. 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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  1. 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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