Blood pressure variability may matter more than your average reading — and your GP probably does not check it

Peter Rothwell's landmark 2010 Lancet study of 2,000 adults found that visit-to-visit systolic variability was a stronger predictor of 5-year stroke risk than average systolic blood pressure. A subsequent analysis found comparable effects for dementia risk. The mechanism is arterial stiffness-related impairment of cerebral autoregulation, with wide systolic swings causing alternating ischaemia and over-perfusion in small cerebral vessels.

Reducing Variability

• Aerobic exercise — improves baroreflex sensitivity and arterial compliance
• Dietary nitrates (beetroot, rocket) — improve endothelial function and reduce arterial stiffness
• Sleep optimisation — non-dipping is often driven by sleep-disordered breathing
• Home blood pressure monitoring over multiple days provides a more accurate picture than single clinic readings