ESOC 2026 | Blood pressure variability and cerebral white matter lesion progression

As we all know that, the blood pressure variability has been determined to contribute to several white matter lesion progression. But previous evidence has been increased and limited by methodological heterogeneity. And in this pooled analysis, and we just did from the MRS sub-study of SPRINT MIND and ACCORD MIND trials, and both of these trials are high-quality RCT, and this trial has investigated whether intensive blood pressure lowering or control can prevent cardiovascular disease or can improve cognitive function. And in both of the trials, they also include a sub-study of MRI and the cerebral white matter lesion assessment. So in this study, and we used both the data from the ACCORD MIND and the SPRINT MIND trial, and we aim to assess the association between blood pressure variability and the white matter progression. And its mediating role in the neuroprotective effects of intensive blood pressure control. And in this pooled analysis, a total of 952 patients were included. And the median blood pressure measurements, the median number of blood pressure measurements was 12. And the median white matter lesion volume was increased from baseline to the follow-up from 1.69 milliliters to 2.58 milliliters. And in our analysis, we found that the higher systolic blood pressure variability was independently associated with faster white matter lesion progression and in the annualized term, and particularly in the highest tertile of blood pressure variability, and also has a faster white matter progression than those in the lower tertiles of blood pressure variability. And in our mediation analysis, and we found that the systolic blood pressure variability was partially mediated by the association between intensive blood pressure control and reduced cerebral white matter lesion progression volume, and the median effect was 0.014 and accounted for about 9% of the total effect. So in this study, we concluded that higher visit-to-visit blood pressure variability was intermittently associated with a faster cerebral white matter progression, and the benefits of intensive blood pressure lowering on white matter integrity was partially mediated by the reduced blood pressure variability, and suggesting that the blood pressure fluctuation or blood pressure stability as one of the modifiable targets to prevent several white matter injuries. And in the future, much more investigation is needed to investigate this direction.

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