Key result
Higher visit-to-visit systolic BP variability is linked to greater abnormal white matter volume progression.
Why the study?
Previous evidence linking visit-to-visit blood pressure variability to white matter lesion progression has been inconsistent and limited by methodological heterogeneity.
Does intensive blood pressure control and reduced visit-to-visit blood pressure variability slow cerebral white matter lesion progression?
Meta-Analysis (n=952)
Yes
Does intensive blood pressure control and reduced visit-to-visit blood pressure variability slow cerebral white matter lesion progression?
Effect estimate: β = 0.017 (95% CI 0.001 to 0.033)
Higher visit-to-visit systolic blood pressure variability is associated with faster white matter lesion progression, and reducing this variability partially mediates the neuroprotective benefits of intensive blood pressure control.
BPV reduction may slow AWM progression in hypertension; confirms partial mediation of intensive BP control benefits.
Background and aims Visit-to-visit blood pressure variability (BPV) may contribute to white matter lesions (WML) progression, but previous evidence has been inconsistent and limited by methodological heterogeneity. We aimed to assess the association between BPV and WML progression and its mediating role in the neuroprotective effects of intensive BP control. Methods We pooled individual participant data from two randomized trials (ACCORD MIND and SPRINT MIND), both including MRI substudies with standardized BP measurements and long-term follow-up (mean 40 and 48 months, respectively). WML progression was quantified as absolute and annualized changes in abnormal white matter (AWM) volume, with inverse hyperbolic sine (asinh)-transformed total change as the primary metric. Results A total of 952 participants(mean age 64.8 years [SD 7.1]; 400 [42%] women) were included, contributing a median of 12 BP measurements. Median AWM volume increased from 1.69 mL to 2.58 mL(0.43 mL per year [SD 0.84]). Higher systolic BPV was independently associated with greater AWM volume progression (β = 0.017, 95%CI 0.001 to 0.033). Intensive BP control was associated with slower AWM volume progression(β = -0.270, 95%CI –0.393 to –0.146). Systolic BPV partially mediated the association between intensive BP control and reduced AWM volume progression(average causal mediation effect 0.014, 95%CI 0.001 to 0.034), accounting for 9.15% of the total effect. Conclusions Higher visit-to-visit systolic BPV was independently associated with faster WML progression. The benefit of intensive BP lowering on white matter integrity was partly mediated by reduced BPV, suggesting BP stability as a modifiable target to prevent white matter injury. Conflict of interest All authors: nothing to disclose.
No takes yet. Share an insight, caveat, or question.
Zhao et al. (2026) conducted a meta-analysis in White matter lesions (n=952). Visit-to-visit systolic blood pressure variability was evaluated on Inverse hyperbolic sine (asinh)-transformed total change in abnormal white matter (AWM) volume (β = 0.017, 95% CI 0.001 to 0.033). Higher visit-to-visit systolic blood pressure variability was independently associated with greater abnormal white matter volume progression (β = 0.017; 95% CI 0.001-0.033).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: