Elevated short-term blood pressure variability and abnormal circadian BP patterns are independent predictors of MACE in essential hypertension, and their coexistence identifies a particularly high-risk phenotype.
Key Findings
Results
High blood pressure variability (BPV) was associated with a significantly greater incidence of major adverse cardiovascular events (MACE) compared to low BPV.
MACE incidence was 34.2% in the high BPV group versus 17.1% in the low BPV group (p < 0.001)
The study included 500 adults with essential hypertension who underwent 24-hour ambulatory BP monitoring
Short-term BPV was assessed using the standard deviation of 24-hour systolic BP
Median follow-up was 4.2 years, during which 128 patients (25.6%) experienced MACE
Results
High BPV remained an independent predictor of MACE after adjustment for other risk factors.
Adjusted hazard ratio for high BPV was 1.89 (95% CI 1.32–2.71, p < 0.001)
Cox proportional hazards regression models were used to evaluate associations with outcomes
This association was independent of mean BP levels
Results
Reverse dipping circadian pattern was associated with increased cardiovascular risk.
Circadian patterns were classified as dipper, non-dipper, or reverse dipper based on nighttime systolic BP decline
Reverse dipping was identified as an independent risk factor for MACE
This finding was derived from a retrospective cohort of 500 hypertensive adults
Results
Patients with both elevated BPV and abnormal circadian patterns had the highest risk of MACE.
The coexistence of high BPV and abnormal circadian BP patterns identified a particularly high-risk phenotype
The combination of these two markers provided additive prognostic value beyond either marker alone
This finding suggests a combined risk stratification approach using both BPV and circadian pattern assessment
Conclusions
Ambulatory blood pressure monitoring (ABPM)-based dynamic BP assessment may improve cardiovascular risk stratification beyond mean BP levels.
Both BPV and circadian pattern classification were derived from 24-hour ABPM data
The study was a retrospective cohort design with 500 patients followed for a median of 4.2 years
Primary outcome (MACE) included myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death
What This Means
This research suggests that how much a person's blood pressure fluctuates over 24 hours, and whether their blood pressure follows a normal day-night rhythm, are both important predictors of serious heart and blood vessel problems in people with high blood pressure. In a study of 500 hypertensive patients followed for about four years, those whose blood pressure varied the most throughout the day were roughly twice as likely to suffer a heart attack, stroke, heart failure hospitalization, or cardiovascular death compared to those with less variable blood pressure. People whose blood pressure did not drop at night as expected — or actually rose at night (called 'reverse dippers') — were also at elevated risk.
The most striking finding was that patients who had both high blood pressure variability and an abnormal nighttime pattern faced the greatest cardiovascular danger of all, representing a particularly high-risk group. This suggests these two factors work together to amplify risk in a way that neither does alone. Importantly, these risks were identified above and beyond what would be predicted by simply knowing a patient's average blood pressure level.
This research suggests that standard clinical measurements of average blood pressure may miss important risk information that can be captured by 24-hour ambulatory blood pressure monitoring. Assessing how much blood pressure fluctuates and whether normal day-night patterns are preserved could help doctors better identify which hypertensive patients are at the highest risk of serious cardiovascular events, potentially allowing for more targeted preventive care.
Ma Q, Wang S, Chen H. (2026). Twenty-Four-Hour Blood Pressure Variability Combined With Circadian Rhythm Patterns in Predicting Cardiovascular Events in Hypertensive Patients.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70342