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A study of 57,611 UK Biobank participants found that greater variation in blood pressure between research visits was associated with higher risk of death. Variation in diastolic pressure and mean arterial pressure was also associated with stroke, while no significant link to dementia was found. The observational findings do not show that blood pressure fluctuations cause these outcomes.
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, and 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 the observational study does not show that they cause these outcomes.
Researchers led by Dr. Fariba Ahmadizar of Amsterdam University Medical Center assessed blood pressure readings taken at participants’ initial assessment and at least one later visit. They accounted for the time between measurements when calculating variability. Participants were followed for a median of 5.1 years from the first visit at which variability could be calculated.
During follow-up, 1,460 participants died and 571 had a stroke; 319 developed dementia. Greater variability in all four measures studied—systolic pressure, diastolic pressure, mean arterial pressure and pulse pressure—was associated with a higher risk of death from any cause. Those associations remained after researchers accounted for average blood pressure, blood sugar status and other factors. Greater variability in diastolic pressure and mean arterial pressure was also associated with higher stroke risk. The researchers found no statistically significant association with dementia.
For each one-standard-deviation increase in variability, systolic pressure was associated with an 11% higher risk of death, and diastolic pressure with an 8% higher risk. For stroke, the reported increases were 12% for diastolic pressure variability and 10% for mean arterial pressure variability. These percentages describe relative risk differences per standard deviation in variability; they do not translate directly into a specific change in blood pressure measured in mmHg.
What Blood Pressure Fluctuations May Add
Routine assessments commonly focus on average blood pressure, while variability between visits is not routinely included in risk assessment. The study raises the possibility that repeated readings could reveal risk information that a single average does not capture. If further research supports that use, variability might help clinicians identify some people whose risk is not apparent from average readings alone.
The findings also point to a possible overlap between blood sugar status and blood pressure variability. Participants with type 2 diabetes and high systolic pressure variability were 2.8 times as likely to die during follow-up as those with normal blood sugar and low variability. The researchers estimated 10-year mortality risk at about 2.9% for the former group and 1.0% for the latter. These comparisons combine two differences, so they do not isolate the contribution of variability.
How the UK Biobank Study Worked
The analysis included participants with blood pressure measured at an initial assessment 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. Prediabetes refers to blood sugar higher than normal but below the level used to classify diabetes.
The researchers compared outcomes across differing levels of blood pressure variation between visits, taking the interval between readings into account. The study was observational: it tracked associations in existing participant data rather than assigning an intervention to change blood pressure variability. That design can identify patterns, but cannot establish that variability itself caused deaths or strokes.
“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
Cause and Clinical Use Remain Open
The results show associations, not cause and effect. Other factors could help explain why participants with greater variability had higher risks, despite the researchers’ adjustments. The report also does not establish whether reducing fluctuations would reduce the risk of death or stroke, or whether measuring variability would improve decisions in routine care.
The study’s risk comparisons need careful interpretation. In particular, the 2.8-fold mortality comparison combines type 2 diabetes and high systolic variability against normal blood sugar and low variability. It cannot be read as the effect of variability alone. The reported percentage changes per standard deviation also do not specify an individual’s likely outcome.
Research Needed Before Routine Screening
Ahmadizar said further research is needed before blood pressure variability can be recommended for routine clinical use. Researchers still need to determine whether the fluctuations can be reduced and, if so, whether doing so lowers stroke or death risk. Until those questions are answered, the study offers evidence of a relationship in this participant group rather than a new clinical recommendation.
Key Questions
What did the researchers find?
Greater variation in four blood pressure measures between research visits was associated with higher risk of death. Variation in diastolic pressure and mean arterial pressure was also associated with stroke.
Does the study show that blood pressure variation causes death or stroke?
No. The study was observational, so it found associations but could not establish that variability caused the outcomes.
What did the study find about diabetes?
Participants with type 2 diabetes and high systolic pressure variability had a 2.8 times higher risk of death than participants with normal blood sugar and low variability. That comparison combines both factors and does not show the separate effect of variability.
Was blood pressure variability linked to dementia?
The researchers found no statistically significant association between blood pressure variability and dementia in this study.
Should people change how they monitor or manage blood pressure?
The study does not establish a new monitoring or treatment recommendation. Its authors said more research is needed before variability can be recommended for routine clinical use.
Source: rss
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