Title: Association of blood pressure variability with cardiovascular events and mortality in old age

Abstract

Elevated blood pressure (BP) is a severe medical condition that significantly increases the risks of organ damage. Hypertension has been consistently demonstrated with a greater risk for cardiovascular events and all-cause mortality. Most studies have used mean BP as a significant risk factor associated with cardiovascular events, and medical guidelines for managing hypertension are based on usual or mean BP. However, there is accumulating evidence that increased variability in BP measurement is associated with an excessive risk of cardiovascular outcomes and mortality independent of BP mean and other vascular risk factors. BP variability (BPV) is a complex phenomenon that includes short-term (within a period of 24 hours) and long-term fluctuations over time. Short-term and long-term BPV are independently associated with the development, progression, and severity of cardiac and vascular damage and an increased risk of cardiovascular events and mortality. Furthermore, results of clinical trial and cohort studies have concluded that antihypertensive drug classes differ in their effects on BPV associated risk of cardiovascular outcomes such as stroke and coronary heart disease. These results have prompted discussion on whether antihypertensive treatment should be targeted not only towards reducing mean BP levels but also to stabilizing BPV to achieve reliable control of BP gradually, which might be helpful in the prevention of morbidity and mortality in elderly adults.