Prognostic impact of short- and mid-term blood pressure variability on long-term outcomes after acute myocardial infarction
K Konstantinou, A Koumeli, A Apostolos, K Dimitriadis, K Pappelis, C Chrysohoou, A Kasiakogias, A Sakalidis, P Tsioufis, E Mantzouranis, V Panoulas, K Kalogeras, P Nihoyannopoulos, D Tousoulis, K TsioufisAbstract
Background
Blood pressure variability (BPV) reflects impaired cardiovascular regulation and has been linked to adverse prognosis. The long-term prognostic significance of short-term and mid-term BPV assessed during the index hospitalization for acute myocardial infarction (AMI) remains incompletely understood.
Methods
In a prospective cohort of AMI patients, short-term BPV was quantified using systolic and diastolic ARV from 24-hour ABPM, while mid-term BPV was calculated as the SD of daily in-hospital systolic blood pressure measurements. Patients were followed for 3 years. Cox proportional hazards models assessed associations with all-cause mortality and composite adverse cardiovascular outcomes.
Results
Higher mid-term systolic BPV was strongly associated with adverse long-term prognosis. Patients in the highest quartile (Q4) of SBP-SD had a significantly increased risk of composite outcomes (HR 29.88, 95% CI 10.93–81.66) and all-cause mortality (HR 11.85, 95% CI 2.81–49.91) compared with Q1.
Short-term systolic BPV measured by SBP-ARV independently predicted all-cause mortality (HR 1.37, 95% CI 1.25–1.51) and composite adverse events (HR 1.29, 95% CI 1.22–1.36). In contrast, diastolic BPV was primarily associated with arrhythmias and heart failure hospitalization, with weaker associations for mortality. These relationships persisted after multivariable adjustment.
Conclusion
Both short-term and mid-term systolic BPV assessed during AMI hospitalization independently predict long-term mortality and cardiovascular events. BPV represents a stable and powerful prognostic marker that may inform post-infarction surveillance and therapeutic strategies.