Abstract Body (Do not enter title and authors here): Background: Higher blood-pressure variability (BPV) across multiple visits has been associated with greater risk for mortality and adverse cardiovascular and neurocognitive outcomes. However, no studies have examined associations of BPV with sudden cardiac death (SCD), a leading mechanism of death among adults.

Methods: We used individual-level participant (ppt) data from 5 cohorts that are included in the LRPP dataset, (CARDIA, ARIC, Framingham Original and Offspring, and CHS), using baseline visits from the 1980s-2000s. We included ppts aged 40-80 years with at least 3 blood pressure (BP) measurements. Visit-to-visit BPV was quantified over 15 years using the standard deviation (SD) across all visits or the average real variability (ARV; average absolute difference between successive BP measurements, also taking the order of the BP measurements into account). SCD was adjudicated by each cohort using standardized definitions. Cox models (adjusted for covariates) were assessed to examine associations of BPV measures with SCD.

Results: There were 23,499 ppts (mean age 52.7±8.7 years, 55.3% women, 16.9% Black) followed for 15 years for BPV data and then for 10.3±6.6 years for SCD; 484 ppts (2.1%) experienced SCD. The mean SD and ARV were 11.1±6.3 and 11.9±7.3 mm Hg for systolic BP, 6.4±3.5 and 7.0±4.0 mm Hg for diastolic BP, and 7.0±3.9 and 7.8±4.6 mmHg for mean arterial pressure (MAP), respectively. After adjustment for age, sex, and race, each 1 mm Hg greater SD or ARV in MAP was associated with 9% (95% CI, 7-11%) or 6% (95% CI, 5-8%) higher hazards for SCD, respectively (Table). Associations of BPV with SCD were partially attenuated but remained significant after adjustment for other risk factors, baseline BP, and change in BP from baseline to end of observation. The pattern of results was overall similar for MAP, systolic BP, and diastolic BP. Ppts in the highest vs lowest quartiles of BPV were at approximately 50% higher adjusted risk for SCD (Table).

Conclusions: Long-term BPV in middle age is associated with SCD, even after adjusting for underlying BP change with age and other risk factors. BPV may be useful as a marker to identify individuals in the general population at higher risk for sudden death.