{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:40:49Z","timestamp":1784130049371,"version":"3.55.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hypertens Res"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>This post hoc analysis of the ENGAGE AF-TIMI 48 trial assesses differences in cardiovascular and bleeding events according to visit-to-visit blood pressure variability (BPv) in 19,680 patients with a minimum of 4 blood pressure measurements post randomization. Patients were categorized into four groups based on the standard deviation of systolic blood pressure (SBP-SD). In comparisons of the fourth vs first quartile of SBP-SD adjusted for components of the CHA<jats:sub>2<\/jats:sub>D<jats:sub>2<\/jats:sub>-VASc score and baseline SBP, there were no differences in the odds of stroke, cardiovascular mortality, or all-cause mortality. However, there were statistically significant increases in the risk of major bleeding (OR 1.9, (1.6\u20132.25)). myocardial infarction (OR 1.42 (1.08\u20131.87)) and heart failure outcomes (OR 1.49 (1.3\u20131.72)) in the fourth quartile of BPv. This post-hoc analysis shows that BPv is independently associated with an increased risk of bleeding, MI, and heart failure outcomes in a population with AF on oral anticoagulation.<\/jats:p>","DOI":"10.1038\/s41440-024-02083-x","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T08:41:55Z","timestamp":1739954515000},"page":"1613-1618","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Long-term visit-to-visit blood pressure variability and risk of cardiovascular and bleeding events: insights from the ENGAGE AF-TIMI 48 trial"],"prefix":"10.1038","volume":"48","author":[{"given":"Riccardo","family":"Proietti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Gerard","family":"Palazzolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian T.","family":"Ruff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.","family":"Giugliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"2083_CR1","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1093\/ajh\/hpt167","volume":"26","author":"M Nagai","year":"2013","unstructured":"Nagai M, Kario K. Visit-to-visit blood pressure variability, silent cerebral injury, and risk of stroke. Am J Hypertens. 2013;26:1369\u201376.","journal-title":"Am J Hypertens"},{"key":"2083_CR2","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1097\/HJH.0000000000000028","volume":"32","author":"EK Chowdhury","year":"2014","unstructured":"Chowdhury EK, Owen A, Krum H, Wing LM, Nelson MR, Reid CM. Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients. J Hypertens. 2014;32:525\u201333.","journal-title":"J Hypertens"},{"key":"2083_CR3","doi-asserted-by":"publisher","first-page":"329","DOI":"10.7326\/M14-2803","volume":"163","author":"P Muntner","year":"2015","unstructured":"Muntner P, Whittle J, Lynch AI, Colantonio LD, Simpson LM, Einhorn PT, et al. Visit-to-Visit Variability of Blood Pressure and Coronary Heart Disease, Stroke, Heart Failure, and Mortality: A Cohort Study. Ann Intern Med. 2015;163:329\u201338.","journal-title":"Ann Intern Med"},{"key":"2083_CR4","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.018585","volume":"10","author":"E Kodani","year":"2021","unstructured":"Kodani E, Inoue H, Atarashi H, Okumura K, Yamashita T, Otsuka T, et al. Impact of blood pressure visit-to-visit variability on adverse events in patients with nonvalvular atrial fibrillation: subanalysis of the J-RHYTHM Registry. J Am Heart Assoc. 2021;10:e018585.","journal-title":"J Am Heart Assoc."},{"key":"2083_CR5","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1161\/HYPERTENSIONAHA.117.10106","volume":"70","author":"M Proietti","year":"2017","unstructured":"Proietti M, Romiti GF, Olshansky B, Lip GYH. Systolic blood pressure visit-to-visit variability and major adverse outcomes in atrial fibrillation: The AFFIRM Study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management). Hypertension. 2017;70:949\u201358.","journal-title":"Hypertension"},{"key":"2083_CR6","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","volume":"369","author":"RP Giugliano","year":"2013","unstructured":"Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093\u2013104.","journal-title":"N Engl J Med"},{"key":"2083_CR7","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/01.hjh.0000914052.55849.76","volume":"41","author":"G Parati","year":"2023","unstructured":"Parati G, Bilo G, Kollias A, Pengo M, Ochoa JE, Castiglioni P, et al. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper \u2217. J Hypertens. 2023;41:527\u201344.","journal-title":"J Hypertens"},{"key":"2083_CR8","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1159\/000443614","volume":"3","author":"N Saji","year":"2016","unstructured":"Saji N, Toba K, Sakurai T. Cerebral small vessel disease and arterial stiffness: Tsunami effect in the brain? Pulse (Basel). 2016;3:182\u20139.","journal-title":"Pulse (Basel)"},{"key":"2083_CR9","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.1935","volume":"11","author":"JH Bae","year":"2021","unstructured":"Bae JH, Kim JM, Park KY, Han SH. Association between arterial stiffness and the presence of cerebral small vessel disease markers. Brain Behav. 2021;11:e01935.","journal-title":"Brain Behav"},{"key":"2083_CR10","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1093\/eurheartj\/ehad814","volume":"45","author":"A Gupta","year":"2024","unstructured":"Gupta A, Whiteley WN, Godec T, Rostamian S, Ariti C, Mackay J, et al. Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial. Eur Heart J. 2024;45:1159\u201369.","journal-title":"Eur Heart J"},{"key":"2083_CR11","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1016\/j.amjmed.2016.02.028","volume":"129","author":"RP Giugliano","year":"2016","unstructured":"Giugliano RP, Ruff CT, Wiviott SD, Nordio F, Murphy SA, Kappelhof JA, et al. Mortality in patients with atrial fibrillation randomized to Edoxaban or Warfarin: Insights from the ENGAGE AF-TIMI 48 Trial. Am J Med. 2016;129:850\u2013e2.","journal-title":"Am J Med"}],"container-title":["Hypertension Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41440-024-02083-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-024-02083-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-024-02083-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T22:05:33Z","timestamp":1743977133000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41440-024-02083-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,19]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["2083"],"URL":"https:\/\/doi.org\/10.1038\/s41440-024-02083-x","relation":{},"ISSN":["0916-9636","1348-4214"],"issn-type":[{"value":"0916-9636","type":"print"},{"value":"1348-4214","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,19]]},"assertion":[{"value":"16 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 February 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Dr. Giugliano is a member of the TIMI Study Group of the Brigham and Women\u2019s Hospital, which has received research grant support to support clinical trials from Anthos Therapeutics, Daiichi Sankyo; and has received honoraria for CME programme, lectures and\/or consulting from Artivion, Daiichi Sankyo, Medical Education Resources, Menarini, PhaseBio, SAJA Pharmaceutics, Samsung, Sanofi Aventis, Servier, and Summeet. MGP, CTR, and RPG are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women\u2019s Hospital from Abbott, Abiomed Inc, Amgen, Anthos Therapeutics, ARCA Biopharma Inc, AstraZeneca, Boehringer Ingelheim, Daiichi-Sankyo, Ionis Pharmaceuticals Inc, Janssen Research and Development LLC, MedImmune, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals Inc, Roche, Saghmos Therapeutics Inc, Softcell Medical Limited, The Medicines Company, Verve Therapeutics Inc, and Zora Biosciences RP and GYHL have no disclosure of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The ENGAGE AF-TIMI 48 trail was approved by all relevant institutional review boards and all patients provided informed consent. Pre-registered clinical trial number The pre-registered clinical trial number is NCT00781391.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}