Heterogeneity of Prognostic Studies of 24-Hour Blood Pressure Variability: Systematic Review and Meta-Analysis
Open accessAbstract
In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2-7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods.
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Blood pressure is usually lower in sleep than in wakefulness and has a characteristic surge after awakening.
“BP is usually lower in sleep than in wakefulness and has a characteristic surge after awakening, drawing parallels with the daily pattern of adverse CV events (refs.94-97 and Figure 1).”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [94]
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- Authors
- Taylor, K. S., Heneghan, C. J., Stevens, R. J., Adams, E. C., Nunan, D., & Ward, A.
- Affiliations
- University of Oxford (GB)
- Oxford University Hospitals NHS Trust (GB)
- Corresponding author
- Taylor, Kathryn S.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-05-18
- Volume
- 10
- Issue
- 5
- Pages
- e0126375
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4435972
- OpenAlex
- W1555575787
- Cited by
- 48
- References
- 43
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 7 · 2018: 6 · 2017: 6 · 2016: 4 · 2015: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (RP-PG-0407-10347)
- University of Oxford
- Programme Grants for Applied Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- 24-hour blood pressure variability, prognostic value, cardiovascular risk, cardiovascular mortality, all-cause mortality, cardiovascular events, stroke, coronary artery disease, coefficient of variation, standard deviation, methodological heterogeneity
- MeSH terms
- Adult, Aged, Analysis of Variance, Blood Pressure, Circadian Rhythm, Female, Humans, Hypertension, Male, Middle Aged, Photoperiod
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