Different Impacts of Blood Pressure Variability on the Progression of Cerebral Microbleeds and White Matter Lesions

Abstract

Recent studies have proposed that the usual blood pressure (BP) hypothesis is limited, 2 and they have indicated that visit-to-visit variability in systolic blood pressure (SBP) is a powerful predictor of stroke, independent of mean BP. 3 However, there are few studies based on the clinical significance of long-term BP variability (BPV). 3,4Background and Purpose-Cerebral microbleeds (CMB) and white matter lesions (WML) are cerebral small vessel diseases. Hypertension is considered the most important risk factor. Its mechanism is not yet clarified. Our study assessed the association of blood pressure variability (BPV) with CMB and WML progression. Methods-Patients with a history of ischemic stroke within 1 to 6 months were consecutively recruited and followedup for 12 to 18 months. Blood pressure was measured monthly and controlled to a target level. BPV was quantified by the maximum, standard deviation, coefficient of variation, successive variation, standard deviation independent of mean, and successive variation independent of mean. Magnetic resonance imaging was performed at baseline and the end of the study. CMB and WML were rated using Microbleed Anatomic Rating Scale and Age-Related White Matter Changes scales, respectively. Multiple logistic analyses assessed BPV associations with CMB and WML development. Results-Of 720 patients recruited, 500 and 584 had follow-up results for CMB and WML, respectively; 13.2% and 48.1%showed CMB and WML progression, respectively, over a median of 14 months. Patients with CMB had a higher mean, maximum, standard deviation, coefficient of variation, successive variation, standard deviation independent of the mean, and successive variation independent of the mean in either systolic blood pressure or diastolic blood pressure (P<0.05). Systolic blood pressure variability was an independent risk factor for deep and infratentorial CMB progression, whereas diastolic blood pressure variability was independently associated with CMB development in deep regions. WML progression was not significantly associated with BPV between visits. Conclusion-BPV

Systolic Blood Pressure Variation and Mean Heart Rate Is Associated With Cognitive Dysfunction in Patients With High Cardiovascular Risk

“…33 Accordingly, visit to visit variation of SBP was shown to predict the occurrence of stroke in hypertensive individuals, 34 as well as all-cause mortality in the general population 35 and was associated with microbleeds and white matter lesions in patients after an ischemic stroke. 36 Although associations of blood pressure with cognitive decline are convincing, 1,2,37 secondary analyses of cardiovascular trials aiming to investigate cognitive decline after blood pressure lowering have been inconsistent. The Syst-Eur trial included 2418 patients and was terminated prematurely as a result of significant differences in the incidence of stroke, leading to a short follow-up of only 2 years.…”

“…[38][39][40][41][42][43] Also treatment with RAS-inhibitors and non-RAS inhibitors showed no difference in patients after stroke (Prevention Regimen for Effectively Avoiding Second Strokes [PRoFESS]) 44 or in high risk patients of ONTARGET and TRANSCEND. 24 Interestingly, the association of SBP variation to stroke 7 or cerebral lesions 36 has not been investigated in cardiovascular intervention trials in high risk patients, except in one study on 201 elderly hypertensive individuals in Japan. 16 Because observational studies never proof causality and, in addition, drugs might act differently on SBP variation, 33,34 intervention trials in high risk patients ought to prospectively investigate pharmacological interventions on SBP variation and outcomes.…”

China Stroke Primary Prevention Trial: Visit‐to‐Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients

“…A previous study from this research group showed that visit‐to‐visit BPV significantly accelerated the progress of cerebral microbleeds rather than the progress of cerebral white matter lesions during follow‐up of 1.5 years 24. Considering the higher risk of hemorrhagic stroke in Chinese patients,1 it is necessary to analyze the association between SBPV and subtypes of stroke in China.…”

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

“…In addition, Liu et al have shown that enhanced BPV impacts on the progression of cerebral microbleeds and white matter lesions in patients with a history of ischemic stroke. In this regard, systolic BPV was an independent risk factor for deep and infratentorial cerebral microbleeds progression, whereas diastolic BPV was associated with cerebral microbleeds development in deep regions [43].…”