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High Blood Pressure

Irregular blood pressure



I am a 31 year old, physically-fit male who has been told I have high blood pressure by my physician. When I monitor my readings at home, I generally take 3 consecutive readings. My first is almost always the highest while the third is almost always the lowest which usually fits within a normal range. It is generally the systolic reading which is so variable while my diastolic consistently stays within normal ranges. My systolic reading can generally fluctuate as much as 25 points within 3 consecutive readings. Is there anyway to explain this phenomenon and are there ways to treat this? Thanks.


The phenomenon that you describe is very common.  Most patients show a decrease in blood pressure, especially the systolic, with repeat measurements.  This drop in blood pressure is seen regardless of the time interval between measurements and regardless of who takes the blood pressure.  The cause of this drop is not well known.  It is not related to stress or anxiety, and it is seen in normotensive and hypertensive people.

Some researches think that the higher blood pressure at the first reading is due to an alert reaction which dissipates.  Current guidelines suggest that the blood pressure be measured at least three times at one sitting, and that the average of the three readings be calculated as the "true" blood pressure.

It is not known whether larger variations in blood pressure in an otherwise healthy individual correspond to a larger cardiovascular risk.  There is no proven treatment to minimize the variation, other than ensuring that the measurements are taken using correct technique.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati