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In 57,611 UK Biobank participants, greater variation in blood pressure readings between research visits was associated with a higher risk of death, even after researchers accounted for average blood pressure and other factors. Variation in diastolic pressure and mean arterial pressure was also associated with stroke, but the observational study does not show that fluctuations cause these outcomes or that tracking them in routine care would prevent them.
A study of 57,611 UK Biobank participants found that greater variation in blood pressure between research visits was associated with a higher risk of death, while variation in some measures was also associated with stroke. The findings, presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Milan, suggest that fluctuations may provide information beyond average blood pressure, but do not establish that the fluctuations cause harm or should be tracked routinely in clinical care.
The researchers assessed four measures: systolic and diastolic blood pressure, mean arterial pressure and pulse pressure. They accounted for the time between readings when calculating how much each participant’s measurements varied. The analysis included people with an initial reading and at least one later visit; their average age was 55.4, and 52% were women. At the start, 50,744 had normal blood sugar, 5,397 had prediabetes and 1,470 had type 2 diabetes.
During a median follow-up of 5.1 years from the first visit at which variability could be calculated, 1,460 participants died and 571 had a stroke. Greater variability in all four blood pressure measures was associated with a higher risk of death from any cause. The associations persisted after adjustment for average blood pressure, blood sugar status and other factors.
Each one-standard-deviation increase in systolic pressure variability was associated with an 11% higher risk of death; the corresponding association for diastolic variability was 8%. Greater diastolic pressure and mean arterial pressure variability were associated with stroke risks 12% and 10% higher, respectively, per standard-deviation increase. These are relative associations, not changes in blood pressure measured in millimeters of mercury.
Why Reading Fluctuations May Matter
Routine assessments commonly consider a person’s average blood pressure, while variability between visits is not routinely included in risk assessment, according to the report. If further research confirms that variability adds useful information, it could help identify people whose risk is not apparent from average readings alone.
The diabetes comparisons point to a possible area for closer study. Participants with type 2 diabetes and high systolic variability were 2.8 times as likely to die during follow-up as those with normal blood sugar and low variability. The researchers also estimated 10-year death risks of about 2.9% for the former group and 1.0% for the latter. These comparisons combine blood sugar status and variability, so they do not isolate the contribution of blood pressure fluctuations.
The findings do not show that measuring or reducing variability would prevent stroke or death. The study was observational, and its authors say more evidence is needed before variability can be recommended for routine clinical use.
How Researchers Measured Variation
The study was led by Dr. Fariba Ahmadizar of the Department of General Practice at Amsterdam University Medical Center in the Netherlands. Researchers used repeated blood pressure measurements from UK Biobank participants and considered the elapsed time between visits when estimating variability.
They followed participants for a median of 5.1 years from the first visit when a variability estimate could be made. Across that period, 319 participants developed dementia, 571 had a stroke and 1,460 died. The researchers reported no statistically significant association between blood pressure variability and dementia.
A standard deviation indicates how much variability differed among participants. The reported 11%, 8%, 12% and 10% figures describe differences in relative risk for each standard-deviation increase in variability; they do not specify a corresponding change in mmHg. The source report does not provide the full study paper or enough methodological detail to assess every adjustment and limitation.
“Our findings suggest that changes in blood pressure over time may provide information beyond the average blood pressure readings in routine care.”
— Dr. Fariba Ahmadizar, Amsterdam University Medical Center
What the Study Cannot Establish
Because this was an observational study, it cannot determine whether blood pressure variability contributes to death or stroke, or whether other factors help explain the associations. The source report says associations remained after adjustment for average blood pressure, blood sugar status and other factors, but does not establish cause and effect.
It is also unknown whether fluctuations can be reduced in a way that lowers health risks. The combined diabetes and variability comparisons cannot attribute the higher risk to variability alone. No statistically significant association with dementia was found, which does not establish that no relationship exists.
Evidence Needed Before Clinical Use
The researchers say further studies are needed to test whether blood pressure variability adds reliable information to routine risk assessments. They also identify two unresolved questions: whether fluctuations can be reduced and whether reducing them lowers the risk of stroke or death.
Until those questions are answered, the study supports an association for further investigation, not a recommendation to change how blood pressure is measured or managed. The source report does not specify a date for additional results or identify a planned follow-up study.
Key Questions
What did the study find?
Greater variation in blood pressure between research visits was associated with a higher risk of death. Variation in diastolic pressure and mean arterial pressure was also associated with higher stroke risk.
Does the study show that blood pressure fluctuations cause death or stroke?
No. It was observational, so it found associations but did not prove that fluctuations caused either outcome.
How large were the reported risk differences?
Each one-standard-deviation increase in systolic variability was associated with an 11% higher risk of death; the figure was 8% for diastolic variability. These percentages describe relative associations and cannot be translated directly into a specific change in mmHg.
Should blood pressure variability be used in routine care now?
The study authors said more research is needed before variability can be recommended for routine clinical use.
Was blood pressure variability associated with dementia?
The researchers found no statistically significant association with dementia in this analysis. That result does not prove that no relationship exists.
Source: rss
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