Elevated blood pressure variability is associated with an increased risk of negative health outcomes in adults aged 65 and above—a systematic review and meta-analysis

Abstract Background The clinical relevance of blood pressure variability (BPV) is still unknown, despite increasing evidence associating BPV to negative health outcomes (NHOs). There is currently no gold standard to define high BPV and normal reference values for BPV are lacking. Aim The primary aim was to examine whether high BPV can predict NHO in adults aged ≥65. The predictive value of BPV was compared to mean BP (mBP) when both parameters were available. Methods PubMed and Web of Science were systematically screened; 49 articles (12 retrospective, 18 prospective and 19 cross-sectional studies) were included and evaluated for methodological quality. Meta-analyses were conducted to examine the association of BPV (and mBP when available) with NHO. Results Systolic BPV and systolic mBP seem to indicate at least comparable odds for cardiovascular disease (BPV: odds ratio (OR) = 1.33 (95% CI: 1.19–1.48, P < .00001) vs mBP: OR = 1.06 (95% CI: 1.03–1.09, P = .0002)) and cerebral deterioration (BPV: OR = 1.28 (95% CI: 1.17–1.41, P < .00001) vs mBP: OR = 1.06 (95% CI: 1.04–1.09, P < .00001)). Increased diastolic BPV was associated with higher odds of cerebral deterioration (OR = 1.18 (95% CI: 1.04–1.35), P = .01). Conclusion High systolic BPV and high systolic mBP are associated with 33% and 6% higher odds of cardiovascular disease in adults aged ≥65, respectively. High BPV is also related to an 18%–28% and 11% increased odds of cerebral deterioration and poor stroke recovery. An overview of cut-off values is provided for the most often reported BPV parameters in literature, which can be used as a guideline to identify elevated BPV in clinical practice.