Rethinking hypertension in the brain: from blood pressure control to temporal blood pressure stability—a scoping review
- 1Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
- 2Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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.
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BibTeX
@article{chakraborty2026rethinking,
title = {{Rethinking hypertension in the brain: from blood pressure control to temporal blood pressure stability—a scoping review}},
author = {Sristi Chakraborty and Aparna Ramakrishna Pai},
journal = {Blood Pressure},
year = {2026},
month = nov,
doi = {10.1080/08037051.2026.2754674},
url = {https://doi.org/10.1080/08037051.2026.2754674},
note = {CC BY},
}
RIS
TY - JOUR
TI - Rethinking hypertension in the brain: from blood pressure control to temporal blood pressure stability—a scoping review
AU - Sristi Chakraborty
AU - Aparna Ramakrishna Pai
PY - 2026
DA - 2026/11/07
JO - Blood Pressure
DO - 10.1080/08037051.2026.2754674
UR - https://doi.org/10.1080/08037051.2026.2754674
AB - 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.
SN - 1651-1999
SN - 0803-7051
ER -