BPV

Blood pressure variability (BPV) refers to fluctuations in arterial blood pressure over time. It encompasses changes that occur on short timescales, such as beat-to-beat or within 24 hours, as well as longer timescales spanning days to weeks or visit-to-visit measurements. BPV is distinct from the average or mean blood pressure and can be assessed using ambulatory blood pressure monitoring (ABPM) or home blood pressure measurements. Common metrics include standard deviation, coefficient of variation, and newer measures such as average real variability.

BPV can be characterized as short-term, mid-term, or long-term, depending on the observation window. Short-term BPV is often evaluated with ABPM, capturing day–night fluctuations and responses to activity and stress. Long-term BPV typically reflects variability in clinic or home readings across multiple visits. The choice of metric can influence interpretation of a patient’s vascular risk.

Clinical significance and interpretation: Higher BPV has been associated with an increased risk of cardiovascular events, stroke, and target-organ damage independent of mean blood pressure. Potential mechanisms include arterial stiffness, autonomic dysfunction, and impaired baroreflex sensitivity, as well as measurement-related factors such as white coat or masked hypertension. BPV is influenced by age, sex, obesity, sleep apnea, hydration, timing of measurements, and certain medications.

Management and implications: The primary goal remains reducing overall blood pressure and, when possible, minimizing BPV. Antihypertensive therapy and regimen choices may affect BPV, with some drug classes showing greater reductions in variability in some studies. ABPM or home BP monitoring can guide therapy and identify patterns such as nocturnal hypertension or excessive variability. Lifestyle measures, including weight management, physical activity, sodium reduction, and treatment of sleep apnea, can also contribute to lower BPV. BPV is considered within broader cardiovascular risk assessment and individualized care planning.