Table of ContentsView AllTable of ContentsMeasuring ErrorsMedical CausesMedical SettingsHigh Blood Pressure
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Table of Contents
Measuring Errors
Medical Causes
Medical Settings
High Blood Pressure
Fluctuating blood pressure can be normal, as blood pressure varies somewhat throughout the day. Stress, exercise, and sleep can all make a difference. But if your blood pressure often changes significantly from one healthcare visit to another, there may a problem.
Studies have found that visit-to-visit changes in blood pressure are sometimes linked to a higher risk of heart disease and early death.The presence oflabile hypertension(unstable, fluctuating blood pressure) can suggest an underlying health issue or potential for complications.
This article explains why you may have fluctuating blood pressure and ways your healthcare provider can identify the cause. It offers information about hypertension risk factors and lifestyle changes you can make to limit your risk.
Verywell / Cindy Chung
To prevent errors, bring your home blood pressure monitor to your next healthcare appointment. Work with your healthcare provider to be sure you’re using it correctly. You should also bring your readings to see if you get similar numbers in the office.
Ambulatory Blood Pressure MonitoringSome healthcare providers recommendambulatory blood pressure monitoring. This involves wearing a device at home for a day or two. It checks blood pressure every 15 to 20 minutes during the day and every 30 to 60 minutes at night. The Centers for Medicare & Medicaid Services does cover the cost of this test but it isn’t always available.
Ambulatory Blood Pressure Monitoring
Some healthcare providers recommendambulatory blood pressure monitoring. This involves wearing a device at home for a day or two. It checks blood pressure every 15 to 20 minutes during the day and every 30 to 60 minutes at night. The Centers for Medicare & Medicaid Services does cover the cost of this test but it isn’t always available.
A Word From VerywellFluctuations in blood pressure from minute to minute are common and normal. For this reason, whether you are at home or in the doctor’s office, it’s important that your blood pressure measurement is made in a true “baseline” state. This means that you should not have anything to eat or drink for at least 30 minutes, your bladder should be empty, and you should sit in a chair in a warm, quiet room for at least 5 minutes, with your feet on the floor and your back supported, while not talking or using your phone.—RICHARD N. FOGOROS, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Fluctuations in blood pressure from minute to minute are common and normal. For this reason, whether you are at home or in the doctor’s office, it’s important that your blood pressure measurement is made in a true “baseline” state. This means that you should not have anything to eat or drink for at least 30 minutes, your bladder should be empty, and you should sit in a chair in a warm, quiet room for at least 5 minutes, with your feet on the floor and your back supported, while not talking or using your phone.—RICHARD N. FOGOROS, MD, MEDICAL EXPERT BOARD
Fluctuations in blood pressure from minute to minute are common and normal. For this reason, whether you are at home or in the doctor’s office, it’s important that your blood pressure measurement is made in a true “baseline” state. This means that you should not have anything to eat or drink for at least 30 minutes, your bladder should be empty, and you should sit in a chair in a warm, quiet room for at least 5 minutes, with your feet on the floor and your back supported, while not talking or using your phone.
—RICHARD N. FOGOROS, MD, MEDICAL EXPERT BOARD
Experts are exploring why blood pressure varies from visit to visit. It may be that people with blood pressure swings, especially as they age, have problems with blood vessels, likeendothelial dysfunctionthat affects the vessel linings or stiffness in the arteries.
The ups and downs in their readings could be a clue that they’re at a higher risk of having a heart attack or stroke. Very rarely, blood pressure changes come from apheochromocytoma—a tumor in the adrenal gland.These tumors are usually not cancerous.
Pheochromocytoma tumors cause fluctuating blood pressures, but the diagnosis is the cause in less than 2% of people with blood pressure swings. The vast majority of people with the condition have them for another reason.
Possible medical reasons or lifestyle factors that may contribute to fluctuating blood pressure include stress.You may not experience symptoms, but larger fluctuations can lead to facial flushing, sweating, or headaches.
Blood pressure changes also can occur due to medication use. Other common conditions that may be related to varying blood pressure levels include:
The blood pressure variability can be just one symptom that occurs in a pattern with others, as is the case with skin changes calledlivedo racemosathat also occur with Sneddon syndrome.
Is a Fluctuating Blood Pressure Serious?
Arterial Disease Types: Risk Factors, Causes, and Symptoms
Sometimes just being in a medical setting is enough to throw off your readings.
Whitecoat Hypertension
Withwhite coat hypertension, a person’s blood pressure is high at a healthcare provider’s office, but normal when at home.Experts think the reason could be stress from being in a medical office. That’s why providers often wait for you to rest for five minutes before they take a reading.
Another option is to take your blood pressure twice. If there is a difference of more than 5 millimeters of mercury (mmHg), the readings should be checked again.
Masked Hypertension
Masked hypertension is the opposite problem. It occurs when readings in a medical office are normal. Later, the numbers are high.To sort these issues out, a healthcare provider may recommend home monitoring or ambulatory blood pressure monitoring.
Home monitoring may also be a good idea for:
Do you take blood pressure medication? If you don’t always take your medication as prescribed (for example, skipping or often forgetting doses), it might cause blood pressure changes.
