Background Increasing evidence suggests that blood pressure variability (BPV) may offer prognostic value beyond average blood pressure levels. However, data on the association between BPV of ambulatory blood pressure monitoring and mortality in patients aged 80 and older are limited. This study aimed to investigate the relationship between BPV and all-cause mortality in this population.

Methods A total of 5,838 ABPM records from the Geriatrics Department of Beijing Friendship Hospital, collected between October 12, 2018, and June 9, 2025, were analyzed. Patients were divided into death and non-death groups. Subgroup analyses were performed based on the number of completed ABPM sessions. Cox proportional hazards models assessed the associations between BPV and mortality. Kaplan–Meier analysis and log-rank tests were used to compare survival across groups.

Results A median follow-up of 32.0 months included 727 hypertensive patients aged ≥80 years. Multivariable cox regression and kaplan–meier analyses showed that the reverse-dipper blood pressure pattern was significantly associated with increased mortality. While short-term BPV was not linked to mortality, greater long-term variability in nighttime SBP and daytime DBP was significantly associated with higher mortality.

Conclusion Among individuals aged 80 and older, those with a reverse-dipper pattern and higher long-term BPV had a significantly higher mortality risk, despite achieving recommended blood pressure targets.

The authors have declared no competing interest.

This study was approved by the Ethics Committee of Beijing friendship hospital, the clinical trial number is MR-11-26-021030.

This work is supported by the National Science and Technology Major Project (2021ZD0111000).

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This study was approved by the Ethics Committee of Beijing friendship hospital.

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