Visit-to-visit systolic blood pressure variability and cardiovascular outcomes. New data from a real-world korean population

Hypertension is a major independent risk factor worldwide for adverse fatal or nonfatal cardiovascular (CV) events, such as myocardial infarction, stroke, and heart failure. Each increase of 20 mm Hg of systolic blood pressure (SBP) or 10 mm Hg of diastolic BP, starting from 115 to 75 mm Hg, was found to be associated with a 2-fold increase of CV death rate. A recent meta-analysis showed that the reduction of SBP levels to less than 130 mm Hg significantly reduces CV risk, whereas the SPRINT trial demonstrated that lowering SBP to less than 120 mm Hg is particularly beneficial in high-risk patients in terms of relative risk reduction of CV and all-cause mortality. Major guidelines on hypertension management strongly recommend BP lowering in hypertensive individuals particularly in those at high or very high risk of CV events, for example, subjects with history of CV disease, preclinical organ damage, and diabetes. Therefore, it appears very important to properly discern the hypertensive subjects who have a high CV risk, since they may require a more intensive therapeutic management, which should be aimed not only at BP reduction, but also at the reduction of other concomitant risk factors. Interestingly, accumulating lines of evidence indicate that not only the absolute levels of BP contribute to the incidence of adverse CV events, but also the BP variability. Hypertensive subjects with higher 24-hour BP variability were found to be more susceptible to develop preclinical cardiac and vascular damage and to have a higher incidence of adverse CV events. In addition, previous reports demonstrated that increases in visit-to-visit (VV) BP variability are associated with a worse prognosis in both hypertensive subjects and subjects at high CV risk.