Short-Term and Mid-Term Blood Pressure Variability and Long-Term Mortality

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Until recently, a focus has been made on exploring the influence of average blood pressure on risk of mortality. We go beyond average blood pressure to also investigate mortality risk with respect to variation in blood pressure over two timescales – short-term variation among multiple measures at one visit, and medium-term variation between the measures at two visits several months apart. We present an application of Bayesian hierarchical modeling to the problem of estimating the effect of blood pressure (BP) variability on all-cause and cardiovascular (CV) mortality. We use data from the Third National Health and Nutrition Examination Survey linked with up to 27 years of mortality follow-up. We find that medium-term systolic BP variability had a very significant predictive value for CV and all-cause mortality, around one-third as large as the well-established impact of mean systolic BP. Medium-term diastolic variability had an additional, though smaller, predictive effect. Short-term variability, on the other hand, had little or no measurable predictive value. The medium-term variability effect persisted when controlling for Framingham risk score.