Key result
Higher day-to-day SBP variability is linked to ~29% greater cerebral small vessel disease burden.
Why the study?
High visit-to-visit blood pressure variability relates to cognitive decline and cerebral small vessel disease, but whether day-to-day blood pressure variability also associates with cerebral small vessel disease had not been investigated.
Is day-to-day home blood pressure variability associated with cerebral small vessel disease burden in memory clinic patients?
Cross-Sectional (n=82)
No
Is day-to-day home blood pressure variability associated with cerebral small vessel disease burden in memory clinic patients?
Odds Ratio: 1.29 (95% CI 1.04–1.6)
p-value: p=0.022
Day-to-day systolic blood pressure variability is independently associated with cerebral small vessel disease burden in older patients with cognitive impairment.
BACKGROUND: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-to-day BPV also relates to cSVD has not been investigated. OBJECTIVE: To investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden in older memory clinic patients. METHODS: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0-4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP. RESULTS: For 82 patients (aged 71.2±7.9 years), mean home BP was 140/79±15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04-1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. CONCLUSION: Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints.
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Heus et al. (2020) conducted a cross-sectional in Cognitive impairment and cerebral small vessel disease (n=82). Day-to-day systolic blood pressure variability vs. Lower blood pressure variability was evaluated on Total cerebral small vessel disease (cSVD) MRI burden score (OR 1.29, 95% CI 1.04-1.60, p=0.022). Higher day-to-day systolic blood pressure variability was associated with increased cerebral small vessel disease burden (OR 1.29 per point increase in CV, p=0.022).
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