Short- and mid-term blood pressure variability as predictors of in-hospital outcomes in acute myocardial infarction

Background Blood pressure variability (BPV) is increasingly recognized as a prognostic marker in cardiovascular disease. However, the combined impact of short-term and mid-term BPV on acute, in-hospital outcomes following acute myocardial infarction (AMI) remains insufficiently characterized. Methods In this prospective, single-center cohort study, both short-term and mid-term BPV were evaluated in patients hospitalized with AMI. Short-term BPV was assessed using average real variability (ARV) derived from 24-hour ambulatory blood pressure monitoring (ABPM), while mid-term BPV was calculated as the standard deviation (SD) of daily in-hospital blood pressure measurements. Associations with in-hospital outcomes, including mortality and major adverse cardiovascular events (MACE), were analyzed using multivariable logistic regression models. Results Among 441 AMI patients, increased mid-term systolic BPV (SBP-SD) was strongly associated with in-hospital MACE, with each 1 mmHg increase conferring a 24% higher risk (OR 1.24, 95% CI 1.17–1.31). Patients in the highest quartile (Q4) of SBP-SD demonstrated a markedly elevated risk of in-hospital MACE compared with Q1 (OR 28.89, 95% CI 8.58–97.28). Short-term systolic BPV assessed by ABPM (SBP-ARV) independently predicted in-hospital mortality (OR 1.58, 95% CI 1.21–2.07) and MACE (OR 1.35, 95% CI 1.23–1.48). Elevated diastolic BP-ARV was significantly associated with in-hospital myocardial infarction, malignant arrhythmias, and cardiogenic shock. All associations remained significant after adjustment for mean blood pressure and established clinical risk factors. Conclusion Both short-term and mid-term systolic BPV independently and synergistically predict adverse in-hospital outcomes in AMI patients. BPV assessment during hospitalization may enhance early risk stratification beyond conventional blood pressure metrics.