Blood pressure swings may signal hidden stroke and mortality risk

Clinical takeaway: Consider looking beyond average blood pressure values. Greater visit-to-visit blood pressure variability was associated with a higher risk of stroke and death, suggesting it may help identify higher-risk patients, particularly those with prediabetes or type 2 diabetes.

Blood pressure management typically focuses on achieving target average readings, but fluctuations between visits are not routinely assessed. These findings suggest that variability itself may carry clinically meaningful prognostic information, even after accounting for mean blood pressure and glycemic status.

In this UK Biobank analysis of 57,611 adults, researchers examined whether visit-to-visit blood pressure variability was associated with dementia, stroke, and all-cause mortality across the spectrum of normal glycemia, prediabetes, and type 2 diabetes. The findings, presented at the 2026 EASD Annual Meeting and not yet peer reviewed, were based on a median follow-up of 5.1 years, during which 319 participants developed dementia, 571 experienced a stroke, and 1,460 died.

Higher variability across all blood pressure measures studied was linked to an increased risk of death, independent of average blood pressure levels and other clinical factors. Each standard-deviation increase in systolic blood pressure variability was associated with an 11% higher mortality risk, while a similar increase in diastolic variability was linked to an 8% higher risk. Variability in diastolic blood pressure and mean arterial pressure was also associated with roughly 12% and 10% higher stroke risk, respectively. No significant association with dementia remained after statistical correction.

Risk was especially pronounced among participants with abnormal glucose metabolism. Compared with individuals who had normal blood sugar and low systolic blood pressure variability, those with prediabetes and high variability had a 62% higher mortality risk. Participants with type 2 diabetes and high systolic blood pressure variability were nearly three times more likely to die during follow-up. Model estimates suggested a 10-year mortality risk of approximately 1.0% among those with normal glycemia and low variability versus about 2.9% among those with type 2 diabetes and high variability.

“Our findings suggest that changes in blood pressure over time may provide information beyond the average blood pressure readings in routine care,” said lead investigator Dr. Fariba Ahmadizar, who noted that further research is needed to determine whether reducing these fluctuations can improve outcomes.

Source: Ahmadizar F, et al. (2026 Sep 28-Oct 2) 62nd EASD Annual Meeting, abstract 1147. Visit-to-Visit Blood Pressure Variability, Glycemic Status and the Risk of Dementia, Stroke, and All-Cause Mortality: A UK Biobank Cohort Study