Related Experiment Video

Updated: Apr 6, 2026

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

Published on: September 26, 2018

Visit-to-Visit Variability of Blood Pressure and Coronary Heart Disease, Stroke, Heart Failure, and Mortality: A

Paul Muntner, Jeff Whittle, Amy I Lynch

Annals of Internal Medicine

|July 29, 2015

Insights

High blood pressure variability (BP VVV) increases the risk of cardiovascular disease (CVD) and mortality. Further research is needed to determine if reducing BP VVV can mitigate these risks.

Area of Science:

Cardiology
Hypertension Research
Clinical Epidemiology

Background:

Blood pressure (BP) variability across outpatient visits is often overlooked, considered mere random fluctuation.
This study investigates the clinical significance of visit-to-visit variability (VVV) in BP.

Purpose of the Study:

To assess the association between visit-to-visit variability (VVV) of systolic blood pressure (SBP) and diastolic blood pressure (DBP).
To determine the relationship between BP VVV and cardiovascular disease (CVD) and mortality outcomes.

Main Methods:

A prospective cohort study design was employed.
Post hoc analysis of data from 25,814 participants in the ALLHAT trial.
Systolic BP VVV was calculated as the standard deviation (SD) of SBP measurements over seven visits (6-28 months post-enrollment).

Main Results:

Higher SBP VVV (highest vs. lowest quintile) was significantly associated with increased risk for fatal coronary heart disease (CHD) or nonfatal myocardial infarction (MI) (HR 1.30), all-cause mortality (HR 1.58), and stroke (HR 1.46).
Increased diastolic BP VVV also showed a correlation with CVD events and mortality.
A total of 1194 fatal CHD/MI, 1948 deaths, 606 strokes, and 921 heart failure events were recorded during follow-up.

Conclusions:

Elevated visit-to-visit variability in systolic blood pressure is linked to a greater risk of cardiovascular events and mortality.
Further investigation is warranted to explore whether interventions aimed at reducing BP VVV can improve long-term patient outcomes.

Read full analysis

Abstract

Background:

Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP.

Objective:

To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes.

Design:

Prospective cohort study.

Setting:

Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

Participants:

25 814 ALLHAT participants.

Measurements:

The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure.

Results:

During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality.

Limitation:

Long-term outcomes were not available.

Conclusion:

Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk.

Primary Funding Source:

National Institutes of Health.

More Related Videos

Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness

Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness

Published on: May 3, 2018

Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome

Published on: September 27, 2024

Related Concept Videos

Factors affecting Blood pressure

Factors affecting Blood pressure

Several physiological and lifestyle factors influence blood pressure (BP). Understanding these factors is crucial as they are significant in patient education and blood pressure management.
Physiological Factors:

Hypertension and Regulation of Blood Pressure

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...

Assessing Blood pressure in the Leg

Assessing Blood pressure in the Leg

Proper measurement of leg blood pressure is a critical skill for healthcare providers, ensuring precise and reliable readings. When performed correctly, this procedure informs patient care and enhances the efficacy of interventions. The following text outlines step-by-step guidelines to measure blood pressure in the leg, providing clarity and ease of understanding for practitioners.
Preparation:

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...

Errors occurring during blood pressure monitoring

Errors occurring during blood pressure monitoring

Blood pressure monitoring is a crucial clinical procedure in diagnosing and managing various cardiovascular conditions. Despite its significance, the accuracy of blood pressure measurements can be compromised by multiple factors, potentially leading to either falsely high or low readings. These inaccuracies are critical as they can significantly impact patient care. So, it is vital to understand these challenges deeply and adopt strategic approaches to minimize errors.
Several factors...

Sites for measuring blood pressure

Sites for measuring blood pressure

Blood pressure measurement is a fundamental clinical procedure, providing crucial data for assessing cardiovascular health. Among the various sites for this measurement, the brachial and popliteal arteries are predominantly utilized due to their accessibility and the reliability of their readings. This lesson delves into the anatomical significance, methodology, and considerations of measuring blood pressure at these locations.
The Brachial Artery: Primary Site for Blood Pressure Measurement

Articles linked to this work by shared authors, journal, and citation graph.

Guinea Worm Eradication: New Clinical and Public Health Challenges at the Last Mile.

Tropical medicine and infectious disease·2026

A meta-analysis of the long-term effects of antihypertensive therapy on the risk of major cardiovascular disease across 51 randomized trials.

Nature medicine·2026

Life's Essential 8 and Risk of Severe COVID-19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study.

Journal of the American Heart Association·2026

Intersecting Burdens: Pain and Psychosocial Stressors in Women with HIV and Type 2 Diabetes - Insights from the MACS/WIHS Combined Cohort Study.

Research square·2026

Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis.

Lancet (London, England)·2026

Blood Biomarkers and the Risk of Coronary Disease in Atrial Fibrillation.

Journal of the American Heart Association·2026

See all related articles