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A study presented at the European Association for the Study of Diabetes meeting found that greater variation in blood pressure between research visits was associated with higher risk of death, even after accounting for average blood pressure and other factors. Some measures of variation were also linked to stroke, but the observational findings do not show that blood pressure fluctuations cause these outcomes or that reducing them would lower risk.
Greater variation in blood pressure between research visits was associated with a higher risk of death among 57,611 UK Biobank participants, according to findings presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Milan. Variation in some blood pressure measures was also associated with stroke, although the observational study cannot establish that fluctuations caused either outcome.
The study, led by Dr. Fariba Ahmadizar of Amsterdam University Medical Center in the Netherlands, included participants whose blood pressure was recorded at an initial assessment and at least one later visit. Their average age was 55.4 years, and 52% were women. Researchers accounted for the time between measurements when estimating how much each person’s readings varied.
At the start, 50,744 participants had normal blood sugar, 5,397 had prediabetes and 1,470 had type 2 diabetes. Participants were followed for a median of 5.1 years from the first visit at which variation could be calculated. During follow-up, 1,460 died, 571 had a stroke and 319 developed dementia.
Greater variability across all four measures studied—systolic and diastolic pressure, mean arterial pressure and pulse pressure—was associated with a higher risk of death from any cause. The associations remained after researchers adjusted for average blood pressure, blood sugar status and other factors. Greater variation in diastolic pressure and mean arterial pressure was also associated with stroke. The researchers found no statistically significant association with dementia.
Why Blood Pressure Fluctuations Matter
Routine health assessments generally focus on a person’s average blood pressure. The findings suggest that how much readings change between visits might carry additional information about health risks, including among people whose average readings alone may not flag them as high risk. That possibility could matter for identifying people who may merit closer attention, but the study does not establish how clinicians should use variability in practice.
The reported risk estimates describe associations across groups, not an individual’s forecast. Each one-standard-deviation increase in systolic blood pressure variability was associated with an 11% higher risk of death; the corresponding figure for diastolic variability was 8%. A standard deviation reflects differences in variability between participants, so these percentages do not translate directly into a specific change in blood pressure measured in mmHg.
For stroke, each one-standard-deviation increase in variability was associated with a 12% higher likelihood for diastolic pressure variability and a 10% higher likelihood for mean arterial pressure variability. These results do not mean that blood pressure variability itself has been shown to cause strokes or deaths.
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How the Study Compared Risk
The researchers also examined blood sugar status alongside systolic blood pressure variability. Compared with participants who had normal blood sugar and low variability, those with type 2 diabetes and high variability were 2.8 times as likely to die during follow-up. Participants with prediabetes and high variability had a 62% higher risk of death than the same reference group.
Those comparisons combine blood sugar status and blood pressure variability. The study authors caution that the higher risks cannot be attributed to variability alone. The team also estimated a 10-year risk of death of about 1.0% for participants with normal blood sugar and low systolic variability, compared with about 2.9% for those with type 2 diabetes and high variability. These are estimates for the groups described, not guaranteed outcomes for individuals.
The analysis included people with repeated research measurements, and follow-up began from the first visit at which variability could be calculated. Its findings therefore concern associations in this study population and measurement setting. They do not by themselves show that adding variability to standard clinical assessment would improve decisions or outcomes.
“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
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Limits of the Risk Findings
The study was observational, so it cannot determine whether greater blood pressure variation contributes to death or stroke, or whether it reflects other health factors. Adjustment for average blood pressure, blood sugar status and other factors does not remove every possible source of bias or confounding.
It is also not clear whether reducing fluctuations would reduce the risk of stroke or death. The researchers said further work is needed to establish whether variability can be lowered and whether doing so changes health outcomes. The report does not establish a threshold for “high” variability that should trigger a particular clinical response, nor does it show that variability measurement improves care.
The reported stroke associations applied to diastolic pressure and mean arterial pressure variability; the study summary did not report a statistically significant association for every measure and outcome. No statistically significant link with dementia was found during the follow-up period. That finding is not proof that no relationship exists.
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Research Needed Before Routine Use
The next step is further research into whether blood pressure variability can be reduced and whether a reduction leads to fewer strokes or deaths, as Ahmadizar said. Studies designed to test interventions would be needed to answer the cause-and-effect question left open by this analysis.
For now, the findings add evidence that repeated readings may contain information beyond a single average, but they do not support a new routine screening or treatment recommendation on their own. The study authors said more research is needed before blood pressure variability can be recommended for routine clinical use.
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Key Questions
What did the study find about blood pressure variation?
Greater variation between research visits was associated with a higher risk of death across all four blood pressure measures studied. Variation in diastolic pressure and mean arterial pressure was also associated with stroke.
Does this prove that fluctuating blood pressure causes death or stroke?
No. This was an observational study, which can identify associations but cannot show that blood pressure fluctuations caused the outcomes.
How many people took part, and how long were they followed?
The analysis included 57,611 UK Biobank participants. They were followed for a median of 5.1 years from the first visit at which blood pressure variability could be calculated.
Was blood pressure variability linked to dementia?
The researchers found no statistically significant association between the blood pressure variability measures and dementia in this analysis. That does not establish that no relationship exists.
Should patients or clinicians act on these findings now?
The study does not establish a new clinical recommendation. Its authors said more research is needed before blood pressure variability can be recommended for routine use and to determine whether reducing fluctuations changes health outcomes.
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