The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, assessed through ambulatory BP monitoring, with total and cardiovascular mortality in a large cohort of patients with hypertension. We selected 63 910 subjects from the Spanish ABPM Registry from 2004 to 2014, with a median follow-up of 4.7 years. Systolic and diastolic BP SD from 24 hours, daytime, and nighttime, weighted SD (mean of daytime and nighttime SD weighted for period duration), average real variability (mean of differences between consecutive readings), variation independent of the mean, and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through 24-hour ambulatory BP monitoring performed at baseline. Association with total and cardiovascular mortality (obtained through death certificates) were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In fully adjusted models, daytime, nighttime, and weighted SD, systolic and diastolic, as well as diastolic average real variability, were all significantly associated with total and cardiovascular mortality. Hazard ratios for 1 SD increase ranged from 1.05 to 1.09 for total mortality and from 1.07 to 1.12 for cardiovascular mortality. A nighttime systolic SD ≥12 mm Hg was independently associated with total (hazard ratio: 1.13 [95% CI, 1.06-1.21]) and cardiovascular mortality (hazard ratio: 1.21 [95% CI, 1.09-1.36]). We conclude that short-term BP variability is independently associated with total and cardiovascular mortality in patients with hypertension.

中文翻译：

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短期血压变异性的预后相关性

高血压的短期血压 (BP) 变异性与预后相关性尚未明确确定。我们旨在评估通过动态血压监测评估的短期血压变异性与一大群高血压患者的总死亡率和心血管死亡率之间的关联。我们从 2004 年到 2014 年从西班牙 ABPM 登记处选择了 63 910 名受试者，中位随访时间为 4.7 年。来自 24 小时、白天和夜间的收缩压和舒张压 SD，加权 SD（白天和夜间 SD 的平均值，对持续时间加权），平均实际变异（连续读数之间的差异平均值），独立于平均值的变异，以及 BP 变异比率（收缩压和舒张压 24 小时 SD 之间的比率）通过在基线时进行的 24 小时动态血压监测计算得出。通过调整临床混杂因素和血压的 Cox 回归模型评估与总死亡率和心血管死亡率（通过死亡证明获得）的关联。与存活的患者相比，在随访期间死亡的患者的血压变异性值更高。在完全调整的模型中，白天、夜间和加权 SD、收缩压和舒张压以及舒张压平均真实变异性都与总死亡率和心血管死亡率显着相关。总死亡率增加 1 SD 的危险比范围为 1.05 至 1.09，心血管死亡率为 1.07 至 1.12。夜间收缩压 SD ≥ 12 mmHg 与总死亡率（危险比：1.13 [95% CI，1.06-1.21]）和心血管死亡率（危险比：1.21 [95% CI，1.09-1.36]）独立相关。