Blood pressure variability and white matter hyperintensities after ischemic stroke

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.