Long-term Variability of the Blood Pressure Components and Risk of Mortality Events and Sudden Cardiac Death: A Prospective Cohort Study (2002-2020)

Background and Aims To evaluate the association between variability in systolic blood pressure (SBPV), diastolic blood pressure (DBPV), mean arterial pressure (MAPV), pulse pressure (PPV), and the risk of all-cause mortality, cardiovascular mortality (CV mortality), and sudden cardiac death (SCD) in general population. Methods and results 8,479 participants (5,425 women; mean age 49.0 years) underwent three visits between 2002-2011 at three-year intervals, then were followed up until 2020. Variability of the blood pressure components was assessed using standard deviation (SD) method. Underlying causes of mortality events were adjudicated by the outcome committee. Multivariable Cox proportional hazards regression models were applied and adjusted for a comprehensive set of confounders, including mean BP values and prevalent cardiovascular disease. During a median of 10.1 years, 681, 223, and 145 events of all-cause mortality, CV mortality, and SCD with incidence rates of 8.46, 2.77, and 1.80 per 1,000 person-years occurred, respectively. In multivariable-adjusted analyses, hazard ratios (95% confidence intervals) for the association between 1-SD increase in SBPV, DBPV, MAPV, and PPV and all-cause mortality were calculated as 1.08 (1.02-1.15), 1.12 (1.05-1.20), 1.12 (1.05-1.19), 1.05 (0.99-1.11); for CV mortality were 1.15 (1.04-1.28), 1.17 (1.05-1.30), 1.18 (1.06-1.31), 1.12 (1.02-1.23); regarding SCD were 1.10 (0.96-1.25), 1.16 (1.01-1.33), 1.13 (0.98-1.29), and 1.10 (0.98-1.25), respectively. Compared to participants with low-SBPV/low-DBPV, their counterparts with high-SBPV/high-DBPV had 43% and 49% significantly higher risk of all-cause- and CV mortality, respectively. Conclusions Higher SBP and DBP variability, independent of their mean values, was associated with mortality events, and the latter increased the risk of SCD.