Home Blood Pressure Variability Research Articles

YIA 01-03 OUTCOME-DRIVEN REFERENCE FRAME FOR SELF-MEASURED HOME BLOOD PRESSURE VARIABILITY

Objective: Increased home blood pressure (BP) variability seems to be associated with cardiovascular disease, but the lack of operational thresholds limits its clinical application. Our aim was to define outcome-driven thresholds for day-to-day home BP variability in the general population. Design and Method: The study population consisted of 6312 community-dwelling participants from Ohasama, Japan; Tsurugaya, Japan; Didima, Greece; and Finland. The participants were divided into ten groups by deciles of home BP variability, defined as the coefficient of variation (CV) of the first measurements of each day between 5:00 and 12:00 AM to account for between-cohort differences in measurement protocols. Association between BP variability and cardiovascular mortality or cardiovascular events was assessed using Cox models adjusted for home systolic or diastolic BP, cohort, sex, age, body mass index, smoking status, diabetes status, use of antihypertensive medication, total serum cholesterol and history of cardiovascular disease. Results: Home blood pressure was measured on 22.6 ± 7.6, 15.0 ± 10.4, 3.0 ± 0.12 and 6.8 ± 0.6 days in Ohasama, Tsurugaya, Didima and Finland, respectively. During a mean follow-up of 9.3 ± 3.7 years, 306 and 720 cardiovascular deaths and events occurred, respectively. 1-SD increase in systolic/diastolic home BP variability was associated with cardiovascular mortality (Hazard ratio 1.18/1.22 [95% confidence interval 1.06 − 1.31/1.10−1.34], p = 0.003/ < 0.0001) and cardiovascular events (Hazard ratio 1.15/1.17 [95% confidence interval 1.07−1.23/1.09−1.26], p = 0.0001/<0.0001). Risk of cardiovascular deaths and events was significantly increased in the 10th decile of systolic/diastolic BP variability (CV > 10.7/12.6), as compared with the average risk in the whole population (Table). The results were similar regardless of antihypertensive treatment status. Conclusions: Home BP variability appears to be an independent risk factor for cardiovascular mortality and morbidity. Cardiovascular risk seems to increase when the systolic/diastolic CV of day-to-day home BP is greater than 10.7/12.6. Our current findings could inform guidelines and help clinicians in diagnosing and managing patients.

Evaluation of day-by-day variability of home blood pressure using a home blood pressure telemonitoring system.

There have been no reports indicating how a home blood pressure (HBP) telemonitoring system influences day-by-day HBP variability. We evaluated day-by-day HBP variability using an HBP telemonitoring system, randomizing 60 individuals to either a telemonitoring group or the control group. There were no significant changes in day-by-day HBP variability between the two groups. However, the SD, root mean sum square differences, and the average real variability values for systolic blood pressure only in the control group in the latter half of the 4-week study were significantly greater than those in the first half (P<0.05). A HBP telemonitoring system could be useful in obtaining stable HBP readings over a certain period of time.

The Importance of Home Versus 24-Hour Ambulatory Blood Pressure Monitoring and Assessment of Blood Pressure Variability in Hypertension

Abstract Background: A number of studies reveal that home blood pressure variability is associated with cardiovascular risk factors. However, we do not have a consensus regarding the variability index and the frequency of measurements. Objective: The aim of the study was to assess home blood pressure variability for a period of 7 consecutive days and 24-hour ambulatory blood pressure variability using the average real variability index and to test whether home blood pressure variability represents a suitable parameter for long-term monitoring of the hypertensive patients. Material and methods: A number of 31 hypertensive patients were included in the study, 8 male, 23 female, mean age 60.19±7.35 years. At the inclusion ambulatory blood pressure monitoring was performed, home blood pressure monitoring was carried out for 7 consecutive days with 2 measurements daily. We compared ambulatory blood pressure values, variability using paired t-test. We were looking for correlations between HBP values and cardiovascular risk factors. Results: Ambulatory versus home blood pressure derived mean blood pressure was 131.38±15.2 versus 131.93±8.25, p=0.81. Ambulatory derived variability was 10.65±2.05 versus home variability 10.56±4.83, p=0.91. Home versus ambulatory pulse pressure was 51.8± 9.06 mmHg vs. 54.9±11.9 mmHg, p=0.046. We found positive correlation between HBPV and home BP values, p=0.027, r2=0.1577, (CI: 0.04967 to 0.6588). Home, as well as ambulatory derived variability were positively correlated to age p=0.043, r2=0.1377 (CI: 0.01234 to 0.6451) versus p&lt;0.0001, CI: 0.3870 to 0.8220, r2=0.4302. Conclusion: Assessment of home blood pressure monitoring and variability could represent a well-tolerated alternative for long-term follow-up of hypertension management.

