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Surbakti ED, Rambe AS, Pujiastuti RD. The Relationship between Diastolic Blood Pressure and the Event of the First Ischemic Stroke in Hypertension Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Stroke has been the second leading cause of death and the third cause of disability worldwide. A record of hypertension and an increase in diastolic blood pressure (DBP) after the first stroke were associated with an increased risk of a second stroke. DBP has historically been considered as the leading cause of cardiac arrest in adults with hypertension. In the previous studies, it was found a relationship between DBP with stroke and functional outcomes.
AIM: This research was carried out to determine the relationship between DBP and the event of ischemic stroke for the 1st time in hypertension patients.
METHODS: This research is a case–control that was selected using a consecutive sampling technique, where 47 hypertensive patients with ischemic stroke as the case group were matched with 47 hypertensive patients without stroke as the control group. The research was conducted at H. Adam Malik Hospital, Medan and a network hospital.
RESULTS: In this research, most samples in the case and control groups were men with 30 subjects (63.8%) with a mean age value of 58.11 ± 10.85 years. At TDD ≥90 mmHg, 34 subjects (72.3%) had ischemic stroke and 21 subjects (44.7%) did not. At TDD <90 mmHg, the percentage of ischemic stroke was 13 subjects (27.7%) and 26 subjects (55.3%) were non-ischemic stroke with p = 0.006, OR = 3.02.
CONCLUSION: There is a significantly close relationship between diastolic blood pressure and the event of ischemic stroke.
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Isaman DJM, Herman WH, Ye W. Prediction of transient ischemic attack and minor stroke in people with type 2 diabetes mellitus. J Diabetes Complications 2021; 35:107911. [PMID: 33902996 PMCID: PMC8169622 DOI: 10.1016/j.jdiacomp.2021.107911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 12/14/2022]
Abstract
AIMS People with type 2 diabetes (T2DM) have an increased risk of transient ischemic attack and minor stroke (TIA) which are frequently followed by an ischemic stroke. We aimed to develop a predictive model for incident TIA in people with T2DM. METHODS We pooled data from two longitudinal cohort studies, Atherosclerosis Risk in Communities (ARIC) and the Cardiovascular Health Study (CHS), using a two-stage approach. First, we used a random effects model to interpolate risk factors of individuals between follow-up exams. Second, we used forward selection to develop a proportional hazards model for time to incident TIA. We internally validated our model using 10-fold cross-validation. RESULTS Among 3575 participants with T2DM, mean (SD) age was 60 (10) years and body mass index was 30 (6) kg/m2. Sixty-nine incident TIAs occurred during 38,364 person-years of follow-up. The multivariable model included age at diagnosis of diabetes (hazard ratio 1.13 (95% confidence interval: 1.05,1.21) per year), systolic blood pressure (1.25 (1.04,1.49) per 10 mmHg), a quadratic function of diastolic blood pressure, and history of congestive heart failure (2.08 (1.26, 3.42)). The median cross-validated Harrell's C-index was 0.80. CONCLUSION Blood pressure and heart failure are risk factors for the earliest stages of cerebrovascular disease.
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Affiliation(s)
- Deanna J M Isaman
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America.
| | - William H Herman
- Schools of Nursing, University of Michigan, Ann Arbor, MI, United States of America; School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Wen Ye
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
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Zhang D, Tang Y, Ge J, Liu Y, Jin J, He M. Age and Diastolic Blood Pressure Play an Important Role in the Progression of White Matter Lesions: A Meta-Analysis. Eur Neurol 2020; 83:351-359. [PMID: 32906133 DOI: 10.1159/000510077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION White matter lesions (WMLs) are currently considered as a cerebral microvascular disease, and hypertension is considered as its most important risk factor. This study analysis systematically evaluated the effects of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the progression of WMLs. METHODS We searched the MeSH terms: "white matter," "blood pressure," "hypertension," "Leukoencephalopathy," and "leukoaraiosis" on PubMed and Cochrane from January 2000 to August 2019. A total of 12 closely related literature were included for research. RESULTS The results of the meta-analysis showed that the increase of both SBP and DBP can promote the progression of WMLs (respectively, odds ratio [OR] = 2.90, 95% confidence interval [CI] 2.86-2.94; OR = 3.13, 95% CI 3.03-3.23). Subgroup analysis found that patients with hypertension aged younger than 70 years are at a greater risk of WML progression when their DBP increased (OR = 4.69, 95% CI 3.31-6.65). CONCLUSION The relationship between DBP and WMLs is closer than that of SBP. Also, the risk of WML progression in patients aged under 70 years was higher than that in patients aged over 70 years. Furthermore, when DBP is elevated in patients younger than 70 years of age, the risk of WML progression may be higher. Therefore, it is expected that more researchers will attach importance to the change in DBP and identify the range of blood pressure and strategies that control DBP, thus contributing to delay the progression of WMLs.
