Doctors may be missing signs that people are at risk of stroke because they are not looking at blood pressure readings properly.

New research has found that people with occasionally high blood pressure are more at risk of stroke than those with consistently high readings.

Traditionally, GPs only consider sustained high blood pressure as being a sign that someone is at risk of heart disease or stroke. Occasional readings of high blood pressure are usually ignored as an aberration.

But new research has shown that such sharp variations could be a more accurate indicator of vulnerability to stroke - and could also be used to spot signs of future heart attacks, heart failure and angina.

The findings, reported in The Lancet medical journal, could have major implications for the prevention of strokes and heart attacks.

Experts say clinical guidelines for treating patients should now be reviewed, as currently no special importance is attached to fluctuations in blood pressure.

Researchers looked at how blood pressure variability affected stroke risk in four large groups of participants in previous international trials, each including more than 2,000 patients. All the patients had previously experienced a so-called 'mini-stroke', or transient ischaemic attack (TIA).

Patients with the most variation in systolic blood pressure - the pressure measured with each 'surge' of the beating heart - were six times more likely to have a stroke than those with the least.

Professor Peter Rothwell, from the University of Oxford, who led the study, said: 'Raised blood pressure, or hypertension, accounts for over 50 per cent of the risk of stroke and other vascular events in the population.

'It has long been believed that it is the underlying average blood pressure that determines most of the risk of complications from hypertension and all of the benefit from the drugs that are used to lower blood pressure.

'The work that we have done shows that this hypothesis is only partly true - at least when it comes to stroke, the most common complication of hypertension.

'We have shown that it is variations in people's blood pressure rather than the average level that predicts stroke most powerfully. Occasional high values, and what might be called episodic hypertension, carry a high risk of stroke. Previously, such fluctuations were considered to be benign and uninformative.'

Joe Korner, of the Stroke Association said: 'With this new research it is now important that the clinical guidelines about treating high blood pressure are reviewed. In the meantime, we urge GPs to read this research to help them prescribe the best treatment for people at risk of stroke.

'People already taking medicines to treat high blood pressure must continue to take their medication and should speak to their GP if they have any concerns.'

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