Fimasartan for independent reduction of blood pressure variability in mild-to-moderate hypertension

BackgroundThe angiotensin receptor antagonist fimasartan lowered blood pressure (BP) in a previous large population study. The purpose of this study was to evaluate whether fimasartan treatment for 3 months affects clinical and home BP variability in addition to reducing BP.MethodsThe study enrolled 1,396 patients (mean age 56.2±10.0 years; males 53.6%) with mild-to-moderate hypertension who had a complete set of home BP measurements (morning and evening) and metabolic risk evaluation. During the 3 months of study, fimasartan alone was used to control BP at a daily dose of 30–120 mg. Clinical and home BP measurements were performed before and after the 3-month treatment. BP variability included beat-to-beat variability (clinical) and day-to-day variability (home).ResultsFimasartan reduced BP after 3 months of treatment. The average reduction of clinical systolic BP (c-SBP) was 15.08±18.36 mmHg (P<0.0001), and the average reduction of morning home SBP (m-SBP) was 11.49±19.33 mmHg (P<0.0001). Beat-to-beat variability as standard deviation (SD) of c-SBP was reduced from 4.56±3.22 to 4.24±3.11 mmHg (P=0.0026). Day-to-day variability as SD of m-SBP was reduced from 7.92±6.74 to 6.95±4.97 mmHg (P<0.0001). Multiple regression analysis revealed an independent association between the change in the SD of c-SBP and the change in c-SBP (P=0.0268) and, similarly, between the change in the SD of m-SBP and the change in m-SBP (P=0.0258), after adjusting for age, sex, body mass index, and change in mean BP.ConclusionThis study indicated that 3 months of fimasartan treatment reduced day-to-day BP variability independent of BP reduction in patients with hypertension.

Agreement between ambulatory, home, and office blood pressure variability.

Ambulatory, home, and office blood pressure (BP) variability are often treated as a single entity. Our aim was to assess the agreement between these three methods for measuring BP variability. Twenty-four-hour ambulatory BP monitoring, 28 home BP measurements, and eight office BP measurements were performed on 461 population-based or hypertensive participants. Five variability indices were calculated for all measurement methods: SD, coefficient of variation, maximum-minimum difference, variability independent of the mean, and average real variability. Pearson's correlation coefficients were calculated for indices measured with different methods. The agreement between different measurement methods on the diagnoses of extreme BP variability (participants in the highest decile of variability) was assessed with kappa (κ) coefficients. SBP/DBP variability was greater in daytime (coefficient of variation: 9.8 ± 2.9/11.9 ± 3.6) and night-time ambulatory measurements (coefficient of variation: 8.6 ± 3.4/12.1 ± 4.5) than in home (coefficient of variation: 4.4 ± 1.8/4.7 ± 1.9) and office (coefficient of variation: 4.6 ± 2.4/5.2 ± 2.6) measurements (P < 0.001/0.001 for all). Pearson's correlation coefficients for systolic/diastolic daytime or night-time ambulatory-home, ambulatory-office, and home-office variability indices ranged between 0.07-0.25/0.12-0.23, 0.13-0.26/0.03-0.22 and 0.13-0.24/0.10-0.19, respectively, indicating, at most, a weak positive (r < 0.3) relationship. The agreement between measurement methods on diagnoses of extreme SBP/DBP variability was only slight (κ < 0.2), with the κ coefficients for daytime and night-time ambulatory-home, ambulatory-office, and home-office agreement varying between-0.014-0.20/0.061-0.15, 0.037-0.18/0.082-0.15, and 0.082-0.13/0.045-0.15, respectively. Shorter-term and longer-term BP variability assessed by different methods of BP measurement seem to correlate only weakly with each other. Our study suggests that BP variability measured by different methods and timeframes may reflect different phenomena, not a single entity.

