Blood pressure variability in risk stratification: What does it add?

In this minireview we address the predictive value of blood pressure variability, over and beyond level of pressure, in randomly selected population samples. All reviewed studies had sufficient power, long follow-up duration and a wide age range. We assessed blood pressure variability derived from home visit, self-measured home pressure and 24h ambulatory monitoring. The conclusions are based mainly on novel indices of blood pressure variability: variability independent of the mean, difference between maximum and minimum blood pressure and average real variability. None of these variability indices or morning surge in blood pressure substantially refined risk profiling over and beyond the blood pressure level. In risk stratification, clinicians should concentrate on blood pressure level, the predominant risk factor modifiable by lifestyle measures and antihypertensive drug treatment.