The ASCOT trial investigated the long-term cardiovascular (CV) benefits of blood pressure (BP) treatment, focusing on blood pressure variability (BPV). The study followed 8,580 hypertensive participants for up to 21 years, comparing amlodipine-based and atenolol-based treatments. Key findings showed that systolic BPV was a stronger predictor of CV outcomes than mean systolic blood pressure (SBP), even in patients with controlled SBP. Participants on amlodipine-based treatment had significantly reduced risks of stroke, total CV events, coronary events, and atrial fibrillation compared to those on atenolol-based treatment. The long-term benefits of amlodipine-based treatment were primarily attributed to its effect on reducing systolic BPV during the trial. The study also found that BPV, rather than mean SBP, was a strong predictor of CV outcomes, even in patients with normal blood pressure. These results suggest that BPV should be considered a key factor in risk assessment for hypertensive patients, and future studies may explore BPV as a therapeutic target. The study highlights the importance of BPV in predicting long-term CV outcomes and the potential benefits of amlodipine-based treatment in reducing these risks.The ASCOT trial investigated the long-term cardiovascular (CV) benefits of blood pressure (BP) treatment, focusing on blood pressure variability (BPV). The study followed 8,580 hypertensive participants for up to 21 years, comparing amlodipine-based and atenolol-based treatments. Key findings showed that systolic BPV was a stronger predictor of CV outcomes than mean systolic blood pressure (SBP), even in patients with controlled SBP. Participants on amlodipine-based treatment had significantly reduced risks of stroke, total CV events, coronary events, and atrial fibrillation compared to those on atenolol-based treatment. The long-term benefits of amlodipine-based treatment were primarily attributed to its effect on reducing systolic BPV during the trial. The study also found that BPV, rather than mean SBP, was a strong predictor of CV outcomes, even in patients with normal blood pressure. These results suggest that BPV should be considered a key factor in risk assessment for hypertensive patients, and future studies may explore BPV as a therapeutic target. The study highlights the importance of BPV in predicting long-term CV outcomes and the potential benefits of amlodipine-based treatment in reducing these risks.