Is It Normal for Blood Pressure to Fluctuate?

Blood Pressure Variations Could Be a Clue to Your Heart Health

A senior man checks his blood pressure.
YinYang/E+/Getty Images

Some variation in blood pressure throughout the day is normal, especially as a response to small changes in daily life like stress, exercise, or how well you slept the night before. But fluctuations that occur regularly over a number of doctor visits may indicate an underlying problem.

In fact, a study in the Annals of Internal Medicine found that a higher visit-to-visit variation in blood pressure was significantly linked to a higher risk of cardiovascular disease.

How To Know if Your Blood Pressure Is Fluctuating

First, it’s important to make sure that your blood pressure really is fluctuating.

If you’ve made the measurements yourself using home monitoring equipment or the machines commonly found in grocery stores and pharmacies, the changes you’ve seen might actually be related to errors and/or variations in the measurement process itself.

While home blood pressure monitoring can be an effective and useful tool in some situations, you need proper training to ensure you're using the correct technique, as performing the measurements without this training might explain the variation you see.

Also, drugstore machines -- the kind that require you to sit in a chair and put your arm through a cuff --  are notorious for being poorly calibrated and fairly inaccurate.

To prevent erroneous reads, it is best to bring in your home blood pressure monitor reads and compare them with the reads in your doctor's office.

Alternatively, some doctors recommend ambulatory blood pressure monitoring in which a device is worn by a person at home. The devices measure the blood pressure over a one to two day period every 15 to 20 minutes during the day and every 30 to 60 minutes at night.

This is more costly and not always available, though, so self-recorded home blood pressure measurements are a reasonable alternative.

What Causes a Fluctuating Blood Pressure?

Why is your blood pressure variable from doctor visit to doctor visit?

This is a great question that experts are exploring the answer to more and more. It may be that people with fluctuating blood pressures have an underlying blood vessel problem and that their variable reads serve as a marker or clue that they are at a higher risk of having a heart attack or stroke. 

Very rarely, a fluctuating blood pressure may be due to a pheochromocytoma -- a usually benign tumor in the adrenal gland. This is a rare occurrence, though.

What Is White Coat Hypertension and Masked Hypertension?

It's important to distinguish fluctuating blood pressures from two phenomena known as white-coat hypertension and masked hypertension. 

In the phenomenon white coat hypertension, a person's blood pressure is considered to be "high" at a doctor's office, but normal when at home.

This high blood pressure is attributed to the stress of being in a doctor's office, which is why a nurse will often wait for a person to rest comfortably for five minutes before taking a read. In addition, it's also recommended that two blood pressure reads are taken and repeated if there is a difference of more than 5mmHg.

Masked hypertension is the opposite and occurs when doctor visit blood pressures are normal but out-of-doctor's office reads are high. 

To sort these issues out, a doctor may recommend home monitoring or ambulatory blood pressure monitoring.  Home monitoring may also be recommended for:

  • Persistent high blood pressure reads despite increasing medications
  • Low blood pressure reads while taking high blood pressure medications

Do You Have Hypertension?

If you notice some high blood pressure reads interspersed with normal ones, it's possible you have hypertension but have not been diagnosed with it.

Experts do not know precisely how primary hypertension develops, but it is believed to involve a complex interaction between a person's genes and their environment that affects their heart and kidney function.

That being said, there are clear risk factors or factors that increase a person's chance of developing hypertension like:

  • age (the likelihood of developing hypertension increases the older you get)
  • family history
  • obesity
  • high sodium diet
  • sedentary lifestyle
  • excessive alcohol intake
  • having other medical problems like diabetes or high cholesterol

Secondary hypertension may arise too. Secondary hypertension means that a person's high blood pressure develops from another problem in the body or as a result of taking a medication. Examples of secondary hypertension include:

A Word From Verywell

If you’re sure that the measurements are accurate and the blood pressure swings happen even when you’re relaxed, well-rested, and have no reason that can account for the changes, go see a doctor. 

The good news is that with proper monitoring, healthy lifestyle habits, and medications (if needed), you can gain control over your heart health. 

Sources:

Basile J, Block MJ. Overview of hypertension in adults. In: UpToDate, Bakris GL, Kaplan NM (Eds), UpToDate, Waltham, MA.

Muntner P et al. Vist-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: A cohort study. Ann Intern Med. 2015 Sep 1;163(5):329-38.

Nagai M, Hoshide S, Ishikawa J, Shimada K, Kario K. Visit-to-visit blood pressure variations: new independent determinants for carotid artery measures in the elderly at high risk of cardiovascular disease. J Am Soc Hypertens. 2011 May-Jun;5(3):184-92.

Continue Reading