Short-term blood pressure variability assessed by ambulatory blood pressure monitoring as a predictor of subclinical target organ damage

Background Short-term blood pressure variability (BPV) from 24-h ambulatory blood pressure monitoring (ABPM) lacks evidence for predicting subclinical target organ damage (TOD). Objective The study assessed BPV from ABPM for subclinical TOD prediction in hypertension. Methods This retrospective study screened 180 essential hypertension patients at Quanzhou First Hospital between January 2023 and December 2025, and 176 patients were enrolled after exclusion. All participants underwent standardized 24-h ABPM examination. Several short-term BPV parameters were calculated, including standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) for systolic blood pressure (SBP) and diastolic blood pressure (DBP) across 24-h, daytime, and nighttime periods. Patients were allocated into a TOD group and a non-TOD group based on the presence or absence of subclinical TOD. Multivariate logistic regression was used to assess BPV indices as independent predictors of subclinical TOD. Receiver operating characteristic (ROC) curve analysis assessed the predictive performance of these indices with the area under the curve (AUC) calculated. Results Among 176 patients, 94 were assigned to the TOD group and 82 to the non-TOD group, with balanced baseline characteristics (all P > 0.05). The TOD group showed significantly higher 24-h, daytime, and nighttime BP SD, CV, and ARV (all P < 0.001). Multivariate logistic regression identified nighttime SBP SD, 24-h SBP ARV, and nighttime SBP ARV as independent predictors of subclinical TOD (all P < 0.05). ROC analysis showed nighttime SBP SD had an AUC of 0.837 (95% CI: 0.773–0.901), cutoff 12.25 mmHg, sensitivity 89.4%, specificity 78.0%, outperforming other indices (all P < 0.05). Subgroup analyses confirmed nighttime SBP SD independently predicted cardiac, vascular, and renal TOD, while 24-h SBP ARV predicted cardiac and vascular injury (all P < 0.05). Conclusion Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension.