Rational Pharmacotherapy in Cardiology

Advanced search

High Blood Pressure Variability is an Additional Cardiovascular Risk Factor

Full Text:


Blood pressure (BP) is a highly variable physiological indicator. Most people have BP changes within 40-50 mmHg during the day. Various external factors (from the patient’s position during BP measurement to poor adherence to therapy and abuse of short-acting antihypertensive drugs) affect the assessed indicators. Evaluation of the average daily, intra-visit, as well as long-term ("from visit to visit") BP variability is used in clinical practice. In the past twenty years a number of major studies demonstrated that increased BP variability is an independent prognostic factor that increases the risk of cardiovascular complications. The largest meta-analysis of 41 studies showed that an increase in long-term BP variability was associated with 15% and 18% increase in total and cardiovascular mortality, respectively. According to the IDHOCO project, the threshold coefficient of variation for day-today variability is >11.0/12.8. Different groups of antihypertensive drugs have an uneven effect on BP variability. Consistent data from ASCOT-BPLA, X-CELLENT and ACCOMPLISH studies indicate that among the main groups of antihypertensive drugs, calcium antagonists, mainly amlodipine, have the greatest potential for the variability reduction. A decrease in BP variability, as shown in a post-hoc analysis of CAMELOT and PREVENT studies, has a positive effect on the incidence of major adverse cardiac events (MACE). Thus, the BP variability is an important indicator that reflects the prognosis in hypertensive patients. BP variability reduction can be considered as one of the independent goals of therapy. Calcium antagonists can be considered as first-line drugs for patients with high BP variability.

About the Author

A. V. Rodionov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Anton V. Rodionov – MD, PhD, Associate Professor, Chair of Faculty Therapy №1

Trubetskaya ul. 8-2, Moscow, 119991


1. Cook N.R., Cohen J., Hebert P.R., et al. Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med. 1995;155:701-9.

2. Rakotz M.K., Townsend R.R., Yang J., et al. Medical students and measuring blood pressure: results from the American Medical Association Blood Pressure Check Challenge. J Clin Hypertens (Greenwich). 2017;19:614-9. DOI:10.1111/jch.13018.

3. O'Brien E., Asmar R., Beilin L., et al. European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003;21(5):821-48. DOI:10.1097/00004872-200305000-00001.

4. Berra E., Azizi M., Capron A., et al. Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension. Hypertension. 2016;68(2):297306. DOI:10.1161/HYPERTENSIONAHA.116.07464.

5. Parati G., Liu X., Ochoa J.E., Bilo G. Prognostic relevance of blood pressure variability: role of long-term and very long-term blood pressure changes. Hypertension. 2013;62(4):682-4. DOI:10.1161/HYPERTENSIONAHA.113.01801.

6. Fratolla A., Parati G., Guspidi C., et al. Prognostic value of 24-hour pressure variability. J Hypertens. 1993;11:1133-7. DOI:10.1097/00004872-199310000-00019.

7. Kikuya M., Ohkubo T., Metoki H., et al. Day-by-Day Variability of Blood Pressure and Heart Rate at Home as a Novel Predictor of Prognosis. The Ohasama Study. Hypertension. 2008;52(6):1045-50. DOI:10.1161/HYPERTENSIONAHA.107.104620.

8. Rothwell P.M., Howard S.C., Dolan E., et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;13;375(9718):895-905. DOI:10.1016/S0140-6736(10)60308-X.

9. Johansson J.K., Niiranen T.J., Puukka P.J., Jula A.M. Prognostic value of the variability in home-measured blood pressure and heart rate: the Finn-Home Study. Hypertension. 2012;59(2):212-8. DOI:10.1161/HYPERTENSIONAHA.111.178657.

10. Stevens S.L., Wood S., Koshiaris C., et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ. 2016;354:i4098. DOI:10.1136/bmj.i4098.

11. Juhanoja E.P., Niiranen T.J., Johansson J.K., et al. International Database on Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO) Investigators. Outcome-Driven Thresholds for Increased Home Blood Pressure Variability. Hypertension. 2017;69(4):599-607. DOI:10.1161/HYPERTENSIONAHA.116.08603.

12. Mehlum M.H., Liestøl K., Kjeldsen S.E., et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. Eur Heart J. 2018;39(24):2243-51. DOI:10.1093/eurheartj/ehx760.

13. Clark D. 3rd, Nicholls S.J., St John J., et al. Visit-to-Visit Blood Pressure Variability, Coronary Atheroma Progression, and Clinical Outcomes. JAMA Cardiol. 2019;4(5):437-43. DOI:10.1001/jamacardio.2019.0751.

14. Rothwell P.M., Howard S.C., Dolan E., et al.; ASCOT-BPLA and MRC Trial Investigators. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010;9(5):469-80. DOI:10.1016/S1474-4422(10)70066-1.

15. Zhang Y., Agnoletti D., Safar M.E., Blacher J. Effect of antihypertensive agents on blood pressure variability: the Natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X-CELLENT) study. Hypertension. 2011;58(2):155-60. DOI:10.1161/HYPERTENSIONAHA.111.174383.

16. Webb A.J.S., Fischer U., Mehta Z., Rothwell P.M. Effects of antihypertensive-drug class on interindividual variation in BP and risk of stroke: a systematic review and meta-analysis. Lancet 2010;375:906-15. DOI:10.1016/S0140-6736(10)60235-8.

17. Webb A.J., Rothwell P.M. Effect of dose and combination of antihypertensives on interindividual blood pressure variability: a systematic review. Stroke. 2011;42(10):2860-5. DOI:10.1161/STROKEAHA.110.611566.

18. Park S., Yan P., Cerezo C., Jeffers B.W. Effect of visit-to-visit blood pressure variability on cardiovascular events in patients with coronary artery disease and well-controlled blood pressure. J Am Soc Hypertens. 2016;10(10):799-810. DOI:10.1016/j.jash.2016.08.004.

19. Williams B., Mancia G., Spiering W., et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. DOI:10.1093/eurheartj/ehy339.

20. Kollias A., Stergiou G.S., Kyriakoulis K.G., et al. Treating Visit-to-Visit Blood Pressure Variability to Improve Prognosis. Hypertension. 2017;70(5):862-6. DOI:10.1161/hypertensionaha.117.10087.

21. van den Born B.H., Lip G.Y.H., Brguljan-Hitij J., et al. ESC Council on hypertension position document on the management of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother. 2019;5(1):37-46. DOI:10.1093/ehjcvp/pvy032.

For citation:

Rodionov A.V. High Blood Pressure Variability is an Additional Cardiovascular Risk Factor. Rational Pharmacotherapy in Cardiology. 2020;16(1):94-98. (In Russ.)

Views: 54

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)