Background: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-today BPV also relates to cSVD has not been investigated. Objective: To investigate the cross-sectional association between day-today BPV and total cSVD MRI burden in older memory clinic patients. Methods: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0-4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP. Results: For 82 patients (aged 71.2 ± 7.9 years), mean home BP was 140/79 ± 15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04-1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. Conclusion: Day-today systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints.

Objective: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular with cerebrovascular lesions. It is likely that the causes and consequences of high BPV depend on which temporal resolution is investigated. Day-to-day BPV has been related to cognitive function, but has not been investigated in relation to cSVD. Therefore, we aimed to investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden, in older memory clinic patients. Design and method: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. Four markers of cSVD were visually rated, resulting in a score between 0 and 4: presence of microbleed(s), presence of lacune(s), severe white matter hyperintensities and enlarged perivascular spaces in the basal ganglia. Home blood pressure (BP) measurements were performed for one week according to international guidelines. After removal of day 1, BPV was defined as the coefficient of variation (CV). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, history of cardiovascular disease and mean BP to assess the association between total cSVD score and BPV. Results: In 82 patients (aged 71.2 ± 7.9 years), mean home BP was 140/79 ± 15/9 mmHg. Dementia and mild cognitive impairment were present in 46% and 34%, respectively. 22% of the study population had a total cSVD score of 0. These frequencies 24%, 26%, 20% and 8% for scores of 1, 2, 3 and 4, respectively. Systolic CV was associated with total cSVD burden, with the adjusted odds ratio per point increase in CV = 1.30, 95% confidence interval = 1.05–1.61, p = 0.018. There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. Conclusions: Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering day-to-day systolic BPV should be included in BP management in older people with memory complaints.