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Cerebral small vessel diseases are better associated with ambulatory than office blood pressure measurements
Author(s) -
Melgarejo Jesus D.,
Gutierrez Jose,
Mena Luis Javier,
Lee Joseph H.,
Chavez Carlos A.,
Calmon Gustavo,
Silva Egle,
Terwilliger Joseph Douglas,
Vanassche Thomas,
Verhamme Peter,
Staessen Jan,
Zhang ZhenYu,
Maestre Gladys E.
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.045987
Subject(s) - cardiology , medicine , hyperintensity , dipper , ambulatory blood pressure , ambulatory , dementia , logistic regression , blood pressure , diastole , arterial stiffness , magnetic resonance imaging , disease , radiology
Background Cerebral small vessel diseases (CSVD) is a forerunner of cognitive decline, vascular dementia, Alzheimer’s disease, and stroke. Which BP index is closest associated with CVSD remains unclear. We aimed this study to examine the association of BP levels, measured by the office and ambulatory BP monitoring (ABPM), with CSVDs, and to determine which BP indexes are better associated with CSVDs. Method In the Maracaibo Aging Study, 330 participants (73.3% women; mean age, 58.0 years) underwent ABPM, and magnetic resonance brain imaging to assess white matter hyperintensities (WMH), small artery disease (SAD), and silent brain infarcts (SBI), which were divided into total (SBIt), supratentorial (SBIs), and cortical (SBIc). Statistics included multivariable linear and logistic regression. In models including two BP indexes, we uncorrelated these indexes by regressing one index on the other and by using the residual of one BP index. Result The prevalence of SAD, SBIt, SBIs, and SBIc was 5.8%, 11.8%, 10.1%, and 6.1%; respectively. Multivariable models showed that office, 24‐h, daytime, and nighttime systolic BP (SBP) were significantly associated with WMH, SAD, SBIt, SBIs (P<0.05); all diastolic BP (DBP) indexes were related to WMH, but only nighttime DBP was associated to SAD and SBIs (P<0.05). Adjusted for office SBP, the 24‐h, daytime, and nighttime SBP remained significantly associated with WMH (P<0.01), whereas the opposite was for office SBP after adjustment by 24‐h or daytime SBP. With adjustment for office or daytime SBP, the association between SDA and SBIt with 24‐h and nighttime SBP remained significant (P<0.05); nighttime SBP was additionally related to SBIs. Daytime SBP was not associated with CVSD after adjustments by the office, 24‐h, or nighttime SBP. Adjusted for daytime DBP, nighttime DBP were significantly associated with SDA, SBIi, and SBIs (P<0.05). Conclusion CSVD was related to 24‐h and nighttime BP. Proper control of the ambulatory BP may reduce the risk for CSVD and associated adverse health outcomes.