Within-Subject Blood Pressure Level-Not Variability-Predicts Fatal and Nonfatal Outcomes in a General Population

Rudolph Schutte, Lutgarde Thijs, Yan-Ping Liu, Kei Asayama, Yu Jin, Augustine Odili, Yu-Mei Gu, Tatiana Kuznetsova, Lotte Jacobs, Jan A. Staessen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


To assess the prognostic significance of blood pressure (BP) variability, we followed health outcomes in a family-based random population sample representative of the general population (n=2944; mean age: 44.9 years; 50.7% women). At baseline, BP was measured 5 times consecutively at each of 2 home visits 2 to 4 weeks apart. We assessed within-subject overall (10 readings), within-and between-visit systolic BP variability from variability independent of the mean, the difference between maximum and minimum BP, and average real variability. Over a median follow-up of 12 years, 401 deaths occurred and 311 participants experienced a fatal or nonfatal cardiovascular event. Overall systolic BP variability averaged (SD) 5.45 (2.82) units, 15.87 (8.36) mm Hg, and 4.08 (2.05) mm Hg for variability independent of the mean, difference between maximum and minimum BP, and average real variability, respectively. Female sex, older age, higher-mean systolic BP, lower body mass index, a history of peripheral arterial disease, and use of beta-blockers were the main correlates of systolic BP variability. In multivariable-adjusted analyses, overall and within-and between-visit BP variability did not predict total or cardiovascular mortality or the composite of any fatal plus nonfatal cardiovascular end point. For instance, the hazard ratios for all cardiovascular events combined in relation to overall variability independent of the mean, difference between maximum and minimum BP, and average real variability were 1.05 (0.96-1.15), 1.06 (0.96-1.16), and 1.08 (0.98-1.19), respectively. By contrast, mean systolic BP was a significant predictor of all end points under study, independent of BP variability. In conclusion, in an unbiased population sample, BP variability did not contribute to risk stratification over and beyond mean systolic BP. (Hypertension. 2012;60:1138-1147.). Online Data Supplement
Original languageEnglish
Pages (from-to)1138–1147
Issue number5
Publication statusPublished - Nov 2012


  • blood pressure variability
  • cardiovascular disease
  • population science
  • risk factors
  • epidemiology

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