Paul S. Mueller, MD, MPH, FACP reviewing Stevens SL et al. BMJ 2016 Aug 9.

Large variability increased relative cardiovascular risks by 10% to 20%.

Most studies of blood pressure (BP) as a cardiovascular (CV) risk factor have used mean BP, but evidence suggests that BP variability, independent of mean BP, might also be important (NEJM JW Gen Med Sep 15 2015 and Ann Intern Med 2015; 163:329). In this meta-analysis of 19 prospective cohort studies and 17 clinical trials, researchers evaluated associations between adverse CV events and BP variability in the long term (measured at ≥5 clinic visits), midterm (measured at home ≥12 times on ≥3 days), and short term (measured by ambulatory monitoring for ≤24 hours, with ≥14 daytime readings). Studies that did not adjust for mean BP were excluded.

In studies with low risk for bias, long-term systolic BP variability was associated significantly with 10% to 20% higher risks for all-cause death, CV-related death, stroke, and coronary heart disease events. Midterm systolic BP variability was associated with 15% higher risk for all-cause death, and daytime short-term systolic BP variability was associated with roughly 11% higher risk for all-cause death, CV-related death, and stroke.

CITATION(S):

Stevens SL et al. Blood pressure variability and cardiovascular disease: Systematic review and meta-analysis. BMJ 2016 Aug 9; 354:i4098.

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