Effect of Individualized Intervention on Home Blood Pressure and Blood Pressure Variability in Peritoneal Dialysis Patients with Hypertension

Effect of Individualized Intervention on Home Blood Pressure and Blood Pressure Variability in Peritoneal Dialysis Patients with Hypertension

Potential and Paradoxes of Home Blood Pressure Variability

We present in this review data on home blood pressure variability (HBPV) with consideration of its definition and threshold values. We also present own classification and discuss analysis of results of HBPV and their interpretation in observational and clinical studies, including own data. Experience in this area accumulated during last 30 years, information on pathophysiological mechanisms, prognostic properties of HBPV may be useful for a physician from practical point of view.

Impact of depression on masked hypertension and variability in home blood pressure in treated hypertensive patients.

This study was conducted to determine the effects of depression and/or insomnia on masked hypertension (MHT) compared with other types of HT and on variability in home-measured blood pressure (HBP) and clinic BP (CBP). Three hundred and twenty-eight hypertensives (132 women) aged 68±10 years were classified into four BP types: controlled HT (CHT), white-coat HT, MHT and sustained HT (SHT), based on CBP (140/90 mm Hg) and morning HBP (135/85 mm Hg) measurements. A score of ⩾16 on the Center for Epidemiologic Studies Depression Scale (CES-D) was defined as depression. The mean values and s.d. of BP were calculated from measurements taken during the 14 consecutive days just before the CES-D evaluation. Compared with the CHT group, the risk of depression was 2.77-fold higher in the SHT group and even higher in the MHT group (7.02-fold). The association between depression and MHT was augmented in the presence of insomnia and was somewhat stronger in women. A HBP variability index defined as s.d./mean BPs in both morning and night time was significantly higher in MHT than in the other BP types, whereas that of CBP was not. Both morning and night-time HBP variability were significantly higher in depressive patients than in non-depressives. These suggest that depression is associated with MHT and that increases both morning and night-time HBP variability but not CBP variability. Physicians should be mindful of mental stresses such as depression in their hypertensive patients when forming strategies to control BP over the diurnal cycle.

3D.09

Objective: Increased blood pressure (BP) variability is a possible independent risk factor for cardiovascular events. BP variability has been assessed with several methods of BP measurement in recent literature, although it is unclear whether these measurements of variability with varying timeframes reflect the same phenomenon. The aim of our study was to compare the agreement between ambulatory, home and office BP variability. Design and method: The study population consisted of 509 participants randomly drawn from the population register or recruited by general practitioners on the basis of newly diagnosed untreated hypertension. Ambulatory 24-h blood pressure monitoring, 28 home BP measurements (twice every morning and evening during 7 consecutive days) and 8 office BP measurements (duplicate measurements on 4 visits) were performed in all participants. 3 log-transformed variability indices (SD, standard deviation; CV, coefficient of variation and ARV, average real variability) were calculated for all measurement methods and Pearson's correlations between them were calculated. The agreement of different methods on the diagnoses of extreme BP variability (participants with variability above the highest decile) was also assessed with kappa coefficients. Results: Systolic/diastolic BP variability was greater in 24-h ambulatory (CV: 12.6 ± 2.8 /15.1 ± 3.4) than home (CV: 4.4 ± 1.8/4.7 ± 2.0, p < 0.001 versus ambulatory CV for both) and office (CV: 4.8 ± 2.6/5.3 ± 2.6, p < 0.001 versus ambulatory CV for both) measurements. Ambulatory daytime variability was greater than night-time variability (CV: 11.0 ± 2.8/13.1 ± 3.5 vs. 9.5 ± 3.8/12.8 ± 4.6, p < = 0.001 for both). Pearson's correlation coefficients for systolic/diastolic variability indices between different measurement methods were 0.08–0.34/0.03–0.26, indicating only negligible to weak positive relationship (Table). The agreement of ambulatory, home and office BP variability measures on diagnoses of extreme systolic/diastolic BP variability was only slight, with the kappa coefficients varying between 0.00–0.20/0.03–0.16. Extreme variability was diagnosed in only two persons with all three methods.Conclusions: Shorter-term and longer-term BP variability assessed with different methods of BP measurement seem to correlate only weakly with each other. Our study suggests that BP variability assessed by different methods and timeframes reflects various phenomena, not a single entity.

