Blood Pressure Variability and Alzheimer Disease Biomarkers

Increased blood pressure variability (BPV) is associated with increased risk for dementia, independent of hypertension. The increased risk for dementia associated with high BPV includes probable Alzheimer disease (AD) dementia, but high BPV is also associated with increased risk of stroke and cerebral small vessel disease, which are commonly comorbid with AD. This raises the question of whether high BPV is independently predictive of AD-specific pathophysiology and neurodegeneration, which could have significant clinical implications. Fewer studies have directly addressed this question by examining whether higher BPV predicts future AD biomarker abnormalities that are specific to AD pathophysiology within the amyloid/tau/neurodegeneration framework. This narrative review summarizes current studies on this topic and discusses future directions in the investigation of elevated BPV as a risk factor for AD, the most common cause of dementia in older adults.