Objective: ANCA-associated vasculitis (AAV) is a severe systemic inflammatory disease associated with a heightened risk of cardiovascular complications. Although blood pressure variability has been identified as a prognostic factor in various clinical settings, its significance in patients with AAV remains inadequately explored. We aimed to evaluate whether long term fluctuations in systolic blood pressure (SBP) could predict the risk of death in patients with AAV. Design and method: We retrospectively analyzed data from 95 AAV patients with kidney involvement. We calculated standard deviation (SD) of their SBP measurements across follow-up visits during the maintenance phase to assess variability. Patients were divided into three groups based on SBP variability. We collected clinical and lab data, as well as treatment information, and used Cox regression to study the relationship between SBP variability and mortality. Survival was also analyzed with Kaplan-Meier curves. Results: During a median follow-up of 58 months, 14 patients died. Deceased patients were older and had higher PP and VVV. Hypertension prevalence increased across VVV tertiles (35%, 62%, 69%; p = 0.02). The univariate analysis demostrated that higher SBP SD, pulse pressure (PP), higher 24 h proteinuria and age at onset were associated with outcome (Table 1). After adjusting for age, sex, PP, kidney function, and proteinuria, high SBP variability remained a strong predictor of mortality (HR 15.5, P=0.02, Table 1). Event-free survival was significantly lower in 3rd tertile as shown by Kaplan-Meier curves (Figure 1, log rank test p=0.0014). Conclusions: Our findings indicate that long-term SBP variability is a significant predictor of mortality risk in patients with AAV. Routine monitoring of blood pressure variability may aid in identifying high-risk individuals and shape targeted management strategies.
Bussalino et al. (2026) studied this question.