The association between blood pressure variability and cerebral small-vessel disease: a systematic review and meta-analysis

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dc.contributor.authorTully, P.J.
dc.contributor.authorYano, Y.
dc.contributor.authorLauner, L.
dc.contributor.authorKario, K.
dc.contributor.authorNagai, M.
dc.contributor.authorMooijaart, S.P.
dc.contributor.authorClaassen, J.A.H.R.
dc.contributor.authorSimona Lattanzi, S.
dc.contributor.authorVincent, A.
dc.contributor.authorTzourio, C.
dc.date.issued2020
dc.descriptionIncludes 46 pages of Supplemental Material
dc.description.abstractBackground: Research links blood pressure variability (BPV) with stroke; however, the association with cerebral small‐vessel disease (CSVD) remains unclear. As BPV and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding cerebrovascular morphological characteristics. Methods and Results: A systematic review was performed from inception until March 3, 2019. Eligibility criteria included population, adults without stroke (<4 weeks); exposure, BPV quantified by any metric over any duration; comparison, (1) low versus high or mean BPV and (2) people with versus without CSVD; and outcomes, (1) CSVD as subcortical infarct, lacunae, white matter hyperintensities, cerebral microbleeds, or enlarged perivascular spaces; and (2) standardized mean difference in BPV. A total of 27 articles were meta‐analyzed, comprising 12 309 unique brain scans. A total of 31 odds ratios (ORs) were pooled, indicating that higher systolic BPV was associated with higher odds for CSVD (OR, 1.27; 95% CI, 1.14–1.42; I2=85%) independent of mean systolic pressure. Likewise, higher diastolic BPV was associated with higher odds for CSVD (OR, 1.30; 95% CI, 1.14–1.48; I2=53%) independent of mean diastolic pressure. There was no evidence of a pairwise interaction between systolic/diastolic and BPV/mean ORs (P=0.47), nor a difference between BPV versus mean pressure ORs (P=0.58). Fifty‐four standardized mean differences were pooled and provided similar results for pairwise interaction (P=0.38) and difference between standardized mean differences (P=0.70). Conclusions: On the basis of the available studies, BPV was associated with CSVD independent of mean blood pressure. However, more high‐quality longitudinal data are required to elucidate whether BPV contributes unique variance to CSVD morphological characteristics.
dc.description.statementofresponsibilityPhillip J. Tully, Yuichiro Yano, Lenore J. Launer, Kazuomi Kario, Michiaki Nagai, Simon P. Mooijaart, Jurgen A.H.R. Claassen, Simona Lattanzi, Andrew D. Vincent, Christophe Tzourio, on behalf of the Variability in Blood Pressure and Brain Health Consortium
dc.identifier.citationJournal of the American Heart Association, 2020; 9(1):e013841-1-e013841-16
dc.identifier.doi10.1161/JAHA.119.013841
dc.identifier.issn2047-9980
dc.identifier.issn2047-9980
dc.identifier.orcidTully, P.J. [0000-0003-2807-1313]
dc.identifier.orcidVincent, A. [0000-0002-6428-1070]
dc.identifier.urihttp://hdl.handle.net/2440/124656
dc.language.isoen
dc.publisherWiley
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1053578
dc.rights© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
dc.source.urihttps://www.ahajournals.org/doi/full/10.1161/JAHA.119.013841?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed
dc.subjectBlood pressure measurement/monitoring; blood pressure variability; high blood pressure; meta-analysis; systematic review; white matter disease
dc.titleThe association between blood pressure variability and cerebral small-vessel disease: a systematic review and meta-analysis
dc.typeJournal article
pubs.publication-statusPublished

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