Blood pressure variability and silent cerebral damage in essential hypertension

It is recognized that blood pressure (BP) variability has prognostic significance in determining target organ damage and cardiovascular mortality and morbidity. The aim of this study was to analyze the association between blood pressure variability and the presence of silent cerebral white matter lesions in middle-aged asymptomatic essential hypertensives. We studied 43 middle-aged untreated hypertensive patients. Blood pressure variabilities (short-term and long-term) were evaluated by using both non-invasive, beat-to-beat, continuous finger 24-hour monitoring (Portapres) and oscillometric automated discontinuous ambulatory blood pressure monitoring. All patients underwent cerebral magnetic resonance imaging to detect the presence or not of white matter lesions. Hypertensive patients with cerebral white matter lesions exhibited significantly higher values of long-term systolic blood pressure variability (standard deviation of 24-hour blood pressure) measured both by continuous beat-to-beat monitoring (16.2 ± 3.7 v 13.7 ± 3.6 mmHg; P = 0.047) and by ambulatory blood pressure monitoring (15.2 ± 3.8 v 12.8 ± 2.7 mmHg; P = 0.022). However, these differences were not independent on blood pressure elevation and did not maintain their significance after adjusting for 24-hour systolic blood pressure. Neither short-term systolic blood pressure variability, nor short-term or long-term diastolic blood pressure variabilities showed differences between patients with and without white matter lesions. The present study indicates that long-term systolic blood pressure variability is significantly related to the presence of silent cerebral white matter lesions in essential hypertensive patients, although this relationship is partially dependent on absolute blood pressure elevation.