{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T22:10:15Z","timestamp":1769551815490,"version":"3.49.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2018,5,31]],"date-time":"2018-05-31T00:00:00Z","timestamp":1527724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Blood pressure variability (BPV) has been associated with poor health outcomes in high-risk patients, but its association with more general populations is poorly understood.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We analyzed outcomes from 240,622 otherwise unselected patients who had 10 or more outpatient blood pressure readings recorded over a 3-year period and were aged from 20 to 100 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Whether calculated as SD, average change, or greatest change and systolic or diastolic blood pressure, we found that higher outpatient BPV was associated with subsequent hospitalization and mortality. Systolic pressure average change exceeding 10\u201312 mm Hg or diastolic exceeding 8 mm Hg significantly increased risk of hospitalization and death (odds ratios [ORs] from 2.0 to 4.5). Variability in the highest decile increased risks even more dramatically, with propensity-matched ORs from 4.4 to 42. A systolic change exceeding 35 mm Hg increased the relative risk of death 4.5-fold. Similarly, a diastolic change greater than 23\u201324 mm Hg almost tripled the risks of hospitalization and death. Neither stratification for hypertension nor propensity matching for risk factors within the database affected these associations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Systolic and diastolic variabilities were each associated with subsequent adverse outcomes. Physicians should pay special attention to patients with swings in blood pressure between clinic visits. Electronic medical records should flag such variability.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajh\/hpy088","type":"journal-article","created":{"date-parts":[[2018,5,30]],"date-time":"2018-05-30T19:11:49Z","timestamp":1527707509000},"page":"1113-1119","source":"Crossref","is-referenced-by-count":25,"title":["Visit-to-Visit Variability of Blood Pressure Is Associated With Hospitalization and Mortality in an Unselected Adult Population"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9696-2789","authenticated-orcid":false,"given":"Marc D","family":"Basson","sequence":"first","affiliation":[{"name":"Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn G","family":"Klug","sequence":"additional","affiliation":[{"name":"Department of Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey E","family":"Hostetter","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Wynne","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,5,31]]},"reference":[{"key":"2022111617185689100_CIT0001","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1097\/00004872-199310000-00019","article-title":"Prognostic value of 24-hour blood pressure variability","volume":"11","author":"Frattola","year":"1993","journal-title":"J Hypertens"},{"key":"2022111617185689100_CIT0002","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/00004872-198702000-00013","article-title":"Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension","volume":"5","author":"Parati","year":"1987","journal-title":"J Hypertens"},{"key":"2022111617185689100_CIT0003","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1038\/s41598-017-00380-9","article-title":"Visit-to-visit variability of blood pressure and risk of stroke: results of the Kailuan cohort study","volume":"7","author":"Dai","year":"2017","journal-title":"Sci Rep"},{"key":"2022111617185689100_CIT0004","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1093\/ajh\/hpt092","article-title":"Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study","volume":"26","author":"Suchy-Dicey","year":"2013","journal-title":"Am J Hypertens"},{"key":"2022111617185689100_CIT0005","doi-asserted-by":"crossref","first-page":"2813","DOI":"10.1093\/eurheartj\/ehx250","article-title":"Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial","volume":"38","author":"Vidal-Petiot","year":"2017","journal-title":"Eur Heart J"},{"key":"2022111617185689100_CIT0006","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1161\/STROKEAHA.115.012321","article-title":"Antihypertensive drug use, blood pressure variability, and incident stroke risk in older adults: three-city cohort study","volume":"47","author":"Tully","year":"2016","journal-title":"Stroke"},{"key":"2022111617185689100_CIT0007","doi-asserted-by":"crossref","DOI":"10.1111\/1755-5922.12274","article-title":"Visit-to-visit systolic blood pressure variability predicts treatment-related adverse event of hyponatremia in SPRINT","volume":"35","author":"Goyal","year":"2017","journal-title":"Cardiovasc Ther"},{"key":"2022111617185689100_CIT0008","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1097\/00004872-200312000-00012","article-title":"Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population","volume":"21","author":"Pringle","year":"2003","journal-title":"J Hypertens"},{"key":"2022111617185689100_CIT0009","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12882-017-0514-9","article-title":"The risk of diabetic renal function impairment in the first decade after diagnosed of diabetes mellitus is correlated with high variability of visit-to-visit systolic and diastolic blood pressure: a case control study","volume":"18","author":"Yeh","year":"2017","journal-title":"BMC Nephrol"},{"key":"2022111617185689100_CIT0010","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/sj.jhh.1001301","article-title":"Office blood pressure variability as a predictor of acute myocardial infarction in elderly patients receiving antihypertensive therapy","volume":"16","author":"Hata","year":"2002","journal-title":"J Hum Hypertens"},{"key":"2022111617185689100_CIT0011","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1161\/HYPERTENSIONAHA.111.00138","article-title":"Home blood pressure variability as cardiovascular risk factor in the population of Ohasama","volume":"61","author":"Asayama","year":"2013","journal-title":"Hypertension"},{"key":"2022111617185689100_CIT0012","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1161\/HYPERTENSIONAHA.112.202143","article-title":"Within-subject blood pressure level\u2014not variability\u2014predicts fatal and nonfatal outcomes in a general population","volume":"60","author":"Schutte","year":"2012","journal-title":"Hypertension"},{"key":"2022111617185689100_CIT0013","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on clinical practice guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"2022111617185689100_CIT0014","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/MCA.0000000000000462","article-title":"The impact of blood pressure variability on coronary plaque vulnerability in stable angina: