Day to Day Blood Pressure Variability Associated With Cerebral Arterial Dilation and White Matter Hyperintensity

Abstract

Background: Previous studies suggested blood pressure variability (BPV) might help reveal interactions between blood pressure fluctuation and white matter lesions, and the impact of elevated BPV on white matter hyperintensity (WMH) or cerebral arterial dilation is unclear. Methods: This retrospective observational study involved 2634 stroke-free individuals (68.6±11.1 years, 50.3% female), who underwent magnetic resonance imaging and magnetic resonance angiography scans, from a single center in Shanghai, China. Measurements for variability of blood pressure were made based on 7 days blood pressure recordings. WMHs were quantified from T2-FLAIR images and further classified as periventricular WMH or deep WMH. M1 segment of middle cerebral artery dilation was assessed from magnetic resonance angiography images. General linear model was used to examine the associations. Results: Both increased systolic and diastolic BPV were associated with increased WMH volume (systolic: β =0.02 [95% CI, 0.004–0.03], P =0.01; diastolic: β =0.05 [95% CI, 0.03–0.08], P <0.001). Only periventricular WMH was associated with BPV (systolic: β =0.02 [95% CI, 0.005–0.04], P =0.01; diastolic: β =0.06 [95% CI, 0.04–0.09], P <0.001). MCA dilation was found in 125 individuals (4.75%). Systolic BPV was associated with MCA dilation only in the hypertensive individuals ( β =0.11 [95% CI, 0.06–0.17], P <0.001). Increased WMH volume was found associated with dilated MCA ( β =0.17 [95% CI, 0.11–0.23], P <0.001). Conclusions: Increased BPV might be one of the pathophysiological phenomena involving in the small vessel disease independent of hypertension. Increased BPV might independently contribute to intracranial arterial dilation. Management of BPV might be a target to preserve cerebrovascular wellness.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…This association seemed to be independent of demographic, clinical and assessment characteristics [310]. Increased BP variability (day-to-day measurements) may also play a role [311], as well as orthostatic hypotension in older people [300]. In clinical studies, long-term elevated SBP and pulse pressure incognitivelyhealthyadults aged 50 years or older was clearlyassociatedwith subsequent cognitive decline and dementia [312].…”

Targeting autonomic nervous system as a biomarker of well-ageing in the prevention of stroke

“…In the Chinese residents in Pu-Li town and Kinmen county, Taiwan, average real variability (ARV) index recorded on a short period added significant prognostic information ( Hsu et al, 2016 ). BPV is also associated with cerebral white matter hyperintensity and might be one of the pathophysiological phenomena involving in the small vessel disease independent of hypertension ( Zhang et al, 2022 ). The Hisayama study showed that increased day-to-day BPV is, independently of average home blood pressure, a significant risk factor for the development of all-cause dementia ( Oishi et al, 2017 ).…”

Intracranial Plaque Characteristics of Recurrent Ischemic Stroke After Intensive Medical Therapy for a 6-month Follow-up

“…Besides, poor blood pressure control might also increase blood pressure variability, which has been suggested to exhibit adverse impact on the cerebrovascular system and increase the risk of stroke. 41,42 In addition, this study utilized hr-VW-MRI to assess the associations of intracranial plaque morphologies with stroke recurrence and has demonstrated that a larger MLA was associated with a lower risk of recurrent ischemic events. In alignment with previous studies, a smaller lumen area of the middle cerebral artery might imply an increased risk of first-ever stroke.…”

“…Besides, poor blood pressure control might also increase blood pressure variability, which has been suggested to exhibit adverse impact on the cerebrovascular system and increase the risk of stroke. 41,42…”