Blood pressure variability and organ damage.

Several studies have now shown that hypertension-induced end-organ damage is more closely related to 24-h average blood pressure than to clinic measurements. Furthermore, the degree of variability of blood pressure during a 24-h period bears a relation to organ damage that is independent of average blood pressure value. The measurement of blood pressure variability is a complex task, however, because data from automatic ambulatory blood pressure monitoring should be interpreted with caution, especially if the interval between blood pressure measurements is more than 15 min, and different types of blood pressure variability (e.g., short-term and long-term) can make calculation of variability by standard deviation of 24-h blood pressure values difficult, which further complicates measurement procedures and interpretation. Evidence is growing to suggest that blood pressure variability in hypertension is clinically significant. We have recently shown that over a 7.5-year period, end-organ damage is independently related to the initial blood pressure variability. Although information on the effect of antihypertensive treatment on 24-h blood pressure variability is limited, the available data suggest more of an effect on 24-h average blood pressure levels than on 24-h blood pressure changes. Further studies should investigate treatment effects on different types of blood pressure variability and the impact of treatment on patient protection and prognosis.