BACKGROUND AND OBJECTIVES: Hearing loss is common and undertreated, and the impact of blood pressure variability (BPV) on the development of hearing loss remains unclear. We aimed to examine the age-specific association between visit-to-visit BPV and hearing loss. RESEARCH DESIGN AND METHODS: This nationally representative cohort study included 3,939 adults over 50 years from the Health and Retirement Study in the United States. Variabilities of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were assessed by standard deviation (), coefficient of variation, and variability independent of the mean (VIM), using SBP and DBP from 3 visits. Hearing loss was assessed by self-rated questions. Cox proportional risk models were used to evaluate age-specific associations (50-64, 65-79, and ≥80 years) between BPV and hearing loss. The generalized additive Cox models were further used to visualize the combined effect of age and BPV. RESULTS: During the follow-up up to 7.0 years, 700 participants developed hearing loss. Among people aged under 65 years, we observed a 36% increased risk of hearing loss with per- increment in VIM of SBP (hazard ratio [HR] per 1.36, 95% confidence interval [CI] 1.13-1.63) and a slightly significant association between VIM of DBP (HR per 1.21, 95% CI 1.01-1.45) and hearing loss. We did not observe significant associations among groups aged over 65 years ( > .05). The generalized additive Cox models also showed younger participants had stronger associations between BPV and hearing loss. DISCUSSION AND IMPLICATIONS: Higher visit-to-visit variabilities of SBP were associated with an increased risk of hearing loss in middle-aged adults (50-65 years). Intervention in early BPV may help decrease hearing loss in adults aged over 50 years.