Short-term and mid-term blood pressure variability in acute myocardial infarction: a prospective cohort study on in-hospital and long-term prognostic impact

INTRODUCTION: Blood pressure variability (BPV) is a prognostic marker in hypertension and coronary artery disease (CAD), but its role in acute myocardial infarction (AMI) remains unknown. This study assessed the association of short-term (24-h ambulatory BP monitoring, ABPM) and mid-term BPV with adverse in-hospital and long-term outcomes in AMI patients. METHODS: Mid-term BPV was calculated as the standard deviation (SD) of daily in-hospital BP readings; short-term BPV was measured by average real variability (ARV) from ABPM. Patients were evaluated as continuous variables and by quartiles (Q1-Q4). Logistic regression and Cox models assessed in-hospital and 3-year outcomes. RESULTS: In this prospective, single-center cohort, 441 of 677 AMI patients were included. Each 1 mmHg rise in day-to-day systolic BPV (SBP-SD) increased in-hospital MACE risk by 24% [odds ratio (OR): 1.24, 95% confidence interval (CI): 1.17-1.31], with Q4 showing the highest risk (OR: 28.89, 95% CI: 8.58-97.28). ABPM-derived SBP-ARV predicted in-hospital mortality (OR: 1.58, 95% CI: 1.21-2.07) and MACE (OR: 1.35, 95% CI: 1.23-1.48). Diastolic ARV was linked to in-hospital myocardial infarction (MI), arrhythmias, and shock. At 3-year follow up, Q4 of SBP-SD showed higher risk of composite outcomes (hazard ratio: 29.88, 95% CI: 10.93-81.66) and all-cause mortality (hazard ratio: 11.85, 95% CI: 2.81-49.91). SBP-ARV independently predicted both all-cause mortality (hazard ratio: 1.37, 95% CI: 1.25-1.51) and adverse events (hazard ratio: 1.29, 95% CI: 1.22-1.36), while diastolic BPV was primarily associated with arrhythmias and heart failure hospitalization. CONCLUSION: Systolic BPV independently predicts in-hospital and long-term outcomes in AMI. BPV assessment may aid post-MI risk stratification and guide novel therapeutic strategies in this high-risk population.