Related Experiment Video
Updated: Jul 4, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Blood pressure variability and white matter hyperintensities after ischemic stroke
Nina A Hilkens1, Frank-Erik de Leeuw1, Catharina Jm Klijn1
1Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
Background:
High blood pressure variability (BPV) may be a risk factor for stroke and dementia in patients with ischemic stroke, but the underlying mechanism is unknown. We aimed to investigate whether high BPV is associated with presence and progression of white matter hyperintensities (WMH).
Methods:
We performed a post-hoc analysis on the MRI substudy of the PRoFESS trial, including 771 patients with ischemic stroke who underwent MRI at baseline and after a median of 2.1 years. WMH were rated with a semi-quantitative scale. Visit-to-visit BPV was expressed as the coefficient of variation (interval 3-6 months, median number of visits 7). The association of BPV with WMH burden and progression was assessed with linear and logistic regression analyses adjusted for confounders.
Results:
BPV was associated with burden of periventricular WMH (β 0.36 95%CI 0.19-0.53, per one SD increase in BPV) and subcortical (log-transformed) WMH (β 0.25, 95%CI 0.08-0.42). BPV was not associated with periventricular (OR 1.09, 95%CI 0.94-1.27) and subcortical WMH progression (OR 1.15, 95%CI 0.99-1.35). Associations were independent of mean BP.
Conclusion:
High visit-to-visit BPV was associated with both subcortical and periventricular WMH burden in patients with ischemic stroke, but not with WMH progression in this study.
Insights
High blood pressure variability (BPV) is linked to more white matter hyperintensities (WMH) in stroke patients. However, this study found no association between BPV and the progression of WMH.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Elevated blood pressure variability (BPV) is a potential risk factor for stroke and dementia.
- The precise mechanisms linking BPV to cerebrovascular damage remain unclear.
- White matter hyperintensities (WMH) are associated with stroke and cognitive decline.
Purpose of the Study:
- To investigate the association between high blood pressure variability (BPV) and the presence of white matter hyperintensities (WMH) in patients with ischemic stroke.
- To determine if BPV is associated with the progression of WMH over time.
Main Methods:
- Post-hoc analysis of the PRoFESS trial MRI substudy.
- Included 771 ischemic stroke patients with baseline and follow-up MRI scans (median 2.1 years).
- Assessed WMH using a semi-quantitative scale and BPV via coefficient of variation; adjusted regression analyses were performed.
Main Results:
- BPV showed a significant association with the burden of periventricular WMH (β=0.36) and subcortical WMH (β=0.25).
- No significant association was found between BPV and the progression of either periventricular or subcortical WMH.
- These associations remained significant and independent of mean blood pressure levels.
Conclusions:
- High visit-to-visit blood pressure variability is associated with a greater burden of both subcortical and periventricular white matter hyperintensities in ischemic stroke patients.
- BPV was not found to be associated with WMH progression in this cohort.
- Further research is needed to elucidate the mechanisms linking BPV to WMH burden.
