Blood pressure readings taken in a physician's office can vary due to timing, equipment, and biological factors. Studies have linked variability between visits to an increased risk of cardiovascular disease and death, but little was known about its real-world implications. A retrospective cohort study of over 500,000 adults with more than 7.7 million blood pressure measurements found that visit-to-visit variability in blood pressure was associated with an increased risk of cardiovascular events and all-cause mortality. The study's findings suggest that blood pressure management needs to be reassessed to better account for visit-to-visit variability in real-world practice.

A recent study analyzed blood pressure readings from more than half a million adults to determine how much variation occurs in blood pressure readings between visits. The study found that visit-to-visit variability (VVV) was consistent across all patient subgroups and that the average absolute change between two consecutive visits was about 12 mm Hg. The study suggests that VVV may be leading physicians to prescribe or increase doses of antihypertensive medication unnecessarily. The study also highlights the importance of regularly monitoring blood pressure at home or with ambulatory blood pressure monitoring (ABPM) to obtain more accurate readings, which could be used to adjust medication dosages. The study concludes that more research is needed to understand the relationship between VVV and cardiovascular outcomes.

Rubin R. More Evidence That Hypertension Treatment Decisions Shouldn’t Depend Solely on In-Office Blood Pressure Readings. JAMA. Published online April 26, 2023. doi:10.1001/jama.2023.5538

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