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Int J Gen Med. 2018 Jun 22;11:241-254. doi: 10.2147/IJGM.S164903. eCollection 2018.

Understanding short-term blood-pressure-variability phenotypes: from concept to clinical practice.

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Department of General Medicine, Tang Tock Seng Hospital.
Department of Pharmacy, National University of Singapore, Singapore.
Global Medical Affairs, Asia-Pacific Region, Pfizer Australia, Sydney, NSW, Australia.
Medical Affairs, Pfizer, Singapore.


Clinic blood pressure (BP) is recognized as the gold standard for the screening, diagnosis, and management of hypertension. However, optimal diagnosis and successful management of hypertension cannot be achieved exclusively by a handful of conventionally acquired BP readings. It is critical to estimate the magnitude of BP variability by estimating and quantifying each individual patient's specific BP variations. Short-term BP variability or exaggerated circadian BP variations that occur within a day are associated with increased cardiovascular events, mortality and target-organ damage. Popular concepts of BP variability, including "white-coat hypertension" and "masked hypertension", are well recognized in clinical practice. However, nocturnal hypertension, morning surge, and morning hypertension are also important phenotypes of short-term BP variability that warrant attention, especially in the primary-care setting. In this review, we try to theorize and explain these phenotypes to ensure they are better understood and recognized in day-to-day clinical practice.


ABPM; BPV; HBPM; hypertension; morning surge; nocturnal dipping

Conflict of interest statement

Disclosure KS and SS are employees of Pfizer. MTY underwent indirect patient-care pharmacy training for 3 months at Pfizer, Singapore. The other authors report no conflicts of interest in this work.

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