DOI: 10.1161/jaha.125.046365 ISSN: 2047-9980

Association of Within‐Visit Blood Pressure Changes With Cardiovascular Disease and Mortality Among Individuals Without a History of Hypertension: Results From the UK Biobank

In Tae Jin, Seok‐Jae Heo, Jin Young Park, SungA Bae
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Background

Beyond average blood pressure (BP) levels, short‐term BP fluctuations may carry important prognostic information. However, the clinical significance of within‐visit BP changes remains limited. This study aimed to evaluate the association between within‐visit BP changes and clinical outcomes.

Methods

We analyzed data from the UK Biobank. BP was measured twice, with at least 1 minute between measurements, while participants were seated. Within‐visit BP changes were defined as the absolute difference between 2 consecutive systolic BP measurements, and participants were categorized into within‐visit BP changes quartiles. The primary outcome was all‐cause mortality, and secondary outcomes included new‐onset hypertension and major adverse cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and heart failure). Multivariable Cox proportional hazards models, adjusted for demographics, cardiovascular risk factors, comorbidities, and baseline BP, were used to estimate hazard ratios (HRs).

Results

Higher within‐visit BP changes were associated with elevated systolic and diastolic BP and a higher incidence of hypertension. All‐cause mortality and major adverse cardiovascular events increased progressively across BP changes quartiles, and these results remained consistent in fully adjusted models. Compared with the lowest quartile, the highest quartile showed an elevated risk of all‐cause mortality (HR, 1.070 [95% CI, 1.041–1.100]), nonfatal myocardial infarction (HR,1.070 [95% CI, 1.021–1.121]), stroke (HR,1.086 [95% CI, 1.027–1.148]), and heart failure (HR,1.069 [95% CI, 1.015–1.127]). BP changes as a continuous variable demonstrated a significant linear association without evidence of nonlinearity.

Conclusions

Within‐visit BP changes are independently associated with the development of hypertension, mortality, and major adverse cardiovascular events, supporting its potential role as a marker of long‐term cardiovascular risk.

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