Correlation between systolic blood pressure variability and in-hospital mortality in patients with acute aortic dissection.

BACKGROUND: High blood pressure variability (BPV) may be associated with in-hospital mortality in patients with acute aortic dissection(AAD). This study aimed to investigate the association between BPV and in-hospital mortality in patients with AAD. METHODS: This retrospective study included patients with AAD who presented to the emergency department of the First Affiliated Hospital of Wenzhou Medical University between January 2024 and June 2025. In-hospital mortality was defined as the endpoint for in-hospital mortality. Patients with AAD were categorized into survivor and non-survivor groups according to in-hospital mortality. Blood pressure data during the emergency hospitalization period were collected, and BPV indices, including standard deviation (SD), coefficient of variation (CV), average real variability (ARV), as well as admission, mean, maximum, and minimum systolic and diastolic blood pressure values, were calculated. Multivariable logistic regression models were used to assess the associations. RESULTS: A total of 216 patients with aortic dissection were included, of whom 27 died during hospitalization. Significant differences were observed in systolic blood pressure parameters, including admission, mean, and minimum values, as well as variability indices (SD, CV, VIM, and ARV) (all P < 0.05). Similarly, diastolic blood pressure parameters, including mean and minimum values and variability indices (ARV and VIM), differed significantly between the two groups (all P < 0.05). Multivariable logistic regression analysis demonstrated that SBP-SD and SBP-ARV were independently associated with in-hospital mortality in AAD (OR = 1.043, 95% CI: 1.002-1.085, P = 0.039; OR = 1.061, 95% CI: 1.002-1.123, P = 0.043). CONCLUSIONS: Elevated BPV was found to be associated with an increased risk of in-hospital mortality in patients with AAD. Among the BPV indices, systolic blood pressure ARV was observed to exhibit a relatively stronger association with in-hospital mortality. These findings suggest that BPV may serve as a potential risk marker for adverse in-hospital outcomes in AAD, thereby providing additional insight into blood pressure management strategies.