Is It Normal for Blood Pressure to Fluctuate?

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, studies have found that a higher visit-to-visit variation in blood pressure is associated with a higher risk of cardiovascular disease and all-cause mortality.

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 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. Drugstore machines—the kind that requires 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 your home blood pressure monitor to your next doctor's appointment to be sure you're using it correctly, and also bring the home readings to compare them with the readings 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, however, the Centers for Medicare & Medicaid Services recently approved national coverage for this non-invasive diagnostic test.

Experts are exploring why blood pressure is variable from visit to visit.

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

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

In the phenomenon of 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 5 mmHg.

Masked hypertension is the opposite and occurs when doctor's visit blood pressures are normal but out of the 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 readings despite increasing medications
• Low blood pressure readings while taking high blood pressure medications

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.

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:

• Obstructive sleep apnea
• Medication use (for example, NSAIDs and certain antidepressants)
• Certain endocrine and hormone disorders (for example, hyperthyroidism)

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.