High short-term blood pressure variability predicts long-term cardiovascular mortality in untreated hypertensives but not in normotensives

Pai Feng Hsu, Hao Min Cheng, Cheng Hsueh Wu, Shih Hsien Sung, Shao Yuan Chuang, Edward G. Lakatta, Frank C.P. Yin, Pesus Chou, Chen Huan Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the longterm prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the readto-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8 mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.

Original languageEnglish
Pages (from-to)806-813
Number of pages8
JournalAmerican Journal of Hypertension
Issue number7
StatePublished - Jul 2016


  • Ambulatory blood pressure
  • Blood pressure variability
  • Cardiovascular mortality
  • Hypertension


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