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Blood pressure variability: From predictive marker to intervention target-breaking the vicious cycle of hypertensive

Ruiqin Luo1, Ying Huang1, Yanjun Leng1

  • 1Department of Cardiology, Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine, Shenzhen, Guangdong, Peoples's Republic of China.

Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|December 14, 2025
PubMed

Insights

Blood pressure variability (BPV) significantly drives hypertensive target organ damage (TOD) and cardiovascular events. Controlling BPV alongside average blood pressure is crucial for preventing TOD and improving patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Hypertension Research
  • Clinical Pharmacology

Background:

  • Hypertensive target organ damage (TOD) is a major cause of cardiovascular events and mortality.
  • Despite controlling average blood pressure (BP), TOD progression continues in some patients.
  • Blood pressure variability (BPV) is increasingly recognized as an independent risk factor for TOD.

Purpose of the Study:

  • To systematically review epidemiological evidence linking BPV to TOD.
  • To elucidate the mechanisms by which BPV contributes to TOD pathogenesis.
  • To discuss precision management strategies for attenuating BPV in hypertension.

Main Methods:

  • Systematic review of epidemiological studies on BPV and TOD.
  • Analysis of mechanistic pathways including endothelial dysfunction, inflammation, and arterial stiffness.
  • Review of recent advances in BPV-focused management strategies.

Main Results:

  • BPV is an independent predictor and active contributor to TOD.
  • BPV exacerbates the hypertension-arteriosclerosis cycle.
  • Endothelial dysfunction, inflammation, and arterial stiffness are key mediating pathways.

Conclusions:

  • Clinical management of hypertension should integrate BPV control beyond just mean BP.
  • Targeting BPV is critical for disrupting the TOD vicious cycle.
  • An integrated approach to BP management is essential for cardiovascular event prevention.

Keywords:
Blood pressure variabilityarterial stiffnessprecision treatmentrisk assessmenttarget organ damagevicious cycle

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