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Pulsatile and steady components of blood pressure and subclinical cerebrovascular disease: the Northern Manhattan Study.

ABSTRACT: To assess whether pulse pressure (PP) is associated, independently of mean arterial pressure (MAP), with perivascular spaces (PVS), lacunar lesions presumably ischemic (LPI), and white matter hyperintensity volume (WMHV) seen on brain MRI.Participants in the Northern Manhattan Study had their blood pressure (BP) taken during their baseline enrollment visit and again during a visit for a brain MRI a mean of 7 years later. We assessed small and large PVS, lacunar LPI, and WMHV on MRI. We examined the association of SBP, DBP, MAP, and PP at baseline with subclinical markers of cerebrovascular disease using generalized linear models and adjusting for vascular risk factors.Imaging and BP data were available for 1009 participants (mean age 68?±?8 years, 60% women, 60% Hispanic). DBP was associated with lacunar LPI and WMHV, whereas SBP was associated with small and large PVS. Using MAP and PP together disclosed that the effect size for PP was greater for large PVS, whereas the effect of MAP was greater for lacunar LPI and WMHV. The effects of DBP were flat or negative at any degree of SBP higher than 120?mmHg for small and large PVS, whereas a positive association was noted for lacunar LPI and WMHV with any DBP increase over any degree of SBP.We report here a segregated association between the pulsatile and steady components of the BP with subclinical markers of cerebrovascular disease. These differential associations may reflect the underlying disease of these biomarkers.

SUBMITTER: Gutierrez J

PROVIDER: S-EPMC4871260 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Pulsatile and steady components of blood pressure and subclinical cerebrovascular disease: the Northern Manhattan Study.

Gutierrez Jose J Elkind Mitchell S V MS Cheung Ken K Rundek Tatjana T Sacco Ralph L RL Wright Clinton B CB

Journal of hypertension 20151001 10

<h4>Objectives</h4>To assess whether pulse pressure (PP) is associated, independently of mean arterial pressure (MAP), with perivascular spaces (PVS), lacunar lesions presumably ischemic (LPI), and white matter hyperintensity volume (WMHV) seen on brain MRI.<h4>Methods</h4>Participants in the Northern Manhattan Study had their blood pressure (BP) taken during their baseline enrollment visit and again during a visit for a brain MRI a mean of 7 years later. We assessed small and large PVS, lacunar ...[more]

PMID: 26259124

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Project description:Background and Purpose- Few studies have examined the separate contributions of systolic blood pressure and diastolic blood pressures (DBP) on subclinical cerebrovascular disease, especially using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines. Furthermore, associations with region-specific white matter hyperintensity volume (WMHV) are underexplored. Methods- Using data from the NOMAS (Northern Manhattan Study), a prospective cohort study of stroke risk and cognitive aging, we examined associations between systolic blood pressure and DBP, defined by the 2017 American College of Cardiology/American Heart Association guidelines, with regional WMHV. We used a linear mixed model approach to account for the correlated nature of regional brain measures. Results- The analytic sample (N=1205; mean age 64±8 years) consisted of 61% women and 66% Hispanics/Latinos. DBP levels were significantly related to WMHV differentially across regions (P for interaction<0.05). Relative to those with DBP 90+ mm?Hg, participants with DBP <80 mm?Hg had 13% lower WMHV in the frontal lobe (95% CI, -21% to -3%), 11% lower WMHV in the parietal lobe (95% CI, -19% to -1%), 22% lower WMHV in the anterior periventricular region (95% CI, -30% to -14%), and 16% lower WMHV in the posterior periventricular region (95% CI, -24% to -6%). Participants with DBP 80 to 89 mm?Hg also exhibited about 12% (95% CI, -20% to -3%) lower WMHV in the anterior periventricular region and 9% (95% CI, -18% to -0.4%) lower WMHV in the posterior periventricular region, relative to participants with DBP 90? mm?Hg. Post hoc pairwise t tests showed that estimates for periventricular WMHV were significantly different from estimates for temporal WMHV (Holms stepdown-adjusted P<0.05). Systolic blood pressure was not strongly related to regional WMHV. Conclusions- Lower DBP levels, defined by the 2017 American College of Cardiology/American Heart Association guidelines, were related to lower white matter lesion load, especially in the periventricular regions relative to the temporal region.

Project description:BackgroundLarge blood pressure (BP) variability may contribute to stroke and dementia, but the mechanisms are largely unknown.ObjectivesThis study investigated the association of BP variation, considering its magnitude and direction, with the presence and progression of subclinical brain disease in the general population.MethodsThis study included 2,348 participants age ≥55 years from a prospective cohort study. BP was measured at each visit every 3 to 4 years from 1990 onward. Brain magnetic resonance imaging (MRI) was performed at all visits from 2005 onward. The authors primarily assessed variation as the absolute difference in BP divided by the mean over 2 sequential visits for both systolic BP (SBP) and diastolic BP (DBP), and further assessed the direction of the variation. The authors investigated the multivariate-adjusted associations of BP variation with subsequent measurements of MRI markers of cerebral small vessel disease, brain tissue volumes, and white matter microstructural integrity. Longitudinal changes in these markers also were assessed.ResultsA large SBP variation (top vs. bottom tertiles), measured on average 7 years preceding brain MRI, was associated with higher odds of having severe white matter hyperintensities (WMH) (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.21 to 1.43), lacunes (OR: 1.25; 95% CI: 1.04 to 1.48), and microbleeds (OR: 1.16; 95% CI: 1.03 to 1.31). Similarly, this variation was associated with smaller total brain volume and worse white matter microstructural integrity (all p < 0.001). A large SBP variation was also associated with the progression of WMH (rate ratio [RR]: 1.14; 95% CI: 1.02 to 1.27). Higher burdens of these brain imaging markers were observed with both large rises and falls in SBP. Similar findings were observed for DBP variation.ConclusionsElevated BP variation was associated with a wide range of subclinical brain structural changes, including MRI markers of cerebral small vessel disease, smaller brain tissue volumes, and worse white matter microstructural integrity. These subclinical brain changes could be the underlying mechanisms linking BP variation to dementia and stroke.

Dataset Information

Pulsatile and steady components of blood pressure and subclinical cerebrovascular disease: the Northern Manhattan Study.

Publications

Pulsatile and steady components of blood pressure and subclinical cerebrovascular disease: the Northern Manhattan Study.

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