Wan EYF, Yu EYT, Chin WY, et al. - According to this retrospective cohort study, systolic blood pressure (SBP) visit‐to‐visit variability was strongly linked to cardiovascular disease (CVD) and mortality with no evidence of a threshold effect in a population with diabetes mellitus. SBP visit‐to‐visit variability should be monitored and assessed in routine practice, in addition to controlling overall blood pressure levels, especially in younger patients.

• The sample consisted of 155,982 patients with diabetes mellitus aged 45 to 84 years without CVD at baseline (2008–2010).

• SBP SD obtained from a mixed‐effects model was used to estimate typical SBP variability.

• Cox regression adjusted for patient characteristics was used to assess age‐specific associations (45–54, 55–64, 65–74, 75–84 years) between usual SBP variability, CVD, and mortality risk.

• Forty-nine thousand eight hundred sixteen events (including 34,039 CVD events and 29,211 mortalities) were identified after a median follow‐up of 9.7 years.

• In all age groups, increased SBP variability was independently, positively, and log‐linearly linked with increased CVD and mortality risk, with no indication of threshold effects.

• The increased CVD and mortality risk in the 45 to 54 age group is > 3 times higher than in the 70 to 79 age group per 5 mmHg rise in SBP variability.

• Across all subgroups, the substantial relationships were stable.

• Patients who were younger had a stronger link between SBP variability and event outcomes.