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Review
. 2025 Jun 1;43(6):929-938.
doi: 10.1097/HJH.0000000000003994. Epub 2025 Mar 10.

Blood pressure variability: a review

Spoorthy Kulkarni  1   2 , Gianfranco Parati  3   4 , Sripal Bangalore  5 , Grzegorz Bilo  3   4 , Bum Joon Kim  6 , Kazuomi Kario  7 , Franz Messerli  8 , George Stergiou  9 , Jiguang Wang  10 , William Whiteley  11 , Ian Wilkinson  1   2 , Peter S Sever  12
Affiliations
Review

Blood pressure variability: a review

Spoorthy Kulkarni et al. J Hypertens. .

Abstract

Blood pressure variability (BPV) predicts cardiovascular events independent of mean blood pressure. BPV is defined as short-term (24-h), medium or long- term (weeks, months or years). Standard deviation, coefficient of variation and variation independent of the mean have been used to quantify BPV. High BPV is associated with increasing age, diabetes, smoking and vascular disease and is a consequence of premature ageing of the vasculature. Long-term BPV has been incorporated into cardiovascular risk models (QRISK) and elevated BPV confers an increased risk of cardiovascular outcomes even in subjects with controlled blood pressure. Long-acting dihydropyridine calcium channel blockers and thiazide diuretics are the only drugs that reduce BPV and for the former explains their beneficial effects on cardiovascular outcomes. We believe that BPV should be incorporated into blood pressure management guidelines and based on current evidence, long-acting dihydropyridines should be preferred drugs in subjects with elevated BPV.

Keywords: ASCOT study; blood pressure variability; coronary events; stroke.

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Conflict of interest statement

S.K. received consultancy from Viatris & Mphar and funding from AstraZeneca; G.P. received honoraria from Viatris, Omron and Merck; S.B. received consultancy fees and honoraria from Abbott Vascular, Biotronik, Boston Scientific, Pfizer, Viatris, Shockwave, Inari, Imperative Care and Recor; G.B. received lecture fees from Viatris, Daiichi Sankyo, Neopharmed Gentil, Servier, Alfasigma, & Sanofi; K.K. received grants from Omron Healthcare Ltd, Fukuda Denshi Ltd & A&D Company Ltd; F.M. received consultany fees from Medtronic & Recor; GS received consultancy and lecture fees from AstraZeneca, Menarini, Sanofi-Aventis, Servier, and Viatris; J.-G.W. received honoraria from Novartis, Omron & Pfizer; W.W. received funding from Chief Scientists's Office, HDRUK & Alzheimer's Society and honoraria from Viatris; IW received grants from Viatris & Astra Zeneca, consultancy fees from Vaitris, Roche & Astra Zeneca and honoraria from Viatris; PS received funding, consultany fees, and honoraria from Viatris.

Figures

FIGURE 1
FIGURE 1
Pathophysiology of blood pressure variability (adapted from [12,38,45]) (created using Biorender.com). NO, nitric oxide; RAAS, renin–angiotensin–aldosterone system.
See this image and copyright information in PMC

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