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Affiliation(s)
- Dong Zhang
- Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yi Tang
- Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Jian Ge
- Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yumeng Liu
- Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Jing Jin
- Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Mingli He
- Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China,
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Sluyter JD, Hughes AD, Camargo CA, Thom SAM, Parker KH, Hametner B, Wassertheurer S, Scragg R. Identification of Distinct Arterial Waveform Clusters and a Longitudinal Evaluation of Their Clinical Usefulness. Hypertension 2019; 74:921-928. [PMID: 31446803 PMCID: PMC6742504 DOI: 10.1161/hypertensionaha.119.12625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Clustering of arterial blood pressure (BP) waveform parameters could summarize complex information into distinct elements, which could be used to investigate cumulative (nonredundant) associations. We investigated this hypothesis in a large, adult population-based study (ViDA trial [Vitamin D Assessment] trial). To interpret the clusters and evaluate their usefulness, we examined their predictors and associations with cardiovascular events. In 4253 adults (mean age 65 years; 55% male) without a prior cardiovascular event, suprasystolic oscillometry was performed, yielding aortic pressure waveforms and several hemodynamic parameters. Participants were followed up for 4.6 years (median), accruing 300 cardiovascular events. Principal component analysis reduced 14 arterial waveform parameters to 3 uncorrelated factors that together explained 90% of the variability of the original data. Factors 1, 2, and 3 appeared to represent BP pulsatility, mean BP, and wave reflection, respectively. Across 6 antihypertensive drug classes, there were no differences in brachial systolic (P=0.23) and diastolic (P=0.13) BP; but there were significant variations in factor 3 (P<0.0001), especially for β-blocker use. The first and third factors were positively associated with cardiovascular events (multivariable-adjusted standardized hazard ratio [95% CI]=1.33 [1.18-1.50] and 1.15 [1.02-1.30], respectively), whereas the second factor had a J-shaped relationship, with a nadir corresponding to a brachial diastolic BP of ≈75 mm Hg. In conclusion, BP pulsatility, mean BP, and wave reflection are prognostically meaningful, distinct aspects of arterial function that can be used to summarize physiological variations in multiple arterial waveform parameters and identify truly cumulative associations when used as cardiovascular risk outcomes.
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Affiliation(s)
- John D Sluyter
- From the School of Population Health, University of Auckland, New Zealand (J.D.S., R.S.)
| | - Alun D Hughes
- Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (A.D.H.)
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom (A.D.H.)
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.C.)
| | - Simon A McG Thom
- International Centre for Circulatory Health (S.A.M.T.), Imperial College, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering (K.H.P.), Imperial College, London, United Kingdom
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria (B.H., S.W.)
| | - Siegfried Wassertheurer
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria (B.H., S.W.)
| | - Robert Scragg
- From the School of Population Health, University of Auckland, New Zealand (J.D.S., R.S.)
