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TOPLINE
Among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis undergoing maintenance therapy, greater visit-to-visit systolic blood pressure variability (SBPV) was independently associated with an increased risk for all-cause mortality.
METHODOLOGY
- Researchers conducted a retrospective study to examine whether visit-to-visit BP variability predicts all-cause mortality in 95 patients with ANCA-associated vasculitis (mean age, 68 years; 51% men) receiving maintenance therapy at three Italian nephrology centres between 2001 and 2020.
- SBPV was calculated as the SD of at least four SBP readings, taken with a validated sphygmomanometer at baseline and every 3 months over a 12-month window that began a median of 11 months after diagnosis. Time-averaged SBP and pulse pressure — the mean of all readings over the same window — were also calculated.
- Patients were stratified into low (< 8 mm Hg), middle (8.1-12.5 mm Hg), and high (> 12.6 mm Hg) SBPV tertiles.
- The primary outcome was all-cause mortality over a median follow-up of 78 months.
TAKEAWAY
- Over the follow-up period, 14.7% of patients with ANCA-associated vasculitis died, corresponding to an incidence rate of 30.5 events per 1000 patient-years.
- Each 5 mm Hg increase in SBPV was linked to an approximately twofold increased risk for death (hazard ratio, 2.03; P = .002); in contrast, average SBP over time did not differ significantly between those who died and survivors.
- Patients in the highest SBPV tertile had markedly worse survival than those in the two lower tertiles combined.
- After adjusting for age, sex, myeloperoxidase antibody status, estimated glomerular filtration rate, pulse pressure, and proteinuria, higher SBPV remained independently linked to the risk for all-cause mortality.
IN PRACTICE
"[The study] findings support the integration of BP variability assessment into long-term management strategies aimed at stabilizing BP and mitigating CV [cardiovascular] burden in AAV [antineutrophil cytoplasmic antibody-associated vasculitis]," the authors wrote.
SOURCE
This study was led by Elisabetta Bussalino, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy. It was published online on October 07, 2026, in Clinical Kidney Journal.
LIMITATIONS
The retrospective and observational nature of the study prevented the establishment of causal relationships. Several variables — including platelet counts, disease activity scores, the specifics of immunosuppressive dosing, cause-specific mortality, and changes in kidney function over the full follow-up period — were not analysed. Ambulatory BP, cumulative glucocorticoid exposure, and any changes to antihypertensive treatment during the study were also not recorded.
DISCLOSURES
This study did not receive any funding. The authors reported no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
