Sible IJ, Nation DA, et al. - Findings demonstrate association of blood pressure variability (BPV) with tau accumulation in brain regions vulnerable to Alzheimer disease, independent of average blood pressure. This link was modified by APOEϵ4. Bidirectionality of observations is possible.

• This study included 286 Alzheimer’s Disease Neuroimaging Initiative participants without history of dementia, to determine if BPV in older adults is associated with tau accumulation in brain regions vulnerable to Alzheimer disease and if associations are altered by apoϵ4 carrier status.

• Increased BPV was found to be associated with tau accumulation at follow-up in a temporal meta-region, independent of average blood pressure levels (ß, 0.89) and particularly in entorhinal cortex (ß, 2.57).

• At follow-up, the fastest tau accumulation was evident in Apoϵ4 carriers with elevated BPV.

• Overall, BPV could be a marker of vascular dysfunction associated with early-stage tau pathology contributing to Alzheimer disease.