Ambulatory Blood Pressure Levels in the Prediction of Progression of Cerebral Small Vessel Disease.
Aged
Basal Ganglia Cerebrovascular Disease
/ epidemiology
Blood Pressure
/ physiology
Blood Pressure Monitoring, Ambulatory
/ statistics & numerical data
Cerebral Hemorrhage
/ epidemiology
Cerebral Small Vessel Diseases
/ complications
Disease Progression
Female
Humans
Hypertension
/ complications
Incidence
Leukoencephalopathies
/ epidemiology
Longitudinal Studies
Male
Middle Aged
Predictive Value of Tests
Reference Values
Stroke, Lacunar
/ epidemiology
blood pressure monitoring
cerebral small vessel disease
cerebrovascular diseases
hypertension
longitudinal study
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
19
11
2019
revised:
30
04
2020
accepted:
03
05
2020
pubmed:
9
6
2020
medline:
11
3
2021
entrez:
9
6
2020
Statut:
ppublish
Résumé
We aimed to study the value of ambulatory blood pressure monitoring (ABPM) in predicting the global progression of cerebral small vessel disease (cSVD). Longitudinal cohort study. Data from the population-based Investigating Silent Strokes in Hypertensives study. Individuals with hypertension who were 50 to 70 years of age and stroke free at baseline. In baseline and follow-up visits, patients underwent magnetic resonance imaging and ABPM. Ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were studied as continuous variables and dichotomized according to good or poor control on the basis of 125/75 (24 hours), 130/80 (day), and 110/65 (night) mm Hg cutoff values. Whole cSVD progression was qualitatively scored with 1 point when an incident lesion (incident lacunar infarcts, deep cerebral microbleeds, white matter hyperintensities, and basal ganglia enlarged perivascular spaces) was detected. The score ranged from 0 to 4. We followed up 233 participants with a median age of 65 years within 4 years. A total of 61 (26.2%) and 23 (9.9%) subjects showed cSVD progression in one and two or more markers, respectively. Baseline ambulatory SBP and DBP and nighttime pulse pressure (PP) values were positively correlated with the number of incident cSVD lesions. Interestingly, patients without incident lesions showed greater differences between office and ambulatory BP, thus suggesting an increased white coat effect. Poor DBP control, nighttime PP, and DBP white coat effect were independently associated with cSVD progression. The inclusion of these metrics in a clinical model resulted in a significant increase in the prediction of incident lesions (integrated discrimination improvement = 9.09%; P value <.001). ABPM may help assess cSVD risk of progression, especially by the identification of poor BP control, masked hypertension, and increased nighttime PP. J Am Geriatr Soc 68:2232-2239, 2020.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2232-2239Informations de copyright
© 2020 The American Geriatrics Society.
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