Large fluctuations in blood pressure associated with higher risk of heart disease and kidney failure Interview with:

Elvira Gosmanova MD Department of Nephrology University of Tennessee Health Science Center Memphis TN, 38163

Dr. Elvira Gosmanova

Elvira Gosmanova MD
Department of Nephrology
University of Tennessee Health Science Center
Memphis TN, 38163 What is the background for this study? What are the main findings?

Response: It has been long known that elevated blood pressure is a risk factor for numerous adverse health-related outcomes. However, the majority of individuals do not have blood pressure in a constant range.

In contrary, blood pressure measured in the same individual tends to fluctuate over time. Moreover, some individuals have more blood pressure fluctuation, as compared with others. The impact of fluctuation in blood pressure is still poorly understood. Smaller studies suggested that increased fluctuation in blood pressure may be associated with hazardous health outcomes. However, large scale studies were still lacking. Therefore, we conducted a study involving close to 3 million US veterans to investigate the association of increased visit-to-visit variability of systolic blood pressure (which was our measure of fluctuation of blood pressure over time) and all-cause mortality, and incident coronary heart disease, stroke, and end-stage renal disease.

We found that there was strong and graded increase in the risk of all the above outcomes with increasing visit-to-visit variability of systolic blood pressure. What should readers take away from your report?

Response: Patients with larger fluctuations in blood pressure are at higher risk to die or develop cardiovascular disease, or kidney failure. It is important to pay attention not only to “static” blood pressure values, but also to evaluate whether the same individual has significant swings in blood pressure from low to high values (or vice versa) measured on different occasions. What recommendations do you have for future research as a result of this study?

Response: The understanding of factors leading to variability in blood pressure is the next important step in this area of research. This would allow the development and implementation of interventions targeting modifiable factors that increase blood pressure variability and, therefore, may reduce mortality and cardiovascular and renal disease. Thank you for your contribution to the community.


Gosmanova EO, Mikkelsen MK, Molnar MZ, et al. Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease. J Am Coll Cardiol.2016;68(13):1375-1386. doi:10.1016/j.jacc.2016.06.054.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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