Systolic Blood Pressure Time in Target Range and Cerebral Small Vessel Disease

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Abstract BACKGROUND Whether systolic blood pressure (SBP) time in target range (TTR) associates with cerebral small vessel disease (CSVD) in hypertensive patients remains unclear. METHODS Between December 2020 and August 2023, participants were prospectively included from the Kailuan study. TTR was calculated using linear interpolation with the SBP target range between 120 and 140 mm Hg from 2006 to 2020. Beginning in 2020, brain MRI was conducted to identify CSVD burden and imaging markers, namely, lacunes (LAs), cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVSs), and white matter hyperintensities (WMHs). Logistic regression models were used to assess the association between SBP-TTR and imaging markers of CSVD. RESULTS A total of 797 patients with hypertension were included from the Kailuan Study. Compared with the lowest tertile, the highest tertile of SBP-TTR was associated with a reduced risk of EPVS (OR = 0.67; 95% CI: 0.47–0.96; P = 0.029) and WMHs (OR = 0.66; 95% CI: 0.44–0.97; P = 0.033). This association was independent of SBP variability. No significant associations were found between SBP-TTR and LAs (OR = 0.69; 95% CI: 0.43–1.12; P = 0.133) or CMBs (OR = 0.97; 95% CI: 0.66–1.43; P = 0.869). Subgroup analysis suggested that the protective effect of a higher SBP-TTR against EPVSs was more pronounced in men, participants aged ≥65 years, those with a follow-up duration of ≥5 years, and nondiabetic patients. CONCLUSIONS A higher SBP-TTR is significantly associated with a reduced risk of EPVSs and WMHs, independent of SBP variability.

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