Prognostic value of blood pressure variability in patients with heart failure: a systematic review and meta-analysis

Blood pressure variability (BPV) has been associated with increased morbidity and mortality across various cardiovascular conditions, but its prognostic significance in heart failure (HF) remains insufficiently established. This review aims to assess the potential utility of BPV as a prognostic marker in the HF population. We conducted a systematic review and meta-analysis of 15 studies including 33,022 patients (mean age 66.2 ± 10.5 years). Composite endpoints included all-cause mortality, cardiovascular mortality, HF rehospitalization, nonfatal stroke, nonfatal myocardial infarction, and heart transplantation. Pooled hazard ratios were calculated using a generic inverse variance approach under a random-effects model. Higher long-term BPV was significantly associated with increased risk of composite outcomes (HR 1.20, 95% CI 1.01-1.43; I² = 89%, p = 0.03) and all-cause mortality (HR 1.15, 95% CI 1.05-1.25; I² = 49%, p = 0.001). Daytime short-term BPV showed an inverse association (OR 0.96, 95% CI 0.92-0.99; I² = 0%, p = 0.01), while a U-shaped relationship between long-term BPV and risk of composite outcomes and cardiovascular mortality was observed. These findings suggest that BPV may serve as a prognostic factor for secondary risk stratification in patients with HF.