Background and Purpose- Blood pressure (BP) variability may increase the risk of stroke and dementia. It remains inconclusive whether BP variability is associated with cerebral small vessel disease, a common and potentially devastating subclinical disease that contributes significantly to both stroke and dementia. Methods- A systematic review and meta-analysis of prospective cohort studies that examined the association between BP variability and the presence or progression of established markers of cerebral small vessel disease, including white matter hyperintensities, lacunes, and microbleeds on magnetic resonance imaging. We searched MEDLINE, EMBASE, and Web of Science. Ten studies met the criteria for qualitative synthesis and 7 could be included in the meta-analysis. Data were synthetized using random-effect models. Results- These studies included a total of 2796 individuals aged 74 (mean) ±4 (SD) years, with a median follow-up of 4.0 years. A one SD increase in systolic BP variability was associated with increased odds of the presence or progression of white matter hyperintensities (odds ratio, 1.26 [95% CI, 1.06-1.50]). The association of systolic BP variability with the presence of lacunes (odds ratio, 0.93 [95% CI, 0.74-1.16]) and the presence of microbleeds (odds ratio, 1.13 [95% CI, 0.89-1.44]) were not statistically significant. Conclusions- A larger BP variability may be associated with a higher risk of having a higher burden of white matter hyperintensities. Targeting large BP variability has the potential to prevent cerebral small vessel disease and thereby reducing the risk of stroke and dementia. The potential issue of reverse causation and the heterogeneity in the assessment of cerebral small vessel disease markers should be better addressed in future studies.

中文翻译：

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血压变异性和脑小血管疾病：基于人群的队列研究和系统分析。

背景和目的-血压（BP）的变异性可能会增加中风和痴呆的风险。BP变异性是否与脑小血管疾病（一种常见且可能具有毁灭性的亚临床疾病，对中风和痴呆症均起重要作用）有关，尚无定论。方法-前瞻性队列研究的系统评价和荟萃分析，研究了BP变异性与脑小血管疾病的既定标志物（包括白质高信号，腔隙和磁共振成像上的微出血）之间存在的相关性或相关性。我们搜索了MEDLINE，EMBASE和Web of Science。十项研究符合定性综合标准，七项研究可纳入荟萃分析。使用随机效应模型合成数据。结果-这些研究共纳入2796名年龄在74（平均）±4（SD）岁的个体，中位随访时间为4.0年。收缩压变异性增加1 SD与白质高信号存在或发展的几率增加相关（赔率比为1.26 [95％CI，1.06-1.50]）。收缩压变异性与腔隙的存在（奇数比，0.93 [95％CI，0.74-1.16]）和微出血的存在（奇数比，1.13 [95％CI，0.89-1.44]）之间的相关性无统计学意义。结论-较大的BP变异性可能与白质高信号负担较高的风险较高有关。针对大的BP变异性有可能预防脑小血管疾病，从而降低中风和痴呆的风险。