Blood pressure variability associates with mortality risk of patients with ANCA-associated vasculitis.
5 affiliations
- 1Nephrology, dialysis and Transplantation Unit, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy.
- 2Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Genova, Italy.
- 3Nephrology Unit, Università degli Studi di Brescia-ASST Spedali Civili di Brescia, Brescia, Italy.
- 4Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milano, Italy.
- 5Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.
Abstract
Objectives
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is associated with increased cardiovascular risk, related to persistent inflammation and endothelial dysfunction. Long-term systolic blood pressure variability (SBPV), reflecting vascular damage, may predict outcomes better than mean blood pressure (BP). We investigated the impact of BP control and visit-to-visit BP variability (VVV), on all-cause mortality in AAV patients during maintenance therapy.Methods
We retrospectively studied 95 AAV patients followed at three Italian nephrology centers. SBPV was defined as the standard deviation of ≥4 systolic BP measurements within 12 months from the first SBPV assessment. Patients were stratified by SBPV tertiles. The primary outcome was all-cause mortality.Results
Over a median follow-up of 78 months, 14 patients (14.7%) died. Deceased patients were older and had higher pulse pressure (PP) and VVV. Hypertension prevalence increased across SBPV tertiles (35%, 62%, 69%; P = .02). Mortality rose from 6% in the lowest to 34.5% in the highest SBPV tertile (Fisher's exact, P = .001). Time-averaged systolic BP was not associated with mortality. Conversely, each 5-mmHg increase in SBPV was associated with a two-fold higher risk of death [hazard ratio (HR) 2.03, 95% confidence interval (CI) 1.29-3.20; P = .002]. SBPV remained significantly associated with outcome after full multi-variable adjustment, including age, sex, myeloperoxidase positivity, estimated glomerular filtration rate, PP, and proteinuria (adjusted HR 8.06 per 1 mmHg, 95% CI 1.42-45.54; P = .02).Conclusion
In AAV patients, increased VVV was associated with all-cause mortality outperforming mean systolic BP. Further research is needed to confirm the impact of variable blood pressure on patient outcomes in AAV.
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BibTeX
@article{bussalino2026blood,
title = {{Blood pressure variability associates with mortality risk of patients with ANCA-associated vasculitis.}},
author = {Elisabetta Bussalino and Elisa Russo and Lucia Maccio and Marta Donati and Federica Mescia and Marta Calatroni and Martina Tedesco and Gabriella Moroni and Federico Alberici and Francesca Viazzi and Pasquale Esposito},
journal = {Clinical kidney journal},
year = {2026},
month = oct,
doi = {10.1093/ckj/sfag356},
url = {https://europepmc.org/article/MED/42899105},
note = {CC BY},
}
RIS
TY - JOUR
TI - Blood pressure variability associates with mortality risk of patients with ANCA-associated vasculitis.
AU - Elisabetta Bussalino
AU - Elisa Russo
AU - Lucia Maccio
AU - Marta Donati
AU - Federica Mescia
AU - Marta Calatroni
AU - Martina Tedesco
AU - Gabriella Moroni
AU - Federico Alberici
AU - Francesca Viazzi
AU - Pasquale Esposito
PY - 2026
DA - 2026/10/07
JO - Clinical kidney journal
DO - 10.1093/ckj/sfag356
UR - https://europepmc.org/article/MED/42899105
AB - Objectives Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is associated with increased cardiovascular risk, related to persistent inflammation and endothelial dysfunction. Long-term systolic blood pressure variability (SBPV), reflecting vascular damage, may predict outcomes better than mean blood pressure (BP). We investigated the impact of BP control and visit-to-visit BP variability (VVV), on all-cause mortality in AAV patients during maintenance therapy.Methods We retrospectively studied 95 AAV patients followed at three Italian nephrology centers. SBPV was defined as the standard deviation of ≥4 systolic BP measurements within 12 months from the first SBPV assessment. Patients were stratified by SBPV tertiles. The primary outcome was all-cause mortality.Results Over a median follow-up of 78 months, 14 patients (14.7%) died. Deceased patients were older and had higher pulse pressure (PP) and VVV. Hypertension prevalence increased across SBPV tertiles (35%, 62%, 69%; P = .02). Mortality rose from 6% in the lowest to 34.5% in the highest SBPV tertile (Fisher's exact, P = .001). Time-averaged systolic BP was not associated with mortality. Conversely, each 5-mmHg increase in SBPV was associated with a two-fold higher risk of death [hazard ratio (HR) 2.03, 95% confidence interval (CI) 1.29-3.20; P = .002]. SBPV remained significantly associated with outcome after full multi-variable adjustment, including age, sex, myeloperoxidase positivity, estimated glomerular filtration rate, PP, and proteinuria (adjusted HR 8.06 per 1 mmHg, 95% CI 1.42-45.54; P = .02).Conclusion In AAV patients, increased VVV was associated with all-cause mortality outperforming mean systolic BP. Further research is needed to confirm the impact of variable blood pressure on patient outcomes in AAV.
SN - 2048-8505
SN - 2048-8513
ER -