Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study

Jiandong Zhou; Sharen Lee; Wing T. Wong; Keith S.K. Leung; Wai Kit Ming; Tong Liu; Kamalan Jeevaratnam; Bernard M.Y. Cheung; Gary Tse; Qingpeng Zhang

doi:10.55503/2790-6744.1556

Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study

Jiandong Zhou
, Sharen Lee
, Wing T. Wong
, Keith S.K. Leung
, Wai Kit Ming
, Tong Liu
, Kamalan Jeevaratnam
, Bernard M.Y. Cheung
, Gary Tse^*
, Qingpeng Zhang^*

^*Corresponding author for this work

Department of Data Science

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

3 Downloads (CityUHK Scholars)

Abstract

Introduction: Blood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes.
Methods: The retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of ≥ 5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/ stroke, with follow-up until 31 December 2019.
Results: This study included 37,540 patients (n ¼ 29,597 patients with ≥ 3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (P < 0.001). Higher variance/SD/CV/variability score of both systolic and diastolic blood pressure was significantly associated with increased risks of all-cause mortality and heart failure, acute myocardial infarction and TIA/stroke (P < 0.001). Low baseline/latest/maximum/minimum/mean/median/ RMS systolic blood pressure was significantly associated with shorter time-to-death for all-cause mortality (P < 0.001).
Conclusion: Nonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke.

© 2025 Hong Kong College of Cardiology.

Original language	English
Pages (from-to)	68-89
Number of pages	22
Journal	Journal of the Hong Kong College of Cardiology
Volume	32
Issue number	3
Online published	13 Aug 2025
DOIs	https://doi.org/10.55503/2790-6744.1556
Publication status	Published - 2025

Funding

This study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster Institutional Review Board (HKU/HA HKWC IRB) (UW-20-250 and UW 23-339) and The Joint Chinese University of Hong Kong (CUHK) Hospital Authority New Territories East Cluster (NTEC) Clinical Research Ethics Committee (CREC) (2018.309 and 2018.643) and complied with the Declaration of Helsinki.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Keywords

Blood pressure variability
Cardiovascular event
Epidemiology
Risk

Publisher's Copyright Statement

This full text is made available under CC-BY-NC-ND 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/

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Zhou, J., Lee, S., Wong, W. T., Leung, K. S. K., Ming, W. K., Liu, T., Jeevaratnam, K., Cheung, B. M. Y., Tse, G., & Zhang, Q. (2025). Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study. Journal of the Hong Kong College of Cardiology, 32(3), 68-89. https://doi.org/10.55503/2790-6744.1556

@article{40c64535c3094ec79e9d5d1a01e9ec0c,

title = "Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study",

abstract = "Introduction: Blood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes. Methods: The retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of ≥ 5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/ stroke, with follow-up until 31 December 2019. Results: This study included 37,540 patients (n ¼ 29,597 patients with ≥ 3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (P < 0.001). Higher variance/SD/CV/variability score of both systolic and diastolic blood pressure was significantly associated with increased risks of all-cause mortality and heart failure, acute myocardial infarction and TIA/stroke (P < 0.001). Low baseline/latest/maximum/minimum/mean/median/ RMS systolic blood pressure was significantly associated with shorter time-to-death for all-cause mortality (P < 0.001). Conclusion: Nonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke. {\textcopyright} 2025 Hong Kong College of Cardiology.",

keywords = "Blood pressure variability, Cardiovascular event, Epidemiology, Risk",

author = "Jiandong Zhou and Sharen Lee and Wong, \{Wing T.\} and Leung, \{Keith S.K.\} and Ming, \{Wai Kit\} and Tong Liu and Kamalan Jeevaratnam and Cheung, \{Bernard M.Y.\} and Gary Tse and Qingpeng Zhang",

year = "2025",

doi = "10.55503/2790-6744.1556",

language = "English",

volume = "32",

pages = "68--89",

journal = "Journal of the Hong Kong College of Cardiology",

issn = "1027-7811",

publisher = "Hong Kong College of Cardiology",

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Zhou, J, Lee, S, Wong, WT, Leung, KSK, Ming, WK, Liu, T, Jeevaratnam, K, Cheung, BMY, Tse, G & Zhang, Q 2025, 'Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study', Journal of the Hong Kong College of Cardiology, vol. 32, no. 3, pp. 68-89. https://doi.org/10.55503/2790-6744.1556

Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study. / Zhou, Jiandong; Lee, Sharen; Wong, Wing T. et al.
In: Journal of the Hong Kong College of Cardiology, Vol. 32, No. 3, 2025, p. 68-89.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

TY - JOUR

T1 - Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality

T2 - A Territory-wide Family Medicine Cohort Study

AU - Zhou, Jiandong

AU - Lee, Sharen

AU - Wong, Wing T.

AU - Leung, Keith S.K.

AU - Ming, Wai Kit

AU - Liu, Tong

AU - Jeevaratnam, Kamalan

AU - Cheung, Bernard M.Y.

AU - Tse, Gary

AU - Zhang, Qingpeng

PY - 2025

Y1 - 2025

N2 - Introduction: Blood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes. Methods: The retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of ≥ 5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/ stroke, with follow-up until 31 December 2019. Results: This study included 37,540 patients (n ¼ 29,597 patients with ≥ 3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (P < 0.001). Higher variance/SD/CV/variability score of both systolic and diastolic blood pressure was significantly associated with increased risks of all-cause mortality and heart failure, acute myocardial infarction and TIA/stroke (P < 0.001). Low baseline/latest/maximum/minimum/mean/median/ RMS systolic blood pressure was significantly associated with shorter time-to-death for all-cause mortality (P < 0.001). Conclusion: Nonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke. © 2025 Hong Kong College of Cardiology.

AB - Introduction: Blood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes. Methods: The retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of ≥ 5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/ stroke, with follow-up until 31 December 2019. Results: This study included 37,540 patients (n ¼ 29,597 patients with ≥ 3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (P < 0.001). Higher variance/SD/CV/variability score of both systolic and diastolic blood pressure was significantly associated with increased risks of all-cause mortality and heart failure, acute myocardial infarction and TIA/stroke (P < 0.001). Low baseline/latest/maximum/minimum/mean/median/ RMS systolic blood pressure was significantly associated with shorter time-to-death for all-cause mortality (P < 0.001). Conclusion: Nonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke. © 2025 Hong Kong College of Cardiology.

KW - Blood pressure variability

KW - Cardiovascular event

KW - Epidemiology

KW - Risk

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DO - 10.55503/2790-6744.1556

M3 - RGC 21 - Publication in refereed journal

SN - 1027-7811

VL - 32

SP - 68

EP - 89

JO - Journal of the Hong Kong College of Cardiology

JF - Journal of the Hong Kong College of Cardiology

IS - 3

ER -

Associations Between Five-year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality: A Territory-wide Family Medicine Cohort Study

Abstract

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UN SDGs

Research Keywords

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