Elevated blood pressure variability was associated with a wide range of subclinical structural changes in the brain. These structural changes could be the mechanisms explaining a higher incidence of dementia and stroke.

This study included 2348 participants age ≥55 years in a prospective cohort. Blood pressure was measured in each visit since 1990, and since 2005 all visits included a magnetic resonance imaging scan.

Authors first assessed the absolute difference in blood pressure over two sequential visits for both systolic and diastolic blood pressure.

Then, they assessed the direction of the variation and associated it with the magnetic resonance imaging scans through a multivariate analysis. Small vessel disease, brain tissue volumes, and white matter microstructural integrity were all taken into account.

Higher blood pressure variation (top vs. bottom tertiles) was associated with more severe white matter hyperintensities (odds ratio [OR]: 1.32), lacunes (OR: 1.25), and microbleeds (OR: 1.16).

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Similarly, such variation was associated with smaller total brain volume and worse white matter microstructural integrity.

Such brain damage was observed with both large rises and falls in blood pressure.

Conclusion

Elevated blood pressure variability was associated with a large number of structural brain changes observed through magnetic resonance imaging. These changes, which are subclinical at first, could be the mechanisms that afterwards increase the incidence of dementia and stroke.

Original Title: Blood Pressure Variation and Subclinical Brain Disease.

Reference: Yuan Ma et al. J Am Coll Cardiol 2020;75:2387–99.

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