AN INCREASE in systolic blood pressure variability (SBPV) over time is associated with a significantly higher risk of cardiovascular disease, chronic kidney disease, and overall mortality, according to a new study.
Multifaceted evidence has established that SBPV, independent of average systolic blood pressure, is a key predictor of adverse health outcomes. However, most previous studies evaluated SBPV at a single time point, leaving the impact of changes in SBPV over time less well understood. This recent study addressed that gap by examining how temporal changes in SBPV relate to the risk of cardiovascular events, chronic kidney disease (CKD), dementia, and death in a large UK primary care population.
The analysis included 36,251 UK Biobank participants, with SBPV calculated as the standard deviation of at least three systolic blood pressure readings from two periods: 5–10 years (Period 1) and 0–5 years (Period 2) before enrolment. Participants were followed for a median of 13.9 years. Cox proportional hazards models assessed the association between absolute changes in SBPV and clinical outcomes. Results showed that participants with the greatest increase in SBPV (above the third tertile) had a 23%–33% higher risk of cardiovascular disease, coronary heart disease, stroke, CKD, and all-cause mortality compared to those with the greatest reduction (below the first tertile), all with P for trend < .005. While increases in SBPV were also linked to higher risks of atrial fibrillation, heart failure, and dementia, these associations did not reach statistical significance. Furthermore, those with consistently high SBPV across both periods faced a 28%–46% increased risk of adverse outcomes compared to those with consistently low SBPV. The findings were robust across subgroup and sensitivity analyses, and no non-linear associations were identified14.
In conclusion, rising SBPV over time is a strong, independent predictor of cardiovascular events, CKD, and death. These results highlight the clinical importance of monitoring SBPV longitudinally, not just mean blood pressure, in routine practice. Incorporating SBPV assessment into risk stratification could improve early identification of patients at elevated risk and inform targeted management strategies. Future research should focus on practical approaches for SBPV monitoring, such as home blood pressure measurements, and evaluating interventions, particularly long-acting calcium-channel blockers and thiazide-like diuretics, that may reduce SBPV and its associated risks
Reference
Cheng X et al. Systolic blood pressure variability: risk of cardiovascular events, chronic kidney disease, dementia, and death. European Heart Journal. 2025;ehaf256.
