ABSTRACT
BACKGROUND AND PURPOSE: We assessed whether the load of cerebral small vessel disease (cSVD) and its individual markers, including lacunes, white matter hyperintensities, microbleeds, and enlarged perivascular spaces (EPVS), are associated with arterial stiffness. METHODS: We evaluated cSVD markers in a cohort of 782 hypertensive individuals without history of stroke or dementia. The load of the disease was calculated using an ordinal scale ranging from 0 to 4 (1 point was given for each of the 4 markers examined). The arterial stiffness was tested by measuring the carotid-femoral pulse wave velocity with an oscillometric automatic device. RESULTS: The mean age of the participants (49.6% women) was 62.7±5.4 years, and the mean systolic/diastolic blood pressure was 142.9/77.3 mm Hg (55.5% of the participants had poor blood pressure control). We found 7.2% cases with lacunes, 6.4% with microbleeds, 6.7% with extensive white matter hyperintensities, 24.5% with extensive basal ganglia EPVS, and 40.1% with extensive EPVS in the centrum semiovale. Regarding the cSVD load, 19.7% of the participants scored 1, 6.5% scored 2, and 1.4% scored ≥3. The median carotid-femoral pulse wave velocity was 10.5 m/s (interquartile range, 9.2-11.9) and was associated with lacunes (odds ratio per carotid-femoral pulse wave velocity SD increase, 1.51; 95% confidence interval, 1.13-2.03), extensive basal ganglia EPVS (odds ratio, 1.39; 95% confidence interval, 1.16-1.67), and cSVD load (common odds ratio, 1.42; 95% confidence interval, 1.19-1.68). CONCLUSIONS: We found that, in a cohort of hypertensive individuals, the arterial stiffness is associated with the total load of the cSVD, especially with lacunes and basal ganglia EPVS.
Subject(s)
Basal Ganglia/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Cerebral Small Vessel Diseases/diagnostic imaging , Glymphatic System/diagnostic imaging , Hypertension/physiopathology , Vascular Stiffness/physiology , White Matter/diagnostic imaging , Brain/diagnostic imaging , Carotid Arteries , Cerebral Small Vessel Diseases/physiopathology , Female , Femoral Artery , Humans , Logistic Models , Magnetic Resonance Imaging , Male , Middle Aged , Odds Ratio , Pulse Wave Analysis , Severity of Illness IndexABSTRACT
High blood pressure accelerates normal aging stiffness process. Arterial stiffness (AS) has been previously associated with impaired cognitive function and dementia. Our aims are to study how cognitive function and status (mild cognitive impairment, MCI and normal cognitive aging, NCA) relate to AS in a community-based population of hypertensive participants assessed with office and 24-hour ambulatory blood pressure measurements. Six hundred ninety-nine participants were studied, 71 had MCI and the rest had NCA. Office pulse pressure (PP), carotid-femoral pulse wave velocity, and 24-hour ambulatory PP monitoring were collected. Also, participants underwent a brain magnetic resonance to study cerebral small-vessel disease (cSVD) lesions. Multivariate analysis-related cognitive function and cognitive status to AS measurements after adjusting for demographic, vascular risk factors, and cSVD. Carotid-femoral pulse wave velocity and PP at different periods were inversely correlated with several cognitive domains, but only awake PP measurements were associated with attention after correcting for confounders (beta = -0.22, 95% confidence interval (CI) -0.41, -0.03). All ambulatory PP measurements were related to MCI, which was independently associated with nocturnal PP (odds ratio (OR) = 2.552, 95% CI 1.137, 5.728) and also related to the presence of deep white matter hyperintensities (OR = 1.903, 1.096, 3.306). Therefore, higher day and night ambulatory PP measurements are associated with poor cognitive outcomes.
Subject(s)
Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure/physiology , Cerebral Small Vessel Diseases/psychology , Cognition Disorders/psychology , Hypertension/psychology , Vascular Stiffness/physiology , Aged , Aging/psychology , Brain/blood supply , Brain/pathology , Cerebral Small Vessel Diseases/pathology , Cerebral Small Vessel Diseases/physiopathology , Cognition Disorders/pathology , Cognition Disorders/physiopathology , Female , Humans , Hypertension/pathology , Hypertension/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of TestsABSTRACT
Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean population. This is a cohort study in randomly selected hypertensives, aged 50 to 70 years old, and free of clinical stroke and dementia. On baseline, all participants underwent a brain magnetic resonance imaging to assess prevalence and location of silent infarcts, and data on vascular risk factors, comorbidities, and the presence of subclinical cardiorenal damage (left ventricular hypertrophy and microalbuminuria) were collected. Multivariate analyses were performed to determine SBIs associated factors. A total of 976 patients (49.4% men, mean age 64 years) were enrolled, and 163 SBIs were detected in 99 participants (prevalence 10.1%; 95% CI, 8.4%-12.2%), most of them (64.4%) located in the basal ganglia and subcortical white matter. After adjustment, besides age and sex, microalbuminuria and increasing total cardiovascular risk (assessed by the Framingham-calibrated for Spanish population risk function) were independently associated with SBIs. Male sex increased the odds of having SBIs in 2.5 as compared with females. Our results highlight the importance of considering both global risk assessment and sex differences in hypertension and may be useful to design future preventive interventions of stroke and dementia.