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Foster‐Dingley JC, Moonen JE, van den Berg‐Huijsmans AA, de Craen AJ, de Ruijter W, van der Grond J, van der Mast RC. Lower Blood Pressure and Gray Matter Integrity Loss in Older Persons. J Clin Hypertens (Greenwich) 2015; 17:630-7. [PMID: 25867921 PMCID: PMC8031938 DOI: 10.1111/jch.12550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/03/2015] [Accepted: 03/08/2015] [Indexed: 01/23/2023]
Abstract
In contrast to middle age, it is unclear whether blood pressure (BP) in older persons is associated with cerebral small vessel disease (cSVD). The authors evaluated the association of BP with signs of cSVD as well as gray and white matter integrity in older persons. In 220 participants aged 75 years and older from the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) study, cSVD was assessed with conventional magnetic resonance imaging, and microstructural integrity with diffusion tensor and magnetization transfer (MT) imaging. BP measures were not associated with cSVD. However, lower systolic and diastolic BP and mean arterial pressure were associated with decreased gray matter MT ratio peak height and MT ratio in cortical gray matter. Mean arterial pressure was also associated with increased gray matter diffusivity. A lower level of BP was especially associated with worse gray matter integrity. Results suggest that not only upper but preferably lower thresholds of BP values should be observed in older persons.
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Affiliation(s)
| | - Justine E.F. Moonen
- Department of PsychiatryLeiden University Medical CenterLeidenthe Netherlands
| | | | - Anton J.M. de Craen
- Department of Gerontology and GeriatricsLeiden University Medical CenterLeidenthe Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
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Peng J, Lu F, Wang Z, Zhong M, Sun L, Hu N, Liu Z, Zhang W. Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study. J Am Med Dir Assoc 2014; 15:904-10. [PMID: 25239015 DOI: 10.1016/j.jamda.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 07/08/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study was designed to explore the appropriate blood pressure (BP) target required to reduce cognitive decline and brain white matter lesions (WMLs) in elderly hypertensive patients. METHODS Elderly patients (n = 294, ≥80 years of age) being treated for hypertension were enrolled in a longitudinal study examining cognitive impairment after an initial assessment and a period of 4 years. All patients underwent neurological and cognitive assessment, laboratory examination, and magnetic resonance imaging of the brain. RESULTS The 4-year follow-up examination revealed that body mass index, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure, and Mini-Mental State Examination (MMSE) all showed a significant decline, whereas fasting plasma glucose, white matter hyperintensities (WMH) volume, and the WMH/total intracranial volume (TIV) ratio were significantly increased when compared with baseline observations. Interestingly, the decline in MMSE, as well as the increment of WMH and WMH/TIV ratio was smaller in patients with SBP ranging from 140 to 160 mm Hg than in those whose SBP was lower than 140 mm Hg or higher than 160 mm Hg (P < .05). Furthermore, we observed that a 15 to 35 mm Hg targeted lowering of SBP in the elderly patients was more beneficial to our cognitive analysis than treatments that achieved less than 15 mm Hg or greater than 35 mm Hg (P < .05). CONCLUSIONS In elderly hypertensive patients, there exists a beneficial target for SBP lowering beyond which treatment may not be beneficial for improving or delaying the progression of cognitive impairment and WMLs.
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Affiliation(s)
- Jie Peng
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China
| | - Zhihao Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Zhong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Lixin Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Na Hu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China.
| | - Wei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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Chen JJ, Rosas HD, Salat DH. The relationship between cortical blood flow and sub-cortical white-matter health across the adult age span. PLoS One 2013; 8:e56733. [PMID: 23437228 PMCID: PMC3578934 DOI: 10.1371/journal.pone.0056733] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/14/2013] [Indexed: 11/18/2022] Open
Abstract
Degeneration of cerebral white matter is commonly observed in aging, and the associated degradation in neural connectivity contributes to cognitive decline in older adults. Vascular dysfunction has been implicated as a potential mechanism for general age-related neural tissue deterioration; however, no prior study has examined the direct relationship between cortical vascular health and subcortical white-matter integrity. In this work, we aimed to determine whether blood supply to the brain is associated with microstructural integrity of connective tissue, and whether such associations are regionally specific and mainly accounted for by aging. We examined the association between cerebral blood flow (CBF) in the cortical mantle, measured using arterial spin labeling (ASL), and subcortical white-matter integrity, measured using diffusion tensor imaging (DTI), in a group of healthy adults spanning early to late adulthood. We found cortical CBF to be significantly associated with white-matter integrity throughout the brain. In addition, these associations were only partially tied to aging, as they remained even when statistically controlling for age, and when restricting the analyses to a young subset of the sample. Furthermore, vascular risk was not a prominent determinant of these effects. These findings suggest that the overall blood supply to the brain is an important indicator of white-matter health in the normal range of variations amongst adults, and that the decline in CBF with advancing age may potentially exacerbate deterioration of the connective anatomy of the brain.
