Association of systolic blood pressure variability per unit time with new-onset cardiovascular disease – Evidence from CHARLS

BACKGROUND AND AIM: Blood pressure variability (BPV) is an emerging risk factor for cardiovascular disease (CVD). However, the association between the magnitude of systolic blood pressure (SBP) fluctuations per unit time (utBPV) and CVD remains unclear. This study aimed to investigate the relationship between utBPV and incident CVD in a middle-aged and elderly population. METHODS AND RESULTS: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we enrolled 6134 participants aged ≥45 years without baseline CVD between 2011 and 2015. utBPV was defined as the sum of the absolute differences between consecutive SBP measurements divided by the time interval (mmHg/min). Multivariable logistic regression and restricted cubic spline analyses were employed to examine the association between utBPV and incident CVD, with subgroup analyses stratified by baseline hypertension status.During a median follow-up of 4 years, 657 incident CVD cases were observed. The results demonstrated that utBPV was a risk factor for CVD (OR: 1.018, 95 % CI: 1.005-1.031). In the non-hypertensive population, each 1-unit increase in utBPV was associated with a 2.8 % higher risk (P = 0.002). When analyzed by quartiles, the Q4 group had a 29.5 % increased risk compared to the Q1 group (95 % CI: 0.919-1.825), though the trend was not statistically significant (P = 0.166). No significant association was observed in hypertensive individuals. CONCLUSIONS: utBPV is an independent risk factor for incident CVD in non-hypertensive adults aged 45 years and older. Given its convenience for clinical measurement, utBPV may serve as a practical tool for early CVD risk assessment.