What are the associations of long-term, mid-term, and short-term variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality?
BMJ · 2016 · PMID 27511067 · DOI 10.1136/bmj.i4098
Variations in blood pressure over long, mid, and short terms are linked to increased risks of cardiovascular disease and mortality, independent of average blood pressure.
The question
What are the associations of long-term, mid-term, and short-term variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality?
What they tested
The study aimed to systematically review existing evidence, implying an expectation that blood pressure variability would be associated with cardiovascular outcomes and mortality.
How they did it
The researchers conducted a systematic review and meta-analysis of prospective cohort studies and clinical trials in adults, excluding those on hemodialysis patients. They searched Medline, Embase, Cinahl, and Web of Science up to February 15, 2016, for full-text English articles. Standardized hazard ratios were extracted and combined using random effects meta-analysis for main analyses, excluding studies with high confounding risk. Outcomes included all-cause mortality, cardiovascular disease mortality, and cardiovascular disease events, while variability measures included standard deviation, coefficient of variation, variation independent of mean, and average real variability.
What they found
The review identified 41 papers (19 observational, 17 clinical trial cohorts) comprising 46 separate analyses. Long-term variability was studied in 24 papers, mid-term in four, and short-term in 15. After excluding 23 analyses due to high confounding risk, increased long-term variability in systolic blood pressure was associated with all-cause mortality (HR 1.15), cardiovascular disease mortality (HR 1.18), cardiovascular disease events (HR 1.18), coronary heart disease (HR 1.10), and stroke (HR 1.15). Increased mid-term and short-term variability in daytime systolic blood pressure were also associated with all-cause mortality (HR 1.15 and HR 1.10, respectively).
| Long-term variability: All-cause mortality | 1.15 | |
|---|---|---|
| Long-term variability: CVD mortality | 1.18 | |
| Long-term variability: CVD events | 1.18 | |
| Long-term variability: Coronary heart disease | 1.1 | |
| Long-term variability: Stroke | 1.15 | |
| Mid-term variability: All-cause mortality | 1.15 | |
| Short-term variability: All-cause mortality | 1.1 |
Hazard ratios for various outcomes associated with increased long-term, mid-term, and short-term systolic blood pressure variability.
What it means
Long-term variability in blood pressure is associated with cardiovascular and mortality outcomes, independently of mean blood pressure, with associations similar in magnitude to those of cholesterol measures with cardiovascular disease. Limited data for mid-term and short-term variability showed similar associations.
Limitations
The study noted limited data for mid-term and short-term variability. A significant number of analyses (23) were excluded from the main analyses due to high risks of confounding, indicating a common pitfall in existing research.
The paper at a glance
| Magellan’s evidence label | Blood pressure level and variability (our label for this citation — see PubMed for the paper’s own title and authors) |
|---|---|
| Journal | BMJ |
| Year | 2016 |
| PMID | 27511067 ↗ |
| DOI | 10.1136/bmj.i4098 ↗ |
| Topic | Cardiovascular & vascular aging |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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Research describes the compound or intervention studied. It is not a claim about any specific product.
Molecules & mechanisms in this paper
Each of these is named in the paper’s own words above. Open the monograph for the full mechanism and its other citations.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). What are the associations of long-term, mid-term, and short-term variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality? [Plain-English summary of BMJ 2016, PMID 27511067, DOI 10.1136/bmj.i4098]. Magellan Longevity. https://magellanlongevity.com/study/s155.html@misc{magellan_s155,
title = {What are the associations of long-term, mid-term, and short-term variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/s155.html}},
note = {Plain-English summary of PubMed PMID 27511067; DOI 10.1136/bmj.i4098; BMJ 2016. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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