Higher carotid-femoral pulse wave velocity was independently and dose-dependently associated with basal ganglia enlarged perivascular spaces, with pulsatile blood pressure components (SBP and PP) mediating approximately 43% of this association.
BG-EPVS were identified in 59.4% of participants in this community-based cohort.
Cf-PWV ≥ 10 m/s was independently associated with BG-EPVS after adjustment for cardiovascular risk factors other than blood pressure.
There was a linear dose-response relationship between cf-PWV and BG-EPVS.
The association between cf-PWV and BG-EPVS was stronger among participants aged ≤ 70 years and among males.
Systolic blood pressure (SBP) and pulse pressure (PP) each mediated approximately 43% of the total effect of cf-PWV on BG-EPVS, while diastolic blood pressure (DBP) was not a significant mediator.
Cf-PWV is described as the non-invasive gold standard for assessing aortic stiffness, yet evidence linking it to BG-EPVS in general populations was previously limited.
This research suggests that stiffer arteries — measured using a technique called carotid-femoral pulse wave velocity (cf-PWV), which tracks how fast a pulse travels through the aorta — are linked to a brain imaging finding called enlarged perivascular spaces (EPVS) in the basal ganglia, a deep region of the brain. In a study of nearly 500 adults from a community in China, about 59% of participants had these enlarged spaces visible on MRI scans, and those with higher arterial stiffness (cf-PWV of 10 m/s or more) were about twice as likely to have this finding, even after accounting for other cardiovascular risk factors. The relationship appeared to be linear, meaning higher stiffness was consistently associated with greater likelihood of BG-EPVS. The study also investigated how this relationship works mechanically, finding that blood pressure plays an important intermediary role. Specifically, systolic blood pressure (the top number) and pulse pressure (the difference between the top and bottom numbers) each explained about 43% of the link between arterial stiffness and enlarged perivascular spaces. Diastolic blood pressure (the bottom number) did not appear to be a significant pathway. This suggests that the pulsatile — or 'pounding' — nature of blood pressure, which increases with stiffer arteries, may be a key mechanism by which arterial stiffness affects brain small vessel health. The association was particularly notable in adults aged 70 or younger and in males. Enlarged perivascular spaces in the brain are considered a marker of small vessel disease and have been associated with cognitive decline and stroke risk. This research suggests that arterial stiffness, even before it fully manifests as high blood pressure, may contribute to changes in brain health through its effects on pulsatile blood pressure. Understanding this pathway could have implications for how clinicians think about monitoring and managing cardiovascular and cerebrovascular health together.
Li S, Liu Y, Yang P, Chen S, Hui Y, Zhao X, et al.. (2026). Blood Pressure Mediates the Association Between Carotid-Femoral Pulse Wave Velocity and Basal Ganglia Enlarged Perivascular Spaces: A Community-Based Cross-Sectional Study.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70363