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Affiliation(s)
- J Jean Chen
- Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto, Toronto, Canada.
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Williams BR, Zhang Y, Sawyer P, Mujib M, Jones LG, Feller MA, Ekundayo OJ, Aban IB, Love TE, Lott A, Ahmed A. Intrinsic association of widowhood with mortality in community-dwelling older women and men: findings from a prospective propensity-matched population study. J Gerontol A Biol Sci Med Sci 2011; 66:1360-8. [PMID: 21903611 DOI: 10.1093/gerona/glr144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Widowhood is associated with increased mortality. However, to what extent this association is independent of other risk factors remains unclear. In the current study, we used propensity score matching to design a study to examine the independent association of widowhood with outcomes in a balanced cohort of older adults in the United States. METHODS We used public-use copies of the Cardiovascular Health Study data obtained from the National Heart, Lung, and Blood Institute. Of the 5,795 community-dwelling older men and women aged 65 years and older in Cardiovascular Health Study, 3,820 were married and 1,436 were widows or widowers. Propensity scores for widowhood, estimated for each of the 5,256 participants, were used to assemble a cohort of 819 pairs of widowed and married participants who were balanced on 74 baseline characteristics. The 1,638 matched participants had a mean (± standard deviation) age of 75 (± 6) years, 78% were women, and 16% African American. RESULTS All-cause mortality occurred in 46% (374/819) and 51% (415/819) of matched married and widowed participants, respectively, during more than 11 years of median follow-up (hazard ratio associated with widowhood, 1.18; 95% confidence interval, 1.03-1.36; p = .018). Hazard ratios (95% confidence intervals) for cardiovascular and noncardiovascular mortalities were 1.07 (0.87-1.32; p = .517) and 1.28 (1.06-1.55; p = .011), respectively. Widowhood had no independent association with all-cause or heart failure hospitalization or incident cardiovascular events. CONCLUSIONS Among community-dwelling older adults, widowhood was associated with increased mortality, which was independent of confounding by baseline characteristics and largely driven by an increased noncardiovascular mortality. Widowhood had no independent association with hospitalizations or incident cardiovascular events.
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Sierra C, López-Soto A, Coca A. Connecting cerebral white matter lesions and hypertensive target organ damage. J Aging Res 2011; 2011:438978. [PMID: 21837275 PMCID: PMC3151514 DOI: 10.4061/2011/438978] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 06/02/2011] [Indexed: 11/23/2022] Open
Abstract
Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and various organs, especially the brain, kidney, and retina. The brain is an early target of organ damage due to high blood pressure, which is the major modifiable risk factor for stroke and small vessel disease. Stroke is the second leading cause of death and the number one cause of disability worldwide and over 80% of strokes occur in the elderly. Preclinical hypertensive lesions in most target organs are clearly identified: left ventricular hypertrophy for the heart, microalbuminuria for the kidney, fundus abnormalities for the eye, and intima-media thickness and pulse wave velocity for the vessels. However, early hypertensive brain damage is not fully studied due to difficulties in access and the expense of techniques. After age, hypertension is the most-important risk factor for cerebral white matter lesions, which are an important prognostic factor for stroke, cognitive impairment, dementia, and death. Studies have shown an association between white matter lesions and a number of extracranial systems affected by high BP and also suggest that correct antihypertensive treatment could slow white matter lesions progression. There is strong evidence that cerebral white matter lesions in hypertensive patients should be considered a silent early marker of brain damage.
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Affiliation(s)
- Cristina Sierra
- Hypertension Unit, Department of Internal Medicine, Institute of Medicine and Dermatology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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