Cerebral small vessel disease and blood pressure variability

Abstract

Annotation. Cerebral small vessel disease (CSVD) contributes up to about 25% of strokes and is the second most common cause of dementia and cognitive decline. Hypertensive arteriolosclerosis is the leading cause of CSVD, hence understanding its relationships with blood pressure changes, including blood pressure variability (BPV), is crucial. The aim of the research was to find out relationships between blood pressure parameters and such MRI-features of CSVD, as white matter hyperintensity (WMH), lacunes, perivascular spaces (PVS), brain atrophy in acute-stroke patients during hospitalization time. 160 participants enrolled in our study (56,3% were male, average age – 61,05±10,95, hospitalization time – 10,46 days). Statistical analysis was performed in the GNU Project software packages (2020). GNU PSPP (Version 1.4.1) [Computer Software]. Free Software Foundation. Boston, MA and The jamovi project (2021). Jamovi (Version 2.0) [Computer Software]. MRI was assessed according to “STRIVE” guidelines for cerebral vessel disease. We measured such BP parameters as mean systolic BP, mean diastolic BP, standard deviation and coefficient of variability for both systolic and diastolic BP. A moderate positive correlation was found between systolic BP variability and WMH severity (r=0.3, p=0.03). There was also a tendency for association between systolic BP variability and enlarged PVS at the basal ganglia level, but it was not significant (p=0.09). There was also a significant relationship between mean systolic BP and WMH severity (r=0.3, p<0.005), mean systolic BP and enlarged PVS at the basal ganglia level (r=0.3, p<0.01), mean systolic BP and total CSVD burden (r=0.3, p<0.005). Systolic BP and its variability are associated with WMH and enlarged PVS, which may provide valuable diagnostic and prognostic data about subtypes of CSVD and the consequences of vascular damage to the brain. Systolic BP variability targeting might be beneficial for prevention of CSVD progression.