Open AccessPulse Pressure and Cognitive Decline in Stroke Patients With White Matter Changes
Author(s) -
Wang Zhaolu,
Wong Adrian,
Liu Wenyan,
Yang Jie,
Chu Winnie C.W.,
Au Lisa,
Lau Alexander,
Xiong Yunyun,
Mok Vincent C.T.
Publication year - 2015
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12583
Subject(s) - medicine , quartile , cognitive decline , stroke (engine) , odds ratio , confidence interval , pulse pressure , dementia , arterial stiffness , cardiology , hyperintensity , blood pressure , disease , radiology , magnetic resonance imaging , mechanical engineering , engineering
The authors hypothesized that both high and low pulse pressure ( PP ) may predict cognitive decline in stroke/transient ischemic attack ( TIA ) patients with white matter changes ( WMC s). The authors prospectively followed up 406 ischemic stroke/ TIA patients with confluent WMC s over 18 months. PP was measured at 3 to 6 months after stroke/ TIA and categorized into four groups by quartile. Cognition was assessed 3 to 6 months and 15 to 18 months after stroke/ TIA using the Clinical Dementia Rating and Mini‐Mental State Examination ( MMSE ). Logistic regression showed that patients in the first quartile of PP had a 5.9‐fold higher risk for developing cognitive decline than patients in the third quartile (odds ratio, 5.9; 95% confidence interval, 1.7–20.6), while patients in the fourth quartile had a 3.5‐fold higher risk for cognitive decline than those in the third quartile (odds ratio, 3.5; 95% confidence interval, 1.0–12.4). This U‐shaped relationship was also evident between PP and cognitive decline in MMSE , underlining the role of arterial stiffness and hypoperfusion in cognitive decline related to small vessel disease.