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Long-term blood pressure fluctuation and cerebrovascular disease in an elderly cohort

Adam M Brickman1, Christiane Reitz, José A Luchsinger

  • 1Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. amb2139@columbia.edu

Archives of Neurology
|May 12, 2010
PubMed

Insights

Elevated blood pressure and its long-term fluctuations significantly increase the risk of cerebrovascular disease in older adults. Managing both blood pressure levels and variability is crucial for preventing disability.

Area of Science:

  • Gerontology
  • Neurology
  • Cardiovascular Science

Background:

  • Subclinical cerebrovascular disease is a growing concern in the elderly.
  • Determinants of cerebrovascular disease, including blood pressure (BP) and its fluctuations, require further elucidation.
  • Elevated BP and BP variability may contribute to cerebrovascular disease via ischemic changes and impaired cerebral autoregulation.

Purpose of the Study:

  • To investigate the association between blood pressure (BP) and long-term BP fluctuations with cerebrovascular disease.
  • To identify risk factors for cerebrovascular disease in an aging population.

Main Methods:

  • Community-based epidemiological study (Washington Heights-Inwood Columbia Aging Project) of 686 nondemented older adults.
  • BP measurements collected over three visits at 24-month intervals, with structural MRI.
  • Participants categorized into four groups based on mean BP and BP variability (SD) relative to medians.

Main Results:

  • White matter hyperintensity (WMH) volume showed a linear increase across the four BP groups.
  • The group with the highest mean BP and highest BP variability exhibited the largest WMH volume.
  • The frequency of brain infarction also increased monotonically with higher BP and BP variability (22% to 41%).

Conclusions:

  • Higher blood pressure and greater long-term BP fluctuations are associated with an increased risk of cerebrovascular disease.
  • Cerebrovascular disease is linked to disability in older adults.
  • Interventions should target both elevated BP and long-term BP fluctuations to mitigate cerebrovascular disease risk.
Abstract

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