-1.99, p < 0.001) for PP, independent of their mean values. Patients with fluctuations in PP or HR had a higher risk of nonadherence compared to those with consistent reductions in these measures. Visit-to-visit variability in RPP, DBP, and PP is a significant predictor of nonadherence to beta-blockers, regardless of mean levels. Addressing this variability is critical for improving adherence to antihypertensive treatments and optimizing patient outcomes.

Keywords: blood pressure; medication adherence; rate pressure product; visit‐to‐visit variability.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Odds ratios for the risk of nonadherence to beta‐blocker therapy by deciles of SD for SBP, DBP, PP, and RPP. DBP, diastolic blood pressure; PP, pulse pressure; RPP, rate‐pressure product; SBP, systolic blood pressure; SD, standard deviation.
FIGURE 2
FIGURE 2
Odds ratios for the risk of nonadherence to beta‐blocker therapy by deciles of ASV for SBP, DBP, PP, and RPP. ASV, average successive variability; DBP, diastolic blood pressure; PP, pulse pressure; RPP, rate‐pressure product; SBP, systolic blood pressure.
See this image and copyright information in PMC

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