Visit-to-visit systolic blood pressure variability was independently associated with higher risk of major cardiovascular events in a patient-level pooled analysis of the SPRINT and ACCORD trials published in European Heart Journal. The analysis also identified a J-shaped relationship suggesting increased cardiovascular risk at both low and high levels of systolic BP variability.
The study included 18,415 participants with at least three follow-up visits and a median of 12 blood pressure measurements during 3.6 years of follow-up. Visit-to-visit blood pressure variability was assessed from month 3 onward using multiple variability metrics, including variation independent of mean (VIM). Major cardiovascular events included myocardial infarction, stroke, and cardiovascular death.

Findings

• Higher systolic BP variability measured by SBP-VIM (highest vs lowest tertile) was associated with increased risk of major cardiovascular events (HR 1.15; 95% CI 1.00–1.32).
• Similar associations were observed for myocardial infarction and cardiovascular death.
• Restricted cubic spline analyses demonstrated a J-shaped relationship between systolic BP variability and cardiovascular outcomes (all P < .05).
• The prognostic value of SBP-VIM was comparable to that of mean systolic blood pressure.
• Findings remained consistent across alternative BP variability metrics and became more pronounced with longer follow-up.

The findings suggest that visit-to-visit systolic blood pressure variability may provide prognostic information independent of mean blood pressure levels.