BP Variability Tied to White Matter Lesion Growth

TOPLINEHigher visit-to-visit systolic blood pressure (BP) variability was independently associated with faster progression of cerebral white matter lesions in patients at high cardiovascular risk. Intensive BP control was linked to slowed progression, partly mediated by reduced systolic BP variability.METHODOLOGYA post hoc pooled analysis of individual participant data from two randomized controlled trials (SPRINT MIND and ACCORD MIND) assessed whether visit-to-visit systolic BP variability was associated with abnormal white matter progression.They included 952 participants (mean age, 64.8 years; 42% women) with high cardiovascular risk who had baseline and follow-up brain MRI scans and at least three clinic BP readings taken from the 3-month visit onward, with a median of 12 BP measurements per person.Systolic BP variability was quantified mainly using variation independent of mean (VIM).The primary outcome was progression of abnormal white matter volume, measured as total change from baseline to follow-up MRI.Researchers performed causal mediation analysis to assess whether BP variability explained part of the intensive treatment effect.TAKEAWAYIn fully adjusted models, each unit increase in systolic BP variability VIM was associated with greater abnormal white matter volume progression (beta 0.017; P = .032).Participants in the highest tertile of systolic BP-VIM had 0.160 mL/year faster annualized progression than those in the lowest tertile (P = .017).Intensive BP control was associated with reduced abnormal white matter volume progression compared with standard control (beta -0.270; P < .001).Mediation analysis revealed that systolic BP variability partially mediated the protective effect of intensive BP control on abnormal white matter progression.IN PRACTICE"[The] results may indicate that BPV [BP variability] may represent a modifiable therapeutic target primarily in nondiabetic individuals, whereas in diabetes, white matter injury appears to be driven by distinct microvascular mechanisms," the authors of the study wrote.SOURCEThe study was led by Wenbo Zhao, Xuanwu Hospital Capital Medical University in Beijing, China. It was published online on July 10 in Neurology.LIMITATIONSBoth trials enrolled participants at high cardiovascular risk with few stroke events; thus, the findings may not generalize to those at lower risks or patients with stroke. Trials targeted systolic BP but did not require specific drugs; thus, treatment-related confounding may have remained. Reverse causation cannot be excluded because underlying white matter conditions may have contributed to increased BP variability.DISCLOSURESThe study was supported by multiple sources, including the National Major Science and Technology projects of Brain Science and Brain-inspired Intelligence Young Scientist Class A, the British Heart Foundation, and the National Natural Science Foundation of China. Infrastructural support was provided by the Cambridge British Heart Foundation Center of Research Excellence and the Cambridge University Hospitals National Institute for Health and Care Research Biomedical Research Center. The authors reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.