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See related article, pp 1132–1138The results of a number of studies performed over the years support the hypothesis that short-term blood pressure (BP) variability (BPV) assessed within 24 hours is an independent determinant of organ damage and cardiovascular events in hypertension.1,2 More recently, a few articles have raised interest also in BP fluctuations occurring over longer time periods. Rothwell et al3 assessed the variability in clinic BP or in average 24-hour ambulatory BP values occurring between visits. They analyzed previously collected data demonstrating an independent association of such visit-to-visit variability with (mainly) cerebrovascular events. The principal disadvantage of this approach, however, is its limited applicability in the daily management of hypertensive patients, where it is difficult to obtain BP data under a stable antihypertensive treatment regimen over a consistent number of visits. An alternative method, devoid of this difficulty, is to assess day-by-day BPV making use of home BP values obtained over several days. Its validity is supported by studies demonstrating the relationship of day-by-day BPV with cardiovascular outcomes.4However, in spite of the data supporting the clinical relevance of BP fluctuations over time, a number of reasons have until now prevented the introduction of BPV assessment in daily clinical management of hypertension. Among them is the yet missing direct evidence in humans that a reduction in BPV by treatment provides cardiovascular protection beyond that offered by BP lowering. Moreover, although animal studies suggested the possible beneficial role of calcium channel blockers (CCBs) in lowering BPV independent of mean BP reduction,5 longitudinal data in humans on the ability of antihypertensive drugs to reduce BPV independently from their effect on mean BP levels are still largely missing. A …

Calcium Antagonist Added to Angiotensin Receptor Blocker: A Recipe for Reducing Blood Pressure Variability?