Effect of Olmesartan-Based Therapies on Therapeutic Indicators Obtained Through Out-of-Office Blood Pressure.

Ambulatory blood pressure (BP) correlates more significantly with hypertension-associated cardiovascular mortality and morbidity than BP obtained in the doctor’s office. Assessing ambulatory BP, either through 24-h monitoring or through protocolized self-measurement at home, is essential in diagnosing and monitoring patients with hypertension. Several ambulatory BP-derived indicators are related with cardiovascular prognosis. These include 24-h, daytime and nighttime BP measurements, BP measurements obtained through home self-measurement, dipping status, morning surge, and BP variability. The objective of this article was to review the effect of olmesartan-based antihypertensive therapy on the main risk variables obtained when assessing ambulatory BP.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-015-0042-2) contains supplementary material, which is available to authorized users.

PP.17.31

Objective: The effect of mean blood pressure levels on arterial stiffness development is well known; however, the role of dynamic factors as autonomic dysfunction (AD) over the pulse wave velocity (PWV) in the mid-term is still under evaluation. Objectives: a) To evaluate the contribution of home blood pressure (BP) and heart rate (HR) variability to assess arterial stiffness in essential hypertension (EH). b) To determinate if autonomic dysfunction (increased BP variability and decreased HR variability) is associated to higher PWV. Design and method: We evaluated 202 consecutive hypertensive patients who assist to be evaluated in a primary cardiovascular prevention program. All patients underwent anthropometric measurements. BP and HR were recorded through home BP monitoring/ 7 consecutive days (MicroLife®). Measurements of PWV were carried out using an automatic oscillometric device (Mobil-O-Graph®) at rest. We defined an autonomic dysfunction index (ADI) as follows: -ADI: standard deviation of systolic BP (SBP_SD)/standard deviation of HR (HR_SD) Correlations between mean systolic BP, SBP_SD, HR_SD and ADI with PWV were performed. Results: After applying exclusion criteria 120 patients with EH (135 ± 14/90 ± 10 mm Hg, 55 +/-10 years, 74% male, 107 treated) were included. Mean SBP was associated with PWV (r=0.23, p: 0.01) while SBP_SD showed a higher direct association with PWV (r = 0.32, P < 0.0003), unlike HR_SD (r = -0.20, P = 0.03). The index of autonomic dysfunction –ADI- presented the more significant association with PWV (r = 0.43, p < 0.0001).Conclusions: Home SBP variability showed a higher and direct association than mean SBP values with PWV in EH. The AD phenomenon (expressed as higher BP variability/ lesser BP variability) presented a close positive relationship with PWV, which could indicate some role of mid-term AD in the increment of PWV in essential hypertension.

Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6 ± 1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) (r = 0.23, 0.20; p = 0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP (r = 0.19, 0.31; p = 0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient (β) = 0.19, 0.34; p = 0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV.

Optimal indicators of home BP variability in perimenopausal women and associations with albuminuria and reproducibility: The J-HOT home BP study.

This study investigated the associations between various indicators of home blood pressure (BP) variability and albuminuria as well as the reproducibility of these indicators in perimenopausal women, who are likely to exhibit increased BP variability. As a measure of organ damage, urinary albumin/creatinine ratio (UACR) was examined at baseline in 151 women aged 40-59 years. Home BP was measured in duplicate in both morning and evening for 12 weeks using a home BP monitor. The following home BP variability indicators were calculated biweekly: mean, maximum, minimum, difference between maximum and minimum, average real variability (ARV), SD, and coefficient of variation. In simple correlation, the ARV of systolic BP (SBP) (morning + evening and morning), maximum SBP (evening), and maximum diastolic BP (all time points) were most strongly correlated with UACR. In multivariate linear regression, the maximum, minimum, and ARV of SBP (morning) and both mean and maximum SBP (evening) were significantly associated with Box-Cox transformed UACR after adjustment for age, body mass index, and lifestyle. In particular, maximum SBP had the lowest P value among those BP indicators. Furthermore, maximum morning SBP tended to distinguish high-normal albuminuria (UACR ≥ 10 mg/g Cr) more clearly than mean morning SBP. The mean, maximum, and minimum values of home BP demonstrated the greatest reproducibility among all indicators. Maximum home BP is associated with UACR and exhibits high reproducibility in perimenopausal women. These findings raise the hypothesis that maximum home SBP may be suitable to detect kidney damage.

Response of day-to-day home blood pressure variability by antihypertensive drug class after transient ischemic attack or nondisabling stroke.

Visit-to-visit variability in systolic blood pressure (SBP) is associated with an increased risk of stroke and was reduced in randomized trials by calcium channel blockers and diuretics but not by renin-angiotensin system inhibitors. However, time of day effects could not be determined. Day-to-day variability on home BP readings predicts stroke risk and potentially offers a practical method of monitoring response to variability-directed treatment. SBP mean, maximum, and variability (coefficient of variation=SD/mean) were determined in 500 consecutive transient ischemic attack or minor stroke patients on 1-month home BP monitoring (3 BPs, 3× daily). Hypertension was treated to a standard protocol. Differences in SBP variability from 3 to 10 days before to 8 to 15 days after starting or increasing calcium channel blockers/diuretics versus renin-angiotensin system inhibitors versus both were compared by general linear models, adjusted for risk factors and baseline BP. Among 288 eligible interventions, variability in SBP was reduced after increased treatment with calcium channel blockers/diuretics versus both versus renin-angiotensin system inhibitors (-4.0 versus 6.9 versus 7.8%; P=0.015), primarily because of effects on maximum SBP (-4.6 versus -1.0 versus -1.0%; P=0.001), with no differences in effect on mean SBP. Class differences were greatest for early-morning SBP variability (3.6 versus 17.0 versus 38.3; P=0.002) and maximum (-4.8 versus -2.0 versus -0.7; P=0.001), with no effect on midmorning (P=0.29), evening (P=0.65), or diurnal variability (P=0.92). After transient ischemic attack or minor stroke, calcium channel blockers and diuretics reduced variability and maximum home SBP, primarily because of effects on morning readings. Home BP readings enable monitoring of response to SBP variability-directed treatment in patients with recent cerebrovascular events.

Day-to-Day Variability in Home Blood Pressure Is Associated With Cognitive Decline

Although an association between high blood pressure and cognitive decline has been reported, no studies have investigated the association between home blood pressure and cognitive decline. Home blood pressure measurements can also provide day-to-day blood pressure variability calculated as the within-participant SD. The objectives of this prospective study were to clarify whether home blood pressure has a stronger predictive power for cognitive decline than conventional blood pressure and to compare the predictive power of the averaged home blood pressure with day-to-day home blood pressure variability for cognitive decline. Of 485 participants (mean age, 63 years) who did not have cognitive decline (defined as Mini-Mental State Examination score, &lt;24) initially, 46 developed cognitive decline after a median follow-up of 7.8 years. Each 1-SD increase in the home systolic blood pressure value showed a significant association with cognitive decline (odds ratio, 1.48; P =0.03). However, conventional systolic blood pressure was not significantly associated with cognitive decline (odds ratio, 1.24; P =0.2). The day-to-day variability in systolic blood pressure was significantly associated with cognitive decline after including home systolic blood pressure in the same model (odds ratio, 1.51; P =0.02), whereas the odds ratio of home systolic blood pressure remained positive, but it was not significant. Home blood pressure measurements can be useful for predicting future cognitive decline because they can provide information not only on blood pressure values but also on day-to-day blood pressure variability.

Relationship of self-measured home blood pressure variability to arterial stiffness

Relationship of self-measured home blood pressure variability to arterial stiffness

Factors affecting variability in home blood pressure in patients with type 2 diabetes: post hoc analysis of a cross-sectional multicenter study

Recent studies have shown that variability in home blood pressure has an important role in the progression of organ damage. The objective of this study was to investigate the factors that affect variability in home blood pressure in patients with type 2 diabetes. We assessed the relationship between home blood pressure variability, defined as coefficient of variation of mean of triplicate morning and evening blood pressure for 14 consecutive days, and various factors using univariate and multivariate linear regression analyses in 1114 patients with type 2 diabetes. Age (β=0.149, P<0.001), female sex (β=0.125, P=0.010), duration of diabetes mellitus (β=0.103, P=0.005), heart rate (β=0.136, P<0.001), current smoker (β=0.118, P=0.005), white-coat hypertension (β=0.136, P=0.002) and treatment with calcium channel blockers (β=-0.094, P=0.024) were independently associated with coefficient of variation of morning systolic blood pressure. Our findings implicate that factors that might be intervened such as heart rate, smoking status, use of antihypertensive medication in addition to age, sex and duration of diabetes mellitus are associated with variability in home blood pressure in patients with type 2 diabetes.

Physiological Correlates of Beat-to-Beat, Ambulatory, and Day-to-Day Home Blood Pressure Variability After Transient Ischemic Attack or Minor Stroke

Visit-to-visit and day-to-day variability in systolic blood pressure (SBP) are associated with an increased risk of stroke, more strongly than variability on 24-hour ambulatory BP monitoring, but underlying physiological mechanisms are unclear. We related potentially relevant physiological characteristics to beat-to-beat, ambulatory, and day-to-day BP variability to identify underlying mechanisms and potential therapeutic targets. BP variability (coefficient of variation [CV]) on 1-month home BP monitoring (3 sitting readings, 3× daily), on 24-hour ambulatory BP monitoring, and on 5-minute beat-to-beat monitoring was related to BP reactivity (to mental arithmetic), arterial aging (aortic stiffness: carotid-femoral pulse wave velocity; aortic pulsatility), heart rate variability (CV of normal-to-normal R-R interval), and orthostatic responses. In 223 patients within 6 weeks of a transient ischemic attack or minor stroke, beat-to-beat and home SBP-CVs were associated with response to arithmetic (beat-to-beat odds ratio per SD=1.64; P<0.0001 and home BP monitoring, 1.41; P=0.025), aortic stiffness (1.84; P<0.0001 and 1.31; P=0.04), aortic pulsatility (1.98; P<0.0001 and 1.61; P<0.0001), and heart rate variability-CV of normal-to-normal R-R interval (1.34; P=0.03 and 1.35; P=0.03), independently of age, sex, and aortic BP. Orthostatic BP changes were associated only with SBP-CV on home BP monitoring (0.62; P=0.002). In contrast, no physiological measures were associated with within-day BP variability on awake ambulatory BP monitoring except response to mental arithmetic (1.40; P=0.01). Beat-to-beat and day-to-day SBP variability, but not variability on ambulatory BP monitoring, had similar physiological correlates, suggesting common underlying mechanisms and identifying potentially treatable targets that may be responsible for the relationship between SBP variability and stroke risk.

Is there a role for day-to-day home blood pressure variability in guiding management of hypertension?

1. Although two population-based studies have demonstrated the prognostic value of day-to-day home blood pressure (BP) variability, data are still limited. 2. Thresholds of normality, target levels for treatment and optimal number and times of home measurement needed for better assessment of day-to-day home BP variability also remain to be investigated. 3. Although further prospective studies are required, home BP is a strong and modifiable risk factor, and patient compliance should be encouraged.

Day-by-day variability in self-measured blood pressure at home

To investigate variability in self-measured home blood pressure (HBP) and its effects on carotid artery atherosclerosis and endothelial function in normotensive and mild-moderate hypertensive individuals. This is a cross-sectional study. HBP monitoring over 7 consecutive days, carotid artery ultrasound, and brachial artery flow-mediated dilation (FMD) were performed in 314 normotensive, prehypertensive, and mild-moderate hypertensive volunteers. Variability in HBP was assessed by the SDs of the daily BP average of the last 6 consecutive days. The plasma endothelin-1 (ET-1) level was tested using an enzyme-linked immunosorbent assay. The tendency of SD of systolic HBP increased significantly from the normotension to the moderate hypertension group. SD of systolic HBP was significantly correlated with carotid intima-media thickness (IMT) (r=0.569, P<0.001), stiffness parameter β (r=0.447, P<0.001), FMD (r=-0.636, P<0.001), and ET-1 (r=0.649, P<0.001). SD of diastolic HBP was also correlated with carotid IMT, stiffness parameter β, FMD, and ET-1, but the strength of the correlation was weaker than SD of systolic HBP (all P<0.001). After adjustment of all covariants, SD of systolic HBP was always significantly associated with carotid IMT, stiffness parameter β, FMD, and ET-1. Day-by-day variability in HBP increased with increasing BP level. This was significantly associated with carotid artery atherosclerosis and endothelial function in normotensive and mild-moderate hypertensive individuals. Day-by-day variability in HBP may serve as an important prognostic factor for atherosclerosis and endothelial dysfunction.