an analysis using optical coherence tomography","volume":"28","author":"Aoyama","year":"2017","journal-title":"Coron Artery Dis"},{"key":"2022111617185689100_CIT0015","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1093\/ajh\/hpx076","article-title":"Association between short-term systolic blood pressure variability and carotid intima-media thickness in ELSA-Brasil baseline","volume":"30","author":"Ribeiro","year":"2017","journal-title":"Am J Hypertens"},{"key":"2022111617185689100_CIT0016","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0140-6736(10)60308-X","article-title":"Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension","volume":"375","author":"Rothwell","year":"2010","journal-title":"Lancet"},{"key":"2022111617185689100_CIT0017","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s11906-014-0527-8","article-title":"Visit-to-visit variability of systolic blood pressure and cardiovascular disease","volume":"17","author":"Hussein","year":"2015","journal-title":"Curr Hypertens Rep"},{"key":"2022111617185689100_CIT0018","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1097\/HJH.0000000000001333","article-title":"Visit-to-visit SBP variability and cardiovascular disease in a multiethnic primary care setting: 10-year retrospective cohort study","volume":"35","author":"Chia","year":"2017","journal-title":"J Hypertens"},{"key":"2022111617185689100_CIT0019","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/jch.12037","article-title":"Association between antihypertensive medication adherence and visit-to-visit variability of blood pressure","volume":"15","author":"Muntner","year":"2013","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"2022111617185689100_CIT0020","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1038\/jhh.2016.77","article-title":"Visit-to-visit blood pressure variability, average BP level and carotid arterial stiffness in the elderly: a prospective study","volume":"31","author":"Nagai","year":"2017","journal-title":"J Hum Hypertens"},{"key":"2022111617185689100_CIT0021","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.diabres.2017.03.027","article-title":"Predictive ability of visit-to-visit variability in HbA1c and systolic blood pressure for the development of microalbuminuria and retinopathy in people with type 2 diabetes","volume":"128","author":"Takao","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"key":"2022111617185689100_CIT0022","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3233\/JAD-161172","article-title":"Visit-to-visit blood pressure variability and Alzheimer\u2019s disease: links and risks","volume":"59","author":"Nagai","year":"2017","journal-title":"J Alzheimers Dis"},{"key":"2022111617185689100_CIT0023","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1161\/hs0102.101890","article-title":"Variability in midlife systolic blood pressure is related to late-life brain white matter lesions: the Honolulu-Asia Aging study","volume":"33","author":"Havlik","year":"2002","journal-title":"Stroke"},{"key":"2022111617185689100_CIT0024","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1161\/HYPERTENSIONAHA.110.162255","article-title":"The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994","volume":"57","author":"Muntner","year":"2011","journal-title":"Hypertension"},{"key":"2022111617185689100_CIT0025","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.jash.2017.05.006","article-title":"Predictors of visit-to-visit blood pressure variability in patients with hypertension: an analysis of trials with an amlodipine treatment arm","volume":"11","author":"Wang","year":"2017","journal-title":"J Am Soc Hypertens"},{"key":"2022111617185689100_CIT0026","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/jch.12290","article-title":"Effect of chlorthalidone, amlodipine, and lisinopril on visit-to-visit variability of blood pressure: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial","volume":"16","author":"Muntner","year":"2014","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"2022111617185689100_CIT0027","doi-asserted-by":"crossref","first-page":"2703","DOI":"10.1161\/STROKEAHA.113.002186","article-title":"Genome-wide analysis of blood pressure variability and ischemic stroke","volume":"44","author":"Yadav","year":"2013","journal-title":"Stroke"},{"key":"2022111617185689100_CIT0028","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.jacc.2016.06.054","article-title":"Association of systolic blood pressure variability with mortality, coronary heart disease, stroke, and renal disease","volume":"68","author":"Gosmanova","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2022111617185689100_CIT0029","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/jmp\/4.3.313","article-title":"Choosing among candidates for scarce medical resources","volume":"4","author":"Basson","year":"1979","journal-title":"J Med Philos"},{"key":"2022111617185689100_CIT0030","doi-asserted-by":"crossref","first-page":"i4098","DOI":"10.1136\/bmj.i4098","article-title":"Blood pressure variability and cardiovascular disease: systematic review and meta-analysis","volume":"354","author":"Stevens","year":"2016","journal-title":"BMJ"},{"key":"2022111617185689100_CIT0031","author":"(NICE). NIfHaCE","year":"2016"},{"key":"2022111617185689100_CIT0032","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1111\/jch.12333","article-title":"Blood pressure variability and morning blood pressure surge in elderly Chinese hypertensive patients","volume":"16","author":"Qin","year":"2014","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"2022111617185689100_CIT0033","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1097\/HJH.0000000000000080","article-title":"The effects of weight loss and salt reduction on visit-to-visit blood pressure variability: results from a multicenter randomized controlled trial","volume":"32","author":"Diaz","year":"2014","journal-title":"J Hypertens"},{"key":"2022111617185689100_CIT0034","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/jhh.2015.26","article-title":"Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial","volume":"30","author":"Hong","year":"2016","journal-title":"J Hum Hypertens"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/31\/10\/1113\/47083666\/ajh_31_10_1113.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/31\/10\/1113\/47083666\/ajh_31_10_1113.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T17:19:50Z","timestamp":1668619190000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/31\/10\/1113\/5026118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,31]]},"references-count":34,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,5,31]]},"published-print":{"date-parts":[[2018,9,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpy088","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,10]]},"published":{"date-parts":[[2018,5,31]]}}}