Twenty-four-hour mean blood pressure and variability combined improve the prognostic value of ambulatory blood pressure.

Authors

Giuseppe Mancia, Rita Facchetti, Cesare Cuspidi, Giovanni Corrao, Guido Grassi

Published in

Journal of hypertension. Oct 12, 2026. Epub Oct 12, 2026.

Abstract

To determine whether adding 24-h blood pressure (BP) variability to 24-h mean BP improves the BP predictive value for cardiovascular and all-cause fatal outcomes.
In 1993, among individuals of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population, 24-h mean BP was calculated from the mean of three hourly measurements. BP variability was quantified as the weighted standard deviation of the 24-h mean BP, the 24-h average real variability and the 24-h erratic BP variations by Fourier analysis. Variability values were used after removal of the fraction explained by their linear relationship with 24-h mean BP. Data were adjusted for baseline covariates but because of within-subject comparisons unadjusted data were also used.
During a 24.6 years follow-up, 250 cardiovascular and 798 all-cause deaths occurred. Adding any of the BP variability measures to 24-h mean BP significantly improved the goodness of fit of the data to the Cox prediction model used to estimate cardiovascular risk and all-cause mortality. This occurred also when BP variability was added to the net reclassification improvement (NRI) index. In subgroup analysis, a significant increase in the risk of cardiovascular and all-cause mortality was consistent in subjects with both 24-h mean and variability at least at their median value.
Addition of 24-h BP variability improves the prognostic estimate of the risk of cardiovascular and all-cause mortality associated with 24-h mean BP. This supports an upgrading of information on BP variability in ambulatory BP monitoring reports to better exploit the potential of this approach as risk estimate.

PMID:
42861788
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

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