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We read with interest the article by Arvanitakis et al.,1 which found that both higher mean and more rapidly declining late-life systolic blood pressure (SBP) increased the odds of gross and microinfarcts. A relationship between higher mean SBP and neuronal neurofibrillary tangles was also observed. In examining blood pressure (BP) and neuropathology of aging, recent work highlighted that high—but also low BP—and wide fluctuations of BP levels may increase the risk of dementia, including mixed or Alzheimer dementia.2–4 In addition, antihypertensive medications can specifically address the pulsatile component and variability of BP.4,5 Therefore, it would be interesting to explore whether and how BP variability and pulse pressure relate to brain disease. These analyses would be useful to further understand the vascular contribution to cognitive dysfunction and identify potential therapeutic strategies.
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Author disclosures are available upon request (journal{at}neurology.org).
- © 2019 American Academy of Neurology
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