_{AUTHOR: Liam ONeill}

While elevated systolic blood pressure variability (SBPV) is a known risk factor for adverse health outcomes, new research published in the European Heart Journal suggests that the change in SBPV over time is also a critical prognostic indicator. The study found that an increase in visit-to-visit SBPV over a 10-year period was significantly associated with a higher risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and all-cause mortality, independent of mean systolic blood pressure (SBP).¹

This prospective cohort study analysed primary care data from 36,251 participants in the UK Biobank. Researchers calculated visit-to-visit SBPV, defined as the standard deviation of three or more SBP measurements, during two distinct 5-year intervals prior to study enrolment: 5–10 years before (Period 1) and 0–5 years before (Period 2).

The primary analysis assessed the association between the absolute change in SBPV from Period 1 to Period 2 and the risk of several clinical outcomes, including CVD, coronary heart disease (CHD), stroke, atrial fibrillation and flutter (AF), heart failure (HF), CKD, dementia, and overall mortality. The study also examined risk based on nine SBPV change patterns (e.g., consistently low, low-to-high, consistently high).

Over a median follow-up of 13.9 years, an increase in SBPV from Period 1 to Period 2 was significantly associated with an elevated risk for multiple adverse outcomes. After full adjustment, participants with the greatest increase in SBPV (Tertile 3) had a significantly higher risk compared to those with the greatest reduction (Tertile 1) for:

• CVD (HR 1.23; 95% CI 1.14–1.34)
• CHD (HR 1.30; 95% CI 1.16–1.46)
• Stroke (HR 1.24; 95% CI 1.06–1.44)
• CKD (HR 1.33; 95% CI 1.15–1.52)
• Overall mortality (HR 1.25; 95% CI 1.13–1.38)

When analysing change patterns, individuals with consistently high SBPV across both periods had a 28–46% greater risk of CVD, CHD, stroke, AF, HF, CKD, and overall mortality compared to those with consistently low SBPV. For instance, the risk of HF was 46% higher (HR 1.46; 95% CI 1.15–1.86) and the risk of stroke was 45% higher (HR 1.45; 95% CI 1.18–1.78) in the consistently high group.

These findings underscore the clinical importance of monitoring not just absolute SBPV but also its trajectory over time. While previous meta-analyses have established SBPV as a risk factor,² this study provides novel evidence on the prognostic value of its dynamic changes. The authors concluded, “An increase in SBPV over time was associated with an elevated risk of CVD, CKD, and overall mortality. These findings provide compelling evidence to inform the importance for the management of SBPV in clinical practice.”¹ The results suggest that SBPV is a potentially modifiable factor and that interventions to stabilise blood pressure fluctuations could be a valuable therapeutic goal.

The authors noted the observational nature of the study and called for further research to confirm a causal relationship. They stated that ad hoc designed randomised controlled trials are warranted to validate these findings and to help identify effective strategies for optimal SBPV management.

References

1. Cheng X, Song C, Ouyang F, et al. Systolic blood pressure variability: risk of cardiovascular events, chronic kidney disease, dementia, and death. Eur Heart J. 2025;46(27):2673–2687. https://doi.org/10.1093/eurheartj/ehaf256

2. Stevens SL, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ. 2016;354:i4098. https://doi.org/10.1136/bmj.i4098

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