Background: White matter hyperintensities (WMH) are the commonest manifestation of cerebral small vessel disease, associated with stroke, functional impairment and cognitive decline. They are commonly preceded by hypertension, but the magnitude and clinical importance of this association is unclear.

Aims: Quantify the relationship between blood pressure and white matter hyperintensities across studies

Methods: PubMed and EMBASE were searched for studies reporting associations between concurrent or historic blood pressure and WMH. Beta coefficients from linear models were extracted, whether standardised, unstandardised, unadjusted or adjusted for age, sex and cardiovascular risk factors. Beta-coefficients were combined by fixed and random effects meta-analysis, combining standardised beta-coefficients or unstandardised coefficients measured by consistent methods.

Results: 24 of 3,230 papers were eligible, including 50,999 participants. Systolic blood pressure was significantly associated with WMH volume after maximal adjustment (standardised beta 0.096, 95%CI 0.06-0.133, p<0.001, I2=65%), including for concurrent readings (b=0.106, p<0.001) or readings 5 years previously (b=0.077, p<0.001), and for younger or older populations (mean age <65: b=0.114; >65 b=0.069). Unstandardised, adjusted associations were similar for raw WMHV, log-transformed WMHV or WMHV as percentage of intracranial volume. Unadjusted associations with SBP were greater (standardised beta=0.273, 0.262-0.284, p<0.0001). However, whilst associations with DBP were weaker than SBP (standardised beta=0.065, p<0.001), they were minimally affected by adjustment for age.

Conclusions: A standard deviation increase in SBP is associated with 10% of a standard deviation increase in WMHV, providing the current best estimate of the potential reduction in progression of WMH expected with good control of blood pressure.

背景：白质高信号（WMH）是脑小血管疾病最常见的表现，与中风、功能障碍和认知能力下降有关。它们通常先于高血压，但这种关联的程度和临床重要性尚不清楚。

目的：量化跨研究的血压和白质高信号之间的关系

方法：在 PubMed 和 EMBASE 中搜索报告并发或历史血压与 WMH 之间关联的研究。从线性模型中提取 Beta 系数，无论是标准化、非标准化、未调整还是针对年龄、性别和心血管危险因素进行调整。贝塔系数通过固定和随机效应荟萃分析组合，结合标准化贝塔系数或通过一致方法测量的非标准化系数。

结果：3,230 篇论文中有 24 篇符合条件，包括 50,999 名参与者。最大调整后收缩压与 WMH 体积显着相关（标准化 β 0.096，95%CI 0.06-0.133，p<0.001，I2=65%），包括同时读数（b=0.106，p<0.001）或读数 5几年前（b=0.077，p<0.001），对于较年轻或较年长的人群（平均年龄 <65：b=0.114；>65 b=0.069）。原始 WMHV、对数转换 WMHV 或 WMHV 与颅内体积百分比的非标准化、调整关联相似。未调整的与 SBP 的关联更大（标准化 β=0.273、0.262-0.284、p<0.0001）。然而，虽然与 DBP 的关联弱于 SBP（标准化 β=0.065，p<0.001），但它们受年龄调整的影响最小。

结论：SBP 的标准差增加与 WMHV 标准差增加的 10% 相关，提供了当前对在良好控制血压的情况下预期 WMH 进展可能减少的最佳估计。