Long-term Blood Pressure Fluctuation and Cerebrovascular Disease in an Elderly Cohort

Open Access
Publisher Website
Google Scholar
Abstract
Large and small vessel cerebrovascular disease (CVD) in the elderly, visualized by structural magnetic resonance imaging (MRI) as infarction and white matter hyperintensities (WMHs), is associated with cognitive decline and disability, but its determinants have not been fully explicated. Elevated blood pressure (BP) can cause CVD through a variety of pathways, including atherosclerotic changes,1,2 blood-brain barrier dysfunction,3 lipohyalinosis,4 carotid stenosis,1,2,5 and hemorrhage.6 Elevated BP is associated with poorer cognitive function in older adults and has been shown to be a risk factor for Alzheimer disease.7,8 Increased BP in midlife and late in life is also related to stroke and, although inconsistently, WMH volume.9,10 Studies that examine the association between BP and CVD generally consider BP measurements at 1 time point, limiting the appreciation of the full impact of BP on CVD. In clinical settings, absolute BP is used as a therapeutic target to prevent clinical stroke and heart disease, but BP fluctuation across long periods and its effect on CVD are typically not considered.