Heart Health High Blood Pressure Living With Is It Normal for Blood Pressure to Fluctuate? By Craig O. Weber, MD Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years. Learn about our editorial process Craig O. Weber, MD Medically reviewed by Medically reviewed by Richard N. Fogoros, MD on December 02, 2019 facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Learn about our Medical Review Board Richard N. Fogoros, MD on December 02, 2019 Print 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. Verywell / Cindy Chung Blood Pressure Measurement Errors 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. Medical Causes Experts are exploring why blood pressure is variable from visit to visit. It may be that people with fluctuating blood pressures have an underlying blood vessel problem and that their variable readings serve as a marker or clue that they're at a higher risk of having a heart attack or stroke. Very rarely, fluctuating blood pressure may be due to a pheochromocytoma—a usually benign tumor in the adrenal gland. This is a rare occurrence. White Coat 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 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 millimeters of mercury (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 medicationsLow blood pressure readings while taking high blood pressure medications Fluctuations and 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 don't know precisely how primary hypertension develops, but it's believed to involve a complex interaction between a person's genes and their environment that affects their heart and kidney function. 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 historyObesityHigh sodium dietSedentary lifestyleExcessive alcohol intakeHaving 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 apneaMedication use (for example, NSAIDs and certain antidepressants)Certain endocrine and hormone disorders (for example, hyperthyroidism) Hypertension Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. 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. Was this page helpful? Thanks for your feedback! Looking to start a diet to better manage your high blood pressure? Our nutrition guide can help. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to 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.2019.0751 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). July 2, 2019. American Association of Endocrine Surgeons. Pheochromocytoma (adrenaline-producing adrenal tumor). 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. Additional Reading 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. 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 Basile J, Block MJ. Overview of Hypertension in Adults. In: UpToDate, Bakris GL, Kaplan NM (Eds), UpToDate, Waltham, MA.