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Blood Press
. 2025 Apr 17:1-14.
doi: 10.1080/08037051.2025.2493828. Online ahead of print. Higher blood pressure variability during hospitalization is associated with lower cerebral white matter integrity in COVID-19 patients
Theresa J van Lith 1 , Esther Janssen 1 , Jan-Willem van Dalen 1 2 , Hao Li 1 , Mats Koeneman 3 , Wouter M Sluis 4 , Naomi T Wijers 5 , Marieke Jh Wermer 6 , Menno V Huisman 7 , H Bart van der Worp 4 , Frederick Ja Meijer 8 , Anil M Tuladhar 1 , Sebastian Jh Bredie 9 , Frank-Erik de Leeuw 1
Affiliations
Background: High blood pressure variability (BPV) is associated with cerebrovascular damage and dementia, but it is unknown whether short-term BPV during hospitalization is also associated with cerebral white matter (WM) damage. We examined whether BPV, measured in-hospital using continuous monitoring, is associated with WM microstructural integrity in COVID-19 patients.
Methods: We included hospitalized COVID-19 patients from the CORONavirus and Ischemic Stroke (CORONIS) study who underwent continuous vital signs monitoring using a wearable device during hospital admission and had MRI shortly after discharge. Systolic BPV was calculated as Average Real Variability (ARV) and Coefficient of Variation (CV) with 1-, 5- and 20-minute intervals. We used diffusion tensor imaging (DTI) to assess fractional anisotropy (FA) and peak width of skeletonized mean diffusivity (PSMD) as markers of WM integrity. Associations between BPV and WM integrity were examined with linear regression adjusted for age, mean systolic blood pressure, number of blood pressure measurements and type of respiratory support.
Results: We included 47 COVID-19 patients (mean age: 59.6 years). Blood pressure was measured 6306 ± 4343 times per patient (median admission: 11 days [IQR 7.5-15.0]). Both higher ARV and CV were associated with lower WM microstructural integrity, reflected by lower FA (ARV: β=-0.40, p = 0.010; CV: β=-0.33, p = 0.026) and higher PSMD (CV: β = 0.28, p = 0.038) after adjustment for confounders. Correction for WM hyperintensities did not change these results.
Conclusions: High BPV during hospitalization is associated with lower WM integrity in COVID-19 patients, although causality needs to be demonstrated. Our findings need validation in hospitalized patients without COVID-19 to examine generalizability.
. 2025 Apr 17:1-14.
doi: 10.1080/08037051.2025.2493828. Online ahead of print. Higher blood pressure variability during hospitalization is associated with lower cerebral white matter integrity in COVID-19 patients
Theresa J van Lith 1 , Esther Janssen 1 , Jan-Willem van Dalen 1 2 , Hao Li 1 , Mats Koeneman 3 , Wouter M Sluis 4 , Naomi T Wijers 5 , Marieke Jh Wermer 6 , Menno V Huisman 7 , H Bart van der Worp 4 , Frederick Ja Meijer 8 , Anil M Tuladhar 1 , Sebastian Jh Bredie 9 , Frank-Erik de Leeuw 1
Affiliations
- PMID: 40241653
- DOI: 10.1080/08037051.2025.2493828
Background: High blood pressure variability (BPV) is associated with cerebrovascular damage and dementia, but it is unknown whether short-term BPV during hospitalization is also associated with cerebral white matter (WM) damage. We examined whether BPV, measured in-hospital using continuous monitoring, is associated with WM microstructural integrity in COVID-19 patients.
Methods: We included hospitalized COVID-19 patients from the CORONavirus and Ischemic Stroke (CORONIS) study who underwent continuous vital signs monitoring using a wearable device during hospital admission and had MRI shortly after discharge. Systolic BPV was calculated as Average Real Variability (ARV) and Coefficient of Variation (CV) with 1-, 5- and 20-minute intervals. We used diffusion tensor imaging (DTI) to assess fractional anisotropy (FA) and peak width of skeletonized mean diffusivity (PSMD) as markers of WM integrity. Associations between BPV and WM integrity were examined with linear regression adjusted for age, mean systolic blood pressure, number of blood pressure measurements and type of respiratory support.
Results: We included 47 COVID-19 patients (mean age: 59.6 years). Blood pressure was measured 6306 ± 4343 times per patient (median admission: 11 days [IQR 7.5-15.0]). Both higher ARV and CV were associated with lower WM microstructural integrity, reflected by lower FA (ARV: β=-0.40, p = 0.010; CV: β=-0.33, p = 0.026) and higher PSMD (CV: β = 0.28, p = 0.038) after adjustment for confounders. Correction for WM hyperintensities did not change these results.
Conclusions: High BPV during hospitalization is associated with lower WM integrity in COVID-19 patients, although causality needs to be demonstrated. Our findings need validation in hospitalized patients without COVID-19 to examine generalizability.