Key result
Medium-term systolic BP variability is linked to mortality with ~one-third the impact of mean SBP.
Why the study?
The influence of blood pressure variability over short and medium timescales on long-term all-cause and cardiovascular mortality risk was not well characterized beyond average blood pressure effects.
Does short-term and medium-term blood pressure variability predict long-term all-cause and cardiovascular mortality?
Cohort
Does short-term and medium-term blood pressure variability predict long-term all-cause and cardiovascular mortality?
Medium-term, but not short-term, blood pressure variability is a significant independent predictor of long-term all-cause and cardiovascular mortality, adding prognostic value beyond mean blood pressure and the Framingham Risk Score.
BP variability may associate with mortality beyond mean BP; hypothesis-generating in this cohort and needs prospective validation.
Until recently, there has been a focus on exploring the influence of average blood pressure (BP) on risk of mortality. We go beyond average BP to also investigate mortality risk with respect to variation in BP over 2 timescales-short-term variation among multiple measures at 1 visit, and medium-term variation among the measures at 2 visits several months apart. We present an application of Bayesian hierarchical modeling to the problem of estimating the effect of BP variability on all-cause and cardiovascular mortality. We use data from the Third National Health and Nutrition Examination Survey linked with up to 27 years of mortality follow-up. We find that medium-term systolic BP variability had a very significant predictive value for all-cause mortality in addition to mortality from cardiovascular disease, cerebrovascular disease and heart-attacks combined, approximately 1/3 as large as the well-established impact of mean systolic BP. Medium-term diastolic variability had an additional, although smaller, predictive effect. Short-term variability, in contrast, had little or no measurable predictive value. The medium-term variability effect persisted when controlling for Framingham Risk Score.
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Steinsaltz et al. (2024) reported a cohort. Medium-term and short-term blood pressure variability was evaluated on All-cause and cardiovascular mortality. Medium-term systolic blood pressure variability had a significant predictive value for all-cause and cardiovascular mortality, approximately one-third as large as the impact of mean systolic BP.
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