Is It Normal for Blood Pressure to Fluctuate?

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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 of labile 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.

Causes of Fluctuating Blood Pressure

Verywell / Cindy Chung

Measuring Errors

Home blood pressure monitoring can be effective but you need training to use the equipment correctly. Fluctuating blood pressure numbers could be caused by the cuff or your skill level in using it, and if you're using drugstore machines, they're not known for being accurate.

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 Monitoring

Some healthcare providers recommend ambulatory 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.

Medical Causes

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, like endothelial dysfunction that 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 a pheochromocytoma—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 called livedo racemosa that also occur with Sneddon syndrome.

Is a Fluctuating Blood Pressure Serious?

Normal variations may differ by person. However, large variations may indicate a health condition. One study looked at patients taking blood pressure medicine. They found variations of more than 14 mm Hg in systolic pressure were associated with a 25% increased risk of heart failure.

Medical Settings

Sometimes just being in a medical setting is enough to throw off your readings.

Whitecoat Hypertension

With white 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:

  • Blood pressure readings that stay high even when medications increase
  • Blood pressure readings that stay low even when you take medication

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.

High Blood Pressure

If you notice some high blood pressure readings among the normal ones, it could be that you have hypertension but 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 gradual atherosclerosis, or hardening of the arteries.

Some risk factors raise the chances of having high blood pressure. They include:

  • Age (the chances go up as you get older)
  • Family history
  • Obesity
  • High-sodium diet
  • Not enough physical activity
  • Too much alcohol

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 Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

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.

It's also possible that your readings vary because you're stressed by being in a healthcare setting. If that's the case, your healthcare provider might ask you to use a device that tracks your blood pressure at home for a day or two.

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 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.
  1. 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

  2. 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.

  3. American Heart Association. Monitoring your blood pressure at home.

  4. CMS.gov. Centers for Medicare & Medicaid Services. CMS expands coverage of ambulatory blood pressure monitoring (ABPM).

  5. 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.

  6. American Association of Endocrine Surgeons. Pheochromocytoma: Diagnosis and treatment.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. Muntner P, Whittle J, Lynch A, et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortalityAnn Intern Med. 2015;163(5):329-338. doi:10.7326/m14-2803

  12. 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

  13. 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

  14. American Heart Association. Know your risk factors for high blood pressure.

Additional Reading

By Craig O. Weber, MD
Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years.