If you notice some high blood pressure readings among the normal ones, it could be that you havehypertensionbut have not been diagnosed yet.
Experts don’t know exactly how high blood pressure develops. It may be because your genes and your environment affect how your heart and kidneys work. It may also be due to gradualatherosclerosis, or hardening of the arteries.
Some risk factors raise the chances of having high blood pressure. They include:
Be sure to speak to your healthcare provider about other lifestyle, health, or medication concerns and high blood pressure. They can help you to make changes in your diet, stop smoking, or start a treatment plan for your condition.
Hypertension Healthcare Provider Discussion GuideGet our printable guide for your next healthcare provider’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
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Summary
It’s normal for your blood pressure to go up and down a little during the day. If you’re using a home blood pressure cuff, the readings might be off. The same holds true for drugstore equipment.
Some differences, though, could be related to a health condition. If you’re not getting consistent readings, it’s important to see your healthcare provider about the issue. With proper monitoring, healthy habits, and medications (if needed), you can gain control over your heart health.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Clark D, Nicholls SJ, St John J, et al.Visit-to-visit blood pressure variability, coronary atheroma progression, and clinical outcomes.JAMA Cardiol. 2019;4(5):437-443. doi:10.1001/jamacardio.2019.0751Kario K.Home Blood Pressure Monitoring: Current Status and New Developments.Am J Hypertens. 2021 Aug 9;34(8):783-794. doi:10.1093/ajh/hpab017.American Heart Association.Monitoring your blood pressure at home.CMS.gov. Centers for Medicare & Medicaid Services.CMS expands coverage of ambulatory blood pressure monitoring (ABPM).Bencivenga L, De Souto Barreto P, Rolland Y, Hanon O, Vidal JS, Cestac P,et al.Blood pressure variability: A potential marker of aging.Ageing Res Rev. 2022 Sep;80:101677. doi:10.1016/j.arr.2022.101677.American Association of Endocrine Surgeons.Pheochromocytoma: Diagnosis and treatment.Mann SJ.Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies.Curr Cardiol Rep. 2015 Nov;17(11):99. doi:10.1007/s11886-015-0646-0.Munakata M.Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings.Hypertens Res. 2018 Aug;41(8):553-569. doi:10.1038/s41440-018-0053-1.Doroszko A, Janus A, Szahidewicz-Krupska E, Mazur G, Derkacz A.Resistant Hypertension.Adv Clin Exp Med. 2016 Jan-Feb;25(1):173-83. doi:10.17219/acem/58998.Samanta D, Cobb S, Arya K.Sneddon Syndrome: A Comprehensive Overview.J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2098-2108. doi:10.1016/j.jstrokecerebrovasdis.2019.05.013Muntner P, Whittle J, Lynch A, et al.Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality.Ann Intern Med. 2015;163(5):329-338. doi:10.7326/m14-2803Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-41. doi:10.2147/PRBM.S61192Franklin SS, O’Brien E, Thijs L, Asayama K, Staessen JA.Masked hypertension: a phenomenon of measurement.Hypertension. 2015;65(1):16-20. doi:10.1161/HYPERTENSIONAHA.114.04522American Heart Association.Know your risk factors for high blood pressure.Additional ReadingWang J, Shi X, Ma C, et al.Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease.Journal of Hypertension. 2017;35(1):10-17. doi:10.1097/hjh.0000000000001159
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Clark D, Nicholls SJ, St John J, et al.Visit-to-visit blood pressure variability, coronary atheroma progression, and clinical outcomes.JAMA Cardiol. 2019;4(5):437-443. doi:10.1001/jamacardio.2019.0751Kario K.Home Blood Pressure Monitoring: Current Status and New Developments.Am J Hypertens. 2021 Aug 9;34(8):783-794. doi:10.1093/ajh/hpab017.American Heart Association.Monitoring your blood pressure at home.CMS.gov. Centers for Medicare & Medicaid Services.CMS expands coverage of ambulatory blood pressure monitoring (ABPM).Bencivenga L, De Souto Barreto P, Rolland Y, Hanon O, Vidal JS, Cestac P,et al.Blood pressure variability: A potential marker of aging.Ageing Res Rev. 2022 Sep;80:101677. doi:10.1016/j.arr.2022.101677.American Association of Endocrine Surgeons.Pheochromocytoma: Diagnosis and treatment.Mann SJ.Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies.Curr Cardiol Rep. 2015 Nov;17(11):99. doi:10.1007/s11886-015-0646-0.Munakata M.Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings.Hypertens Res. 2018 Aug;41(8):553-569. doi:10.1038/s41440-018-0053-1.Doroszko A, Janus A, Szahidewicz-Krupska E, Mazur G, Derkacz A.Resistant Hypertension.Adv Clin Exp Med. 2016 Jan-Feb;25(1):173-83. doi:10.17219/acem/58998.Samanta D, Cobb S, Arya K.Sneddon Syndrome: A Comprehensive Overview.J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2098-2108. doi:10.1016/j.jstrokecerebrovasdis.2019.05.013Muntner P, Whittle J, Lynch A, et al.Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality.Ann Intern Med. 2015;163(5):329-338. doi:10.7326/m14-2803Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-41. doi:10.2147/PRBM.S61192Franklin SS, O’Brien E, Thijs L, Asayama K, Staessen JA.Masked hypertension: a phenomenon of measurement.Hypertension. 2015;65(1):16-20. doi:10.1161/HYPERTENSIONAHA.114.04522American Heart Association.Know your risk factors for high blood pressure.Additional ReadingWang J, Shi X, Ma C, et al.Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease.Journal of Hypertension. 2017;35(1):10-17. doi:10.1097/hjh.0000000000001159
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Clark D, Nicholls SJ, St John J, et al.Visit-to-visit blood pressure variability, coronary atheroma progression, and clinical outcomes.JAMA Cardiol. 2019;4(5):437-443. doi:10.1001/jamacardio.2019.0751Kario K.Home Blood Pressure Monitoring: Current Status and New Developments.Am J Hypertens. 2021 Aug 9;34(8):783-794. doi:10.1093/ajh/hpab017.American Heart Association.Monitoring your blood pressure at home.CMS.gov. Centers for Medicare & Medicaid Services.CMS expands coverage of ambulatory blood pressure monitoring (ABPM).Bencivenga L, De Souto Barreto P, Rolland Y, Hanon O, Vidal JS, Cestac P,et al.Blood pressure variability: A potential marker of aging.Ageing Res Rev. 2022 Sep;80:101677. doi:10.1016/j.arr.2022.101677.American Association of Endocrine Surgeons.Pheochromocytoma: Diagnosis and treatment.Mann SJ.Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies.Curr Cardiol Rep. 2015 Nov;17(11):99. doi:10.1007/s11886-015-0646-0.Munakata M.Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings.Hypertens Res. 2018 Aug;41(8):553-569. doi:10.1038/s41440-018-0053-1.Doroszko A, Janus A, Szahidewicz-Krupska E, Mazur G, Derkacz A.Resistant Hypertension.Adv Clin Exp Med. 2016 Jan-Feb;25(1):173-83. doi:10.17219/acem/58998.Samanta D, Cobb S, Arya K.Sneddon Syndrome: A Comprehensive Overview.J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2098-2108. doi:10.1016/j.jstrokecerebrovasdis.2019.05.013Muntner P, Whittle J, Lynch A, et al.Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality.Ann Intern Med. 2015;163(5):329-338. doi:10.7326/m14-2803Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-41. doi:10.2147/PRBM.S61192Franklin SS, O’Brien E, Thijs L, Asayama K, Staessen JA.Masked hypertension: a phenomenon of measurement.Hypertension. 2015;65(1):16-20. doi:10.1161/HYPERTENSIONAHA.114.04522American Heart Association.Know your risk factors for high blood pressure.
Clark D, Nicholls SJ, St John J, et al.Visit-to-visit blood pressure variability, coronary atheroma progression, and clinical outcomes.JAMA Cardiol. 2019;4(5):437-443. doi:10.1001/jamacardio.2019.0751
Kario K.Home Blood Pressure Monitoring: Current Status and New Developments.Am J Hypertens. 2021 Aug 9;34(8):783-794. doi:10.1093/ajh/hpab017.
American Heart Association.Monitoring your blood pressure at home.
CMS.gov. Centers for Medicare & Medicaid Services.CMS expands coverage of ambulatory blood pressure monitoring (ABPM).
Bencivenga L, De Souto Barreto P, Rolland Y, Hanon O, Vidal JS, Cestac P,et al.Blood pressure variability: A potential marker of aging.Ageing Res Rev. 2022 Sep;80:101677. doi:10.1016/j.arr.2022.101677.
American Association of Endocrine Surgeons.Pheochromocytoma: Diagnosis and treatment.
Mann SJ.Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies.Curr Cardiol Rep. 2015 Nov;17(11):99. doi:10.1007/s11886-015-0646-0.
Munakata M.Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings.Hypertens Res. 2018 Aug;41(8):553-569. doi:10.1038/s41440-018-0053-1.
Doroszko A, Janus A, Szahidewicz-Krupska E, Mazur G, Derkacz A.Resistant Hypertension.Adv Clin Exp Med. 2016 Jan-Feb;25(1):173-83. doi:10.17219/acem/58998.
Samanta D, Cobb S, Arya K.Sneddon Syndrome: A Comprehensive Overview.J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2098-2108. doi:10.1016/j.jstrokecerebrovasdis.2019.05.013
Muntner P, Whittle J, Lynch A, et al.Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality.Ann Intern Med. 2015;163(5):329-338. doi:10.7326/m14-2803
Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-41. doi:10.2147/PRBM.S61192
Franklin SS, O’Brien E, Thijs L, Asayama K, Staessen JA.Masked hypertension: a phenomenon of measurement.Hypertension. 2015;65(1):16-20. doi:10.1161/HYPERTENSIONAHA.114.04522
American Heart Association.Know your risk factors for high blood pressure.
Wang J, Shi X, Ma C, et al.Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease.Journal of Hypertension. 2017;35(1):10-17. doi:10.1097/hjh.0000000000001159
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