Open AccessIncreased risk of cognitive impairment and more severe brain lesions in hypertensive compared to non‐hypertensive patients with cerebral small vessel disease
Author(s) -
Pavlovic Aleksandra M.,
Pekmezovic Tatjana,
Trajkovic Jasna Zidverc,
Tomic Gordana,
Cvitan Edita,
Sternic Nada
Publication year - 2018
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.13357
Subject(s) - medicine , leukoaraiosis , hyperintensity , logistic regression , magnetic resonance imaging , univariate analysis , depression (economics) , cohort , cardiology , gastroenterology , disease , multivariate analysis , dementia , radiology , macroeconomics , economics
Although cerebral small vessel disease ( SVD ) is traditionally associated with aging and hypertension ( HT ), there are patients exhibiting sporadic SVD , free of HT . We aimed to investigate the differences in clinical and neuroradiological presentation in SVD patients in reference to the presence of HT as a risk factor ( RF ). Vascular RF , cognitive and functional status were evaluated in a cohort of 424 patients. Patients were classified in two groups based on the presence of HT . Severity of vascular lesions was assessed using 1.5 T magnetic resonance imaging with Age‐Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular ( PV ) and deep subcortical ( DS ) scores. No difference between groups in age and sex distribution was noted. In univariate analysis, HT was associated with vascular cognitive impairment ( vCI ) ( OR 2.30, 1.53‐3.45, P < 0.0001), functional status ( OR 1.47, 1.11‐1.95, P = 0.007), depression ( OR 2.13, 1.23‐3.70, P = 0.007), tARWMC ( OR 1.10, 1.05‐1.16 95% CI , P < 0.0001), Fazekas PV score ( OR 1.34, 1.08‐1.67 95% CI , P = 0.008), Fazekas DS score ( OR 1.95, 1.44‐2.63 95% CI , P < 0.0001) and total number of lacunes ( OR 1.10, 1.02‐1.18 95% CI , P = 0.009). Multivariate logistic regression analysis indicated that HT was an independent RF for vCI ( OR 1.74, 1.09‐2.76 95% CI , P = 0.020) and higher Fazekas DS score ( OR 1.57, 1.11‐2.22 95% CI , P = 0.011). The Kaplan‐Meier curve of estimates of survival of SVD patients without vCI revealed a higher proportion of patients with HT progressing to vCI over time when compared to HT ‐free cases. In patients with sporadic SVD , HT is a contributing factor to worse clinical outcomes and neuroradiological presentation.