Association Between Pulse Pressure and Structural Brain Changes in Aging: A Systematic Review and Meta‐Analysis of Cross‐Sectional and Longitudinal Studies
Bibliographic record
Abstract
BACKGROUND: The aim of this study was to investigate the associations between pulse pressure (PP) and age-related structural brain changes including brain volumes, white matter hyperintensities (WMH), fractional anisotropy, silent brain lesions, microbleeds, cerebral blood flow and metabolism, and beta-amyloid accumulation. METHODS: Systematic review of PubMed (MEDLINE), Scopus, and Ovid Embase (from inception to January 2023) and references of included studies among adult populations was conducted. Findings were summarized narratively and by performing a fixed-effects meta-analysis. Publication bias was tested by a funnel plot and Egger's regression asymmetry test. RESULTS: Forty-seven studies (7 longitudinal) were included (>20 000 participants). In cross-sectional studies, PP consistently positively associated with gray matter volume and white matter hyperintensities with pooled standardized regression coefficients of 0.02 (95% CI, 0.007-0.038) and 0.06 (95% CI, 0.021-0.093), SD increase in PP per 1 SD increase in gray matter volume and white matter hyperintensities, higher odds of having a silent brain lesions pooled odds ratio of 1.11 (95% CI, 1.03-1.20) for 1 SD increase in PP, and cortical beta-amyloid (pooled estimate not available). There was limited evidence of an association with hippocampal volume, fractional anisotropy and mean diffusivity, cerebral microbleeds, cerebral blood flow and velocity, and cerebral metabolism. Longitudinal studies reported a negative association between PP and change in hippocampal volume and positive association with cortical beta-amyloid accumulation, but inconsistent findings were reported for total brain volume and white matter hyperintensities. Longitudinal studies were not available for gray matter volume, fractional anisotropy, silent brain lesions, cerebral microbleeds, and metabolism. Meta-regression provided no evidence that mean study-level arterial pressure modified the relationship between PP and associated brain metric. CONCLUSIONS: Cross-sectional studies suggest a significant positive association between PP to gray matter volume, WMH, silent brain lesions, and cortical beta-amyloid that warrants further investigation by sufficiently powered longitudinal studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.043 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.025 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".