Chesebro AG, Melgarejo JD, Leendertz R, Igwe KC, Lao PJ, Laing KK, Rizvi B, Budge M, Meier IB, Calmon G, Lee JH, Maestre GE, Brickman AM. White matter hyperintensities mediate the association of nocturnal blood pressure with cognition. Neurology. 2020 Apr 28;94(17):e1803-e1810. Epub 2020 Apr 15 PubMed.
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Mayo Clinic College of Medicine
Chesebro et al.’s analysis of the relationship between nocturnal blood pressure, white-matter hyperintensities, and cognition demonstrated the expected associations between “reverse dipping” of nocturnal blood pressure and white-matter hyperintensities. The latter mediated the relationship between nocturnal blood pressure regulation and cognition, but only in hypertensives.
The adverse effects of a failure of blood pressure to decline while asleep have been known for some time, but this analysis, with a reasonably large sample size of late-middle-aged persons, was able to make a credible case for the causal chain of blood pressure dysregulation to white-matter hyperintensities to lower cognitive performance. Whether nocturnal blood pressure control is the “key” pathophysiological event or whether it is simply closely related to some other blood-pressure parameter such as systolic BP, diastolic BP, pulse pressure, change in BP over time, or pulse-wave velocity is unclear, but the fact that the authors could demonstrate an association with cognition mediated by white-matter hyperintensities is compelling evidence for nocturnal blood pressure regulation’s pathophysiologic relevance.
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