Outcome-Driven Thresholds for Increased Home Blood Pressure Variability

Increased blood pressure (BP) variability predicts cardiovascular disease, but lack of operational thresholds limits its use in clinical practice. We aimed to define outcome-driven thresholds for increased day-to-day home BP variability. We studied 6238 individuals (mean age 60.0±12.9, 56.4% women) from Japan, Greece, and Finland. Home BP variability was defined as the coefficient of variation of the first morning BPs on 3 to 7 days. During follow-up of 9.3±3.6 years, 304 cardiovascular deaths and 715 cardiovascular events occurred. A 1 SD increase in systolic/diastolic home BP variability was associated with increased risk of cardiovascular mortality (HR 1.17/1.22; 95% CI 1.06–1.30/1.11–1.34) and cardiovascular events (HR 1.13/1.14; 95% CI 1.05–1.21/1.07–1.23). Risk was increased in the highest decile of systolic/diastolic BP variability (coefficient of variation >11.0/12.8). Individuals with systolic/diastolic coefficient of variation of day-to-day home BP >11.0/12.8 may have an increased risk of cardiovascular disease; these thresholds could help identify individuals at increased cardiovascular risk.