Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clinical implication of visit-to-visit blood pressure variability


In clinical practice, out-of-office blood pressure (BP) measurements, i.e., ambulatory BP monitoring and home BP measurement, provide superior results, reproducibility, and evaluation of the effect of antihypertensive drugs compared with office BP measurement. However, following a report on the clinical impact of visit-to-visit BP variability, in addition to the results of a clinical trial, office BP measurement has regained prominence in clinical and research settings. Many reports have been published on the association between visit-to-visit BP variability and cardiovascular outcomes. However, other indexes of BP variability besides visit-to-visit BP variability can be evaluated in the office. In addition, methodology has been developed for calculation of visit-to-visit BP variability. Although most studies have shown a positive association between visit-to-visit BP variability and cardiovascular outcomes, this association was not observed in some studies. Further research is still needed for clarification.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1


  1. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 esh/esc guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  Google Scholar 

  2. Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2014). Hypertens Res. 2014;37:253–387.

    Article  Google Scholar 

  3. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71:1269–324.

  4. Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895–905.

    Article  Google Scholar 

  5. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.

    Article  CAS  Google Scholar 

  6. Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B, et al. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9:469–80.

    Article  CAS  Google Scholar 

  7. Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010;375:906–15.

    Article  CAS  Google Scholar 

  8. Eguchi K, Kario K, Hoshide Y, Hoshide S, Ishikawa J, Morinari M, et al. Comparison of valsartan and amlodipine on ambulatory and morning blood pressure in hypertensive patients. Am J Hypertens. 2004;17:112–7.

    Article  CAS  Google Scholar 

  9. Rakugi H, Ogihara T, Saruta T, Kawai T, Saito I, Teramukai S, et al. Preferable effects of olmesartan/calcium channel blocker to olmesartan/diuretic on blood pressure variability in very elderly hypertension: COLM study subanalysis. J Hypertens. 2015;33:2165–72.

    Article  CAS  Google Scholar 

  10. Muntner P, Whittle J, Lynch AI, Colantonio LD, Simpson LM, Einhorn PT, et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: a cohort study. Ann Intern Med. 2015;163:329–38.

    Article  Google Scholar 

  11. Hata J, Arima H, Rothwell PM, Woodward M, Zoungas S, Anderson C, et al. Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: The ADVANCE trial. Circulation. 2013;128:1325–34.

    Article  Google Scholar 

  12. McMullan CJ, Bakris GL, Phillips RA, Forman JP. Association of BP variability with mortality among African Americans with CKD. Clin J Am Soc Nephrol. 2013;8:731–8.

    Article  Google Scholar 

  13. Mancia G, Facchetti R, Parati G, Zanchetti A. Visit-to-visit blood pressure variability, carotid atherosclerosis, and cardiovascular events in the European Lacidipine Study on Atherosclerosis. Circulation. 2012;126:569–78.

    Article  Google Scholar 

  14. Hara A, Thijs L, Asayama K, Jacobs L, Wang JG, Staessen JA. Randomised double-blind comparison of placebo and active drugs for effects on risks associated with blood pressure variability in the systolic hypertension in Europe trial. PLoS ONE. 2014;9:e103169.

    Article  Google Scholar 

  15. Chang TI, Reboussin DM, Chertow GM, Cheung AK, Cushman WC, Kostis WJ, et al. Visit-to-visit office blood pressure variability and cardiovascular outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2017;70:751–8.

    Article  CAS  Google Scholar 

  16. Zanchetti A. Wars, war games, and dead bodies on the battlefield: variations on the theme of blood pressure variability. Stroke. 2011;42:2722–4.

    Article  Google Scholar 

  17. Yano Y, Reis JP, Levine DA, Bryan RN, Viera AJ, Shimbo D, et al. Visit-to-visit blood pressure variability in young adulthood and hippocampal volume and integrity at middle age: The CARDIA study. Hypertension. 2017;70:1091–8.

    Article  CAS  Google Scholar 

  18. Hoshide S, Yano Y, Mizuno H, Kanegae H, Kario K. Day-by-day variability of home blood pressure and incident cardiovascular disease in clinical practice: The J-HOP Study (Japan Morning Surge-Home Blood Pressure). Hypertension. 2018;71:177–84.

    Article  CAS  Google Scholar 

  19. Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.

    Article  Google Scholar 

  20. Tientcheu D, Ayers C, Das SR, McGuire DK, de Lemos JA, Khera A, et al. Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension: analysis from the Dallas Heart Study. J Am Coll Cardiol. 2015;66:2159–69.

    Article  Google Scholar 

  21. Bobrie G, Chatellier G, Genes N, Clerson P, Vaur L, Vaisse B, et al. Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004;291:1342–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Satoshi Hoshide.

Ethics declarations

Conflict of interest

Dr. Hoshide reports receiving speaker fee from Takeda Pharmaceutical Company.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hoshide, S. Clinical implication of visit-to-visit blood pressure variability. Hypertens Res 41, 993–999 (2018).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Visit-to-visit blood pressure variability
  • Methodology
  • Cardiovascular outcome

This article is cited by


Quick links