Key result
Adding 24-hour blood pressure variability to mean blood pressure improves prediction of fatal cardiovascular outcomes.
Why the study?
It was uncertain whether adding 24-h blood pressure variability to 24-h mean blood pressure improves prediction of cardiovascular and all-cause fatal outcomes.
Does adding 24-h blood pressure variability to 24-h mean BP improve the predictive value for cardiovascular and all-cause mortality?
Cohort
Does adding 24-h blood pressure variability to 24-h mean BP improve the predictive value for cardiovascular and all-cause mortality?
Incorporating 24-hour blood pressure variability metrics significantly improves the prognostic accuracy of ambulatory blood pressure monitoring for predicting cardiovascular and all-cause mortality.
Erratic 24-h BP variability independently predicted CV mortality beyond mean BP in this cohort; leaves open whether variability metrics should inform risk stratification or trials.
OBJECTIVE: To determine whether adding 24-h blood pressure (BP) variability to 24-h mean BP improves the BP predictive value for cardiovascular and all-cause fatal outcomes. METHODS: In 1993, among individuals of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population, 24-h mean BP was calculated from the mean of three hourly measurements. BP variability was quantified as the weighted standard deviation of the 24-h mean BP, the 24-h average real variability and the 24-h erratic BP variations by Fourier analysis. Variability values were used after removal of the fraction explained by their linear relationship with 24-h mean BP. Data were adjusted for baseline covariates but because of within-subject comparisons unadjusted data were also used. RESULTS: During a 24.6 years follow-up, 250 cardiovascular and 798 all-cause deaths occurred. Adding any of the BP variability measures to 24-h mean BP significantly improved the goodness of fit of the data to the Cox prediction model used to estimate cardiovascular risk and all-cause mortality. This occurred also when BP variability was added to the net reclassification improvement (NRI) index. In subgroup analysis, a significant increase in the risk of cardiovascular and all-cause mortality was consistent in subjects with both 24-h mean and variability at least at their median value. CONCLUSION: Addition of 24-h BP variability improves the prognostic estimate of the risk of cardiovascular and all-cause mortality associated with 24-h mean BP. This supports an upgrading of information on BP variability in ambulatory BP monitoring reports to better exploit the potential of this approach as risk estimate.
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Mancia et al. (2026) reported a cohort. 24-h blood pressure variability combined with 24-h mean blood pressure vs. 24-h mean blood pressure alone was evaluated on Cardiovascular and all-cause fatal outcomes. Over 24.6 years of follow-up (250 cardiovascular and 798 all-cause deaths), adding 24-hour blood pressure variability to 24-hour mean blood pressure significantly improved risk prediction.
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