Higher long-term visit-to-visit blood pressure variability is associated with severe cerebral small vessel disease in the general population

Background Long-term blood pressure (BP) variability is related to several diseases, but its impact on cerebral small vessel disease (cSVD) is uncertain. The study explored the relationship between BP variability, total cSVD burden, and its typical features. Method The study involved 1284 participants from the Kailuan cohort. From 2006 to 2022, systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) variability were calculated as low, middle, or high. Magnetic resonance imaging was used to identify white matter hyperintensities (WMH), lacunae (LA), cerebral microbleeds (CMBs), and visible perivascular spaces (PVS). The burden of cSVD was defined as non, mild, moderate, or severe. Logistic regression was used to estimate the odds ratio (OR) and confidence interval (CI). Results High SBP variability was associated with moderate cSVD burden (OR=1.89, 95% CI: 1.09-3.29) and PVS (OR= 1.62, 95%CI: 1.10-2.39). The DBP was associated with LA (OR=1.74, 95%CI: 1.06-2.84). The PP showed obvious risk effects on moderate/severe cSVD burden (OR= 1.99, 95%CI: 1.17-3.41; OR=2.49, 1.34-4.63). These associations were modified by age and hypertension status. In the young adults (age<60 years old), only high PP variability associated with severe cSVD burden (OR=3.33, 95%CI: 1.31-8.44), LA (OR=3.02, 95%CI: 1.31-6.93), and PVS (OR=1.86, 95%CI: 1.20-2.88). The risk effect of SBP and PP variability on cSVD burden was only significant in the participants with hypertension. Conclusion High long-term BP variability, especially in combination with hypertension, is a risk factor for total cSVD burden, LA, and PVS. it is crucial to pay attention to PP variability in young adults.