Twenty-four hour blood pressure variability and the prevalence and the progression of cerebral white matter hyperintensities

N.L. Starmans*, F.J. Wolters, A.E. Leeuwis, E.E. Bron, H.P.B. La Rocca, J. Staals, G.J. Biessels, L.J. Kappelle

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Blood pressure variability (BPV) is related to cerebral white matter hyperintensities (WMH), but longitudinal studies assessing WMH progression are scarce. Patients with cardiovascular disease and control participants of the Heart-Brain Connection Study underwent 24-hour ambulatory blood pressure monitoring and repeated brain MRI at baseline and after 2 years. Using linear regression, we determined whether different measures of BPV (standard deviation, coefficient of variation, average real variability (ARV), variability independent of the mean) and nocturnal dipping were associated with WMH and whether this association was mediated or moderated by baseline cerebral perfusion. Among 177 participants (mean age: 65.9 +/- 8.1 years, 33.9% female), the absence of diastolic nocturnal dipping was associated with higher WMH volume at baseline (beta = 0.208, 95%CI: 0.025-0.392), but not with WMH progression among 91 participants with follow-up imaging. None of the BPV measures were associated with baseline WMH. Only 24-hour diastolic ARV was significantly associated with WMH progression (beta = 0.144, 95%CI: 0.030-0.258), most profound in participants with low cerebral perfusion at baseline (p-interaction = 0.042). In conclusion, absent diastolic nocturnal dipping and 24-hour diastolic ARV were associated with higher WMH volume. Whilst requiring replication, these findings suggest that blood pressure patterns and variability may be a target for prevention of small vessel disease.
Original languageEnglish
Pages (from-to)801-811
Number of pages11
JournalJournal of Cerebral Blood Flow and Metabolism
Issue number5
Early online date1 Jan 2023
Publication statusPublished - May 2023


  • Blood pressure variability
  • cerebral perfusion
  • cerebrovascular disease
  • nocturnal dipping
  • white matter hyperintensities

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