Arterial pressure and cerebral blood flow variability: Friend or foe? A review

Caroline A. Rickards, Yu Chieh Tzeng

Research output: Contribution to journalReview articlepeer-review

55 Scopus citations


Variability in arterial pressure and cerebral blood flow has traditionally been interpreted as a marker of cardiovascular decompensation, and has been associated with negative clinical outcomes across varying time scales, from impending orthostatic syncope to an increased risk of stroke. Emerging evidence, however, suggests that increased hemodynamic variability may, in fact, be protective in the face of acute challenges to perfusion, including significant central hypovolemia and hypotension (including hemorrhage), and during cardiac bypass surgery. This review presents the dichotomous views on the role of hemodynamic variability on clinical outcome, including the physiological mechanisms underlying these patterns, and the potential impact of increased and decreased variability on cerebral perfusion and oxygenation. We suggest that reconciliation of these two apparently discrepant views may lie in the time scale of hemodynamic variability; short time scale variability appears to be cerebroprotective, while mid to longer term fluctuations are associated with primary and secondary end-organ dysfunction.

Original languageEnglish
Article numberArticle 120
JournalFrontiers in Physiology
Volume5 APR
StatePublished - 2014


  • Blood pressure variability
  • Cerebral blood flow (CBF)
  • Cerebral blood flow variability
  • End organ damage
  • Hemodynamic oscillations


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