Key result
Higher mid-term systolic BPV after AMI is linked to ~29.9-fold higher composite adverse outcomes.
Why the study?
The long-term prognostic significance of short-term and mid-term blood pressure variability assessed during the index hospitalization for acute myocardial infarction remains incompletely understood.
Does higher short-term and mid-term blood pressure variability during index hospitalization predict long-term all-cause mortality and composite adverse cardiovascular outcomes in patients with acute myocardial infarction?
Cohort
Does higher short-term and mid-term blood pressure variability during index hospitalization predict long-term all-cause mortality and composite adverse cardiovascular outcomes in patients with acute myocardial infarction?
Both short-term and mid-term systolic blood pressure variability assessed during hospitalization for acute myocardial infarction independently predict 3-year all-cause mortality and composite cardiovascular events.
High mid-term systolic BP variability during AMI hospitalization was associated with composite risk; hypothesis-generating for prospective trials before any practice change.
Background Blood pressure variability (BPV) reflects impaired cardiovascular regulation and has been linked to adverse prognosis. The long-term prognostic significance of short-term and mid-term BPV assessed during the index hospitalization for acute myocardial infarction (AMI) remains incompletely understood. Methods In a prospective cohort of AMI patients, short-term BPV was quantified using systolic and diastolic ARV from 24-hour ABPM, while mid-term BPV was calculated as the SD of daily in-hospital systolic blood pressure measurements. Patients were followed for 3 years. Cox proportional hazards models assessed associations with all-cause mortality and composite adverse cardiovascular outcomes. Results Higher mid-term systolic BPV was strongly associated with adverse long-term prognosis. Patients in the highest quartile (Q4) of SBP-SD had a significantly increased risk of composite outcomes (HR 29.88, 95% CI 10.93–81.66) and all-cause mortality (HR 11.85, 95% CI 2.81–49.91) compared with Q1. Short-term systolic BPV measured by SBP-ARV independently predicted all-cause mortality (HR 1.37, 95% CI 1.25–1.51) and composite adverse events (HR 1.29, 95% CI 1.22–1.36). In contrast, diastolic BPV was primarily associated with arrhythmias and heart failure hospitalization, with weaker associations for mortality. These relationships persisted after multivariable adjustment. Conclusion Both short-term and mid-term systolic BPV assessed during AMI hospitalization independently predict long-term mortality and cardiovascular events. BPV represents a stable and powerful prognostic marker that may inform post-infarction surveillance and therapeutic strategies.
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Κωνσταντίνου et al. (2026) conducted a cohort in Acute myocardial infarction. Higher mid-term and short-term systolic blood pressure variability (Q4 of SBP-SD and SBP-ARV) vs. Lowest quartile (Q1) of systolic blood pressure standard deviation was evaluated on Composite adverse cardiovascular outcomes and all-cause mortality (HR 29.88, 95% CI 10.93-81.66). Higher mid-term systolic BPV (Q4 vs Q1) after AMI strongly predicted composite adverse outcomes (HR 29.88, 95% CI 10.93-81.66) and all-cause mortality (HR 11.85, 95% CI 2.81-49.91).
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