The Clinical Significance of Ambulatory Blood Pressure on Cerebral Small Vessel disease. A Systematic Review and meta-analysis of the Literature.

purpose of reviewBlood pressure (BP) is involved in the pathogenesis of cerebral small vessel disease (CSVD) and clinical research confirms this strong correlation. Data showing whether daytime or nighttime BP is the most important variable of CSVD are conflicting. Therefore, the purpose of this meta-analysis is to evaluate the impact daytime and nighttime BP in terms of CSVD correlation. Additionally, we evaluated the role of nocturnal BP variation for the same purpose. RECENT

findingsWe systematically searched PubMed and Scopus databases to extract data evaluating the association between different ABPM components (24 h, day- and nighttime BP, dipping patterns) and imaging features of CSVD (white matter hypersensitivies, lacunes, cerebral microbleeds). Study quality was evaluated with the Newcastle-Ottawa scale. In the qualitative synthesis, 24 studies with 6822 patients were included. The pooled analysis of 19 studies showed that increased 24 h SBP is associated with 41% increased risk of CSVD, and this is consistently observed for both daytime and nighttime SBP. this effect is largely driven by the impact of 24 h, day- and night-time SBP on CMBs. Impaired nocturnal BP patterns are strongly associated with CSVD, specifically non-dipping profile with an OR of 2.24 (95% CI: 1.31-3.16) compared to dipping pattern. Reverse dipping was associated with CMBs with an increased OR of 3.02 (95% CI: 1.61, 4.42). Obtaining information on different components of ABPM (24 h, day- and night-time BP, dipping profile) may allow identification of patients at higher risk for CSVD including its specific subtypes, specifically CMBs.