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A study of 57,611 UK Biobank participants found that greater variation in blood pressure between visits was associated with a higher risk of death, even after accounting for average blood pressure and other factors. Some measures of variation were also associated with stroke, but the observational results do not show that blood pressure fluctuations cause these outcomes or that tracking them in routine care would improve health.
Greater variation in blood pressure readings between research visits was associated with a higher risk of death in a study of 57,611 UK Biobank participants, researchers reported at the European Association for the Study of Diabetes meeting in Milan. Variation in some blood pressure measures was also associated with stroke, although the observational study cannot show that fluctuations caused either outcome.
The study, led by Dr. Fariba Ahmadizar of Amsterdam University Medical Center, included people whose blood pressure was measured at an initial assessment and at least one later visit. Participants had an average age of 55.4 years, and 52% were women. At the start, 50,744 had normal blood sugar, 5,397 had prediabetes and 1,470 had type 2 diabetes.
Researchers assessed variability in four measures: systolic and diastolic blood pressure, mean arterial pressure and pulse pressure. They accounted for the time between measurements. Participants were followed for a median of 5.1 years from the first visit at which variability could be calculated. During that period, 1,460 participants died, 571 had a stroke and 319 developed dementia.
Higher variability across all four measures was associated with greater risk of death from any cause. The associations persisted after the researchers adjusted for average blood pressure, blood sugar status and other factors. Each one-standard-deviation increase in systolic variability was associated with an 11% higher risk of death; the corresponding figure for diastolic variability was 8%. A standard deviation describes differences in variability across participants, not a specific change in blood pressure in mmHg.
Why Blood Pressure Swings Matter
Routine risk assessment gives substantial attention to a person’s average blood pressure. The findings suggest that changes between readings might carry additional information about risk, potentially identifying people whose average measurement alone does not flag them as higher risk. That possibility could matter to clinicians and patients if further research confirms it.
The study also found associations between greater variability in diastolic pressure and mean arterial pressure and stroke. For each one-standard-deviation increase in variability, stroke likelihood was 12% higher for diastolic pressure and 10% higher for mean arterial pressure. These are relative associations within the study, not estimates of an individual’s personal risk or a prescribed threshold for action.
The results do not establish that lowering variability would prevent deaths or strokes. Nor do they show that clinicians should change treatment based on variability. Ahmadizar said more research is needed before it can be recommended for routine clinical use.
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Diabetes and Variability Findings
The researchers also compared outcomes across combinations of blood sugar status and systolic blood pressure variability. Compared with participants who had normal blood sugar and low variability, those with type 2 diabetes and high variability were 2.8 times as likely to die during follow-up. Participants with prediabetes and high variability had a 62% higher risk than the same reference group.
The study authors caution that those comparisons combine blood sugar status and blood pressure variability; the difference cannot be attributed to variability alone. Their estimated 10-year risk of death was about 1.0% for participants with normal blood sugar and low systolic variability, compared with about 2.9% for those with type 2 diabetes and high variability. These estimates describe the study groups and should not be read as forecasts for any one person.
No statistically significant association with dementia was found. The report describes the research as observational, meaning the team examined patterns in existing participant data rather than assigning people to a treatment intended to change blood pressure variability.
“Our findings suggest that changes in blood pressure over time may provide information beyond the average blood pressure readings in routine care.”
— Dr. Fariba Ahmadizar, Department of General Practice, Amsterdam University Medical Center
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Limits of the Observational Evidence
The study found associations, not cause and effect. Adjusting for average blood pressure, blood sugar status and other factors strengthens the analysis but cannot rule out all differences between participants that might help explain the results. The report does not establish why blood pressure varied or whether the variability itself contributed to later events.
It also remains unknown whether fluctuations can be reduced safely and consistently, and whether reducing them would lower the risk of stroke or death. The findings do not provide a clinical cutoff for “high” variability or show how often readings would need to be taken to use variability in care. No statistically significant dementia association was reported; that is not proof that no relationship exists.
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Research Needed Before Clinical Use
Further research would need to test whether blood pressure variability adds reliable, practical information to current risk assessment and whether an intervention that reduces it improves health outcomes. As Ahmadizar noted, a key question is whether fluctuations can be reduced and whether doing so changes the risk of stroke or death.
Until those questions are answered, the study does not support treating variability as a proven clinical target or changing medication on that basis. Its findings were presented at the 2026 EASD meeting; the source report does not specify a subsequent trial, publication date or clinical guideline change.
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Key Questions
What did the study find?
Among 57,611 UK Biobank participants, greater variation in blood pressure between research visits was associated with higher risk of death. Greater variability in certain measures was also associated with stroke. The study did not establish that variability caused these outcomes.
Does blood pressure variability mean a high average reading?
No. The researchers examined how much readings varied between visits, a measure distinct from average blood pressure. The reported associations remained after adjustment for average blood pressure and other factors.
What did the study report about diabetes?
Participants with type 2 diabetes and high systolic blood pressure variability had 2.8 times the risk of death compared with participants with normal blood sugar and low variability. Because this comparison combines diabetes status and variability, it does not isolate the effect of either factor.
Should patients change treatment because of these findings?
The study does not establish that changing treatment to reduce variability prevents stroke or death, and its lead researcher said more research is needed before variability can be recommended for routine clinical use. People considering changes to blood pressure care should discuss them with a qualified health professional.
Did the researchers find a link with dementia?
No statistically significant association with dementia was found in this study. That result does not prove that blood pressure variability has no relationship with dementia; it means the analysis did not identify a statistically significant link.
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