The Importance of Instability and Visit-to-visit Variability of Blood Pressure

Giuseppe Schillaci; Giacomo Pucci


Expert Rev Cardiovasc Ther. 2010;8(8):1095-1097. 

In This Article

Abstract and Introduction


Spontaneous fluctuations of blood pressure from visit to visit have usually been disregarded as a trivial factor that confounds the 'true' associations of an individual's long-term average blood pressure with disease. The paper under evaluation shows that visit-to-visit blood pressure variability is an independent predictor of future cardiovascular events in hypertensive patients and in subjects surviving a transient cerebral ischemia. Episodic elevations of blood pressure in nonhypertensive subjects seem to carry similar adverse prognostic significance. There is some evidence that different blood pressure-lowering drug classes may differ in their effects on visit-to-visit blood pressure variability, but these findings need to be confirmed in further studies.


The adverse cardiovascular consequences of hypertension are believed to depend primarily on absolute blood pressure (BP) values, and it is currently accepted that average BP is the main target for preventing cardiovascular morbidity and mortality in hypertensive subjects. The clinical value of BP fluctuations around the mean, and especially of the unsystematic BP variations from visit to visit, which are usually recorded during a prolonged clinical observation of months or years, has received little attention thus far.

This article evaulates a recent paper by Rothwell et al.[1] and a number of related papers,[2–4] which questioned the axiom that average BP is the most important (or even the only) factor to be considered in the clinical management of hypertensive patients, and raised the issue of the importance of 'random' fluctuations of BP over long periods of observation.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: