Work

Rethinking hypertension in the brain: from blood pressure control to temporal blood pressure stability—a scoping review

Year: 2026

Type: review

Abstract: BACKGROUND: Temporal blood pressure variability (BPV) may contribute to cerebrovascular injury beyond mean blood pressure (BP), yet the mechanisms linking antihypertensive treatment patterns to temporal BP instability remain incompletely understood. This scoping review synthesised evidence linking treatment instability, pharmacodynamic determinants of BP control, temporal BPV, and cerebrovascular vulnerability. METHODS: PubMed and Embase were searched for studies evaluating antihypertensive medication adherence, pharmacodynamic persistence, BPV, and cerebrovascular outcomes. Data were charted using a standardised form and synthesised narratively according to predefined thematic domains. RESULTS: The available evidence suggests that inconsistent antihypertensive exposure and reduced pharmacodynamic persistence may contribute to increased temporal BPV. Generally BP fluctuations are associated with cerebral small vessel disease, white matter injury, vascular cognitive impairment, and other manifestations of cerebrovascular vulnerability independent of mean BP. This review investigates the relationship between treatment instability, pharmacodynamic determinants, and temporal BPV and proposes a hypothesis-generating conceptual framework to facilitate future individualised risk stratification and guide prospective investigation. CONCLUSIONS: Current evidence supports expanding hypertension management beyond achieving mean BP targets to include optimisation of temporal BP stability. Recognising treatment persistence and pharmacodynamic coverage as determinants of BP stability provides a clinically relevant framework for improving cerebrovascular protection and individualised risk assessment. These findings support consideration of temporal BP stability as a potential complementary dimension of hypertension management for preventing chronic cerebrovascular injury and vascular cognitive dysfunction.

Source: Blood Pressure

DOI: 10.1080/08037051.2026.2754674

Authors: Sristi Chakraborty, Aparna Ramakrishna Pai

Institutions: Manipal Academy of Higher Education, Kasturba Medical College, Manipal

Language: English

Topic: Blood Pressure and Hypertension Studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,650