Some analyses of variability have not adjusted for mean blood pressure, potentially confounding high variability with high mean blood pressure,11 or have adjusted for a mean that is not fully consistent with the variability measure.12 Others, in using 24 hour mean to adjust for daytime variability, might have turned high daytime variability into a surrogate marker for nocturnal or 24 hour blood pressure.13 Further studies have defined variability on the basis of measurements taken during follow up, but analysed it as a baseline risk factor,14 15 16 potentially introducing problems of informative censoring or immortal time bias.17 Informative censoring occurs when reasons for loss to follow up are confounded with the exposure (eg, if individuals with extreme or erratic blood pressures are withdrawn from studies because of concerns about safety). Immortal time bias can occur if individuals are required to have a certain number of blood pressure measurements in order to be included in analysis for mortality outcomes. The time up until the qualifying measurement becomes «immortal time,» because, by definition, death could not occur earlier..
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