Blood pressure variability ratio: a novel marker associated with metabolic syndrome in patients without known cardiovascular disease

Metabolic syndrome (MetS) significantly increases cardiovascular risk and is associated with subclinical organ damage, including arterial stiffness. The Blood Pressure Variability Ratio (BPVR), derived from ambulatory blood pressure monitoring (ABPM), is a novel, easily calculated marker proposed to reflect arterial stiffness. This study evaluated the association between BPVR and MetS, and compared its diagnostic performance to the Ambulatory Arterial Stiffness Index (AASI). A total of 196 patients without known cardiovascular or cerebrovascular disease who underwent ABPM between March and September 2024 were included. BPVR was calculated as the ratio of the standard deviation of systolic to diastolic blood pressure over 24 hours. MetS was diagnosed using the revised ATP III criteria. Logistic regression, ROC analysis, and Integrated Discrimination Improvement (IDI) were performed to evaluate the predictive utility of BPVR and AASI. Patients with MetS were older and had higher BMI, glucose, LDL, and triglyceride levels. BPVR was significantly elevated in the MetS group and showed a moderate correlation with AASI (r = 0.509). Each 0.1-unit increase in BPVR was associated with a 25.6% higher odds of MetS (OR: 1.256, p = 0.014). ROC analysis showed similar performance for BPVR (AUC: 0.685) and AASI (AUC: 0.692). Decision curve analysis demonstrated greater net clinical benefit for models incorporating BPVR. BPVR is a promising and practical marker for identifying MetS, with predictive performance comparable to AASI. Its simplicity may support its integration into routine clinical assessments. Further validation is warranted.