Home Blood Pressure Variability

A series of studies in the last decades have indicated that the risk of cardiovascular complications may not only depend on the magnitude of the elevation of average BP levels per se but also on an increased blood pressure variability. This concept has been supported by several reports, showing that increasing values of blood pressure variability either in the short term (24 h), in the midterm (day-by-day), or in the long term (visit-to-visit), may contribute to cardiovascular risk prediction over and above the impact of average BP levels. This chapter will focus on the day-by-day variations in BP values self-measured at home by patients, by addressing their mechanisms, the methodological aspects that should be considered for their assessment based on home BP measurements as well as their clinical relevance for cardiovascular prognosis. We will also address some yet pending issues which still make application of day-by-day Home Blood Pressure (HBP) variability difficult in daily practice. These include the additional contribution given by HBP variability to risk prediction, on top of what is offered by average HBP levels, and whether antihypertensive treatment strategies should be targeted at reducing not only average BP levels but also the degree of day-by-day blood pressure variability in order to optimize cardiovascular protection.