Association of blood pressure variability and incidence of stroke: a systematic review and meta-analysis

Blood pressure variability (BPV) has emerged as a significant risk factor for cardiovascular events and mortality. The association between BPV and the incidence of cerebrovascular events is increasingly recognized as crucial in understanding stroke risk management. This review aims to investigate the relationship between BPV and the incidence of stroke. A comprehensive literature review was conducted using the PubMed database for studies published between 2010 and 2024. A total of 23 studies were included in this review, providing insight into short-term, mid-term and long-term BPV and their respective impacts on stroke risk. The studies reviewed consistently indicate that increased BPV, especially long-term, is strongly correlated with a higher risk of ischemic and hemorrhagic strokes. A meta-analysis of 17 studies ( n = 3 130 248 participants, weighted mean age 59 years, median follow-up 4.6 years) indicated hazard ratio of increasing systolic visit-to-visit BPV for incident stroke (adjusted for mean blood pressure) 1.40, 95% confidence intervals (1.10-1.77). BPV is an important factor in predicting stroke risk, independent of mean blood pressure levels. Managing BPV may offer an additional therapeutic target, both for primary and secondary prevention.