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Visit-to-visit blood pressure variability and progression of white matter hyperintensities over 14 years
Esther Janssen1, Jan Willem van Dalen1, Mengfei Cai2
1Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
Insights
Visit-to-visit blood pressure variability (BPV) is linked to worsening white matter hyperintensities (WMH) and new lacunes in individuals with cerebral small vessel disease (SVD) over 14 years.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Blood pressure variability (BPV) is implicated in cerebral small vessel disease (SVD) and may elevate stroke and dementia risk.
- The long-term impact of BPV on SVD progression remains under investigation.
Purpose of the Study:
- To investigate the association between visit-to-visit BPV and white matter hyperintensity (WMH) progression over 14 years.
- To examine the relationship between BPV and MRI markers of SVD after 14 years.
Main Methods:
- Utilized data from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) with 199 participants.
- Calculated BPV as the coefficient of variation (CV) of blood pressure across four visits spanning 14 years.
- Employed linear-mixed effects models for WMH progression and regression models for MRI markers.
Main Results:
- Systolic BPV correlated with increased WMH progression (β=0.013, 95% CI 0.005–0.022).
- Systolic BPV was associated with a higher risk of incident lacunes (OR: 1.10, 95% CI 1.01–1.21).
- No significant association was found between systolic BPV and grey/white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD), or microbleed count.
Conclusions:
- Visit-to-visit systolic BPV is linked to accelerated WMH progression and increased lacune formation in SVD patients over 14 years.
- Further research is required to establish the causal relationship between BPV and SVD progression.
Abstract:
Purpose: There is evidence that blood pressure variability (BPV) is associated with cerebral small vessel disease (SVD) and may therefore increase the risk of stroke and dementia. It remains unclear if BPV is associated with SVD progression over years. We examined whether visit-to-visit BPV is associated with white matter hyperintensity (WMH) progression over 14 years and MRI markers after 14 years.
Abstract:
Materials and methods: We included participants with SVD from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) who underwent baseline assessment in 2006 and follow-up in 2011, 2015 and 2020. BPV was calculated as coefficient of variation (CV) of BP at all visits. Association between WMH progression rates over 14 years and BPV was examined using linear-mixed effects (LME) model. Regression models were used to examine association between BPV and MRI markers at final visit in participants.
Abstract:
Results: A total of 199 participants (60.5 SD 6.6 years) who underwent four MRI scans and BP measurements were included, with mean follow-up of 13.7 (SD 0.5) years. Systolic BPV was associated with higher progression of WMH (β = 0.013, 95% CI 0.005 - 0.022) and higher risk of incident lacunes (OR: 1.10, 95% CI 1.01-1.21). There was no association between systolic BPV and grey and white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD) or microbleed count after 13.7 years.
Abstract:
Conclusions: Visit-to-visit systolic BPV is associated with increased progression of WMH volumes and higher risk of incident lacunes over 14 years in participants with SVD. Future studies are needed to examine causality of this association.
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01:23Assessment of blood pressure in brachial artery(two-step method)
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:28Factors affecting Blood pressure
Physiological Factors:
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.