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A study of 57,611 UK Biobank participants presented at the EASD Annual Meeting in Milan found that greater variation in blood pressure between visits was associated with a higher risk of death, independent of average blood pressure. Participants with type 2 diabetes and high systolic blood pressure variability were 2.8 times more likely to die than those with normal blood sugar and low variability.
Greater variation in blood pressure between medical visits was associated with a higher risk of death from any cause in a study of more than 57,000 UK Biobank participants, researchers from the Netherlands reported at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan. The study, led by Dr. Fariba Ahmadizar of Amsterdam University Medical Center, also linked variation in some blood pressure measures to strokes, and found that high blood pressure variability combined with type 2 diabetes was associated with nearly three times the risk of death.
The analysis included 57,611 participants whose blood pressure was measured at an initial assessment and at least one later visit. Their average age was 55.4 years and 52% were women. At the start, 50,744 participants had normal blood sugar, 5,397 had prediabetes, and 1,470 had type 2 diabetes. The researchers calculated how much blood pressure varied between visits, accounting for the time between measurements.
Over a median follow-up of 5.1 years, 319 participants developed dementia, 571 had a stroke, and 1,460 died. Greater variability in all four blood pressure measures studied — systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse pressure — was associated with a higher risk of death from any cause. These associations persisted after adjusting for average blood pressure, blood sugar status and other factors, meaning the variation itself carried information beyond the average readings used in routine care.
Each one-standard-deviation increase in systolic blood pressure variability was associated with an 11% higher risk of death; the corresponding figure for diastolic blood pressure variability was 8%. Greater variability in diastolic blood pressure and mean arterial pressure was also associated with strokes, with stroke likelihood 12% and 10% higher, respectively, per one-standard-deviation increase. No statistically significant associations were found for dementia.
Why Visit-to-Visit Variation Matters Clinically
Unlike average blood pressure, blood pressure variability is not routinely taken into account when doctors assess cardiovascular risk. The results suggest that tracking how much a patient’s blood pressure fluctuates between visits could help identify high-risk patients who might otherwise be overlooked based on average readings alone.
The combined-risk findings were especially pronounced. Compared with participants who had normal blood sugar and low systolic blood pressure variability, those with type 2 diabetes and high variability were 2.8 times more likely to die during follow-up, while participants with prediabetes and high variability had a 62% higher risk of death. The researchers estimated the 10-year risk of death at roughly 1.0% for those with normal blood sugar and low variability, versus approximately 2.9% for those with type 2 diabetes and high variability. The authors caution that these figures combine blood sugar status and variability, so the increased risk cannot be attributed to variability alone.
How the Study Was Designed
The study drew on the UK Biobank, a large long-term health study that collects repeated measurements from participants over time. Because each participant had at least two blood pressure readings, the researchers could calculate visit-to-visit variability while adjusting for the intervals between measurements. A standard deviation was used to describe how much variability differed between participants, which means the reported percentages cannot be directly translated into a specific change in blood pressure measured in mmHg.
The findings were presented at the EASD Annual Meeting in Milan, Italy, held September 28 to October 2, 2026, by researchers from the Department of General Practice at Amsterdam University Medical Center.
“Our findings suggest that changes in blood pressure over time may provide information beyond the average blood pressure readings in routine care. However, more research is needed before blood pressure variability can be recommended for routine clinical use.”
— Dr. Fariba Ahmadizar, Department of General Practice, Amsterdam University Medical Center
Causation and Clinical Use Still Unproven
Dr. Ahmadizar noted that the study was observational, meaning it did not prove that blood pressure variability causes death or strokes — only that the two are associated. It is not yet known whether reducing blood pressure fluctuations is possible, or whether doing so would lower the risk of stroke or death.
The researchers also stated that more research is needed before blood pressure variability can be recommended for routine clinical use. The findings were presented at a conference and described in a meeting report; full peer-reviewed publication details were not provided in the report.
Research Needed Before Practice Changes
Future studies will need to test whether blood pressure variability can be reduced through treatment or lifestyle changes, and whether such reduction translates into fewer strokes and deaths. Researchers must also clarify whether variability should be incorporated into standard risk assessments alongside average blood pressure. In the meantime, the findings do not change current clinical guidance, and patients with questions about their blood pressure readings should discuss them with a qualified healthcare professional.
Key Questions
Does blood pressure variability cause death or strokes?
No causal conclusion can be drawn. The study was observational, so it shows an association only. Dr. Ahmadizar noted the study did not prove causality.
How much did the risk of death increase?
Each one-standard-deviation increase in systolic blood pressure variability was associated with an 11% higher risk of death; for diastolic variability the figure was 8%. Participants with type 2 diabetes and high systolic variability were 2.8 times more likely to die than those with normal blood sugar and low variability.
Should doctors now measure blood pressure variability?
Not yet. The researchers said more research is needed before variability can be recommended for routine clinical use, including whether fluctuations can be reduced and whether that lowers risk.
What about dementia?
The study found no statistically significant associations between blood pressure variability and dementia during the follow-up period.
Who was studied?
The analysis included 57,611 UK Biobank participants with blood pressure measured at an initial assessment and at least one later visit. Their average age was 55.4 years, 52% were women, and they were followed for a median of 5.1 years.
Source: rss
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