Hypertension has strong adverse effects on cardiovascular diseases, and increased blood pressure (BP) variability (BPV) is closely associated with the development of hypertensive organ injuries and the occurrence of cardiovascular diseases. Similar to other forms of BPV, short-term beat-to-beat BPV has also been established as a risk factor for cardiovascular diseases. Baroreflex failure is the major mechanism involved in the pathophysiology of short-term beat-to-beat BPV. Previous clinical and animal studies have demonstrated that baroreflex failure disrupted beat-to-beat BPV and hypertensive organ damage. Moreover, short-term beat-to-beat BPV was an independent determinant of vascular elasticity. Although, the clinical measurement tools and therapeutics for beat-to-beat BPV are not sufficient, we should consider that large beat-to-beat BPV is an important risk factor for cardiovascular diseases in patients with hypertension.