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Nomoto K, Hirashiki A, Ogama N, Kamihara T, Kokubo M, Sugimoto T, Sakurai T, Shimizu A, Arai H, Murohara T. Septal E/e' Ratio Is Associated With Cerebral White Matter Hyperintensity Progression in Young-Old Hypertensive Patients. Circ Rep 2023; 5:38-45. [PMID: 36818523 PMCID: PMC9908522 DOI: 10.1253/circrep.cr-22-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Background: The incidence of hypertension increases with age, as does that of brain abnormalities associated with cerebral pathologic and functional degeneration. Little is known about the relationship between hypertension-related cardiac changes and cerebral pathologic degeneration. We examined the relationship between left ventricular (LV) diastolic dysfunction and cerebral white matter hyperintensity (WMH) progression in young-old hypertensive patients. Methods and Results: This single-center prospective longitudinal observational study included 156 individuals aged 65-75 years with well-controlled hypertension, normal LV contraction, and no history of symptomatic heart failure. WMH was quantified on brain magnetic resonance imaging (MRI). The primary outcome was the rate of WMH volume progression between the baseline and follow-up MRI (∆WMH). Participants were classified into tertiles on the basis of ∆WMH (small, medium, and large ∆WMH). The mean (±SD) age at recruitment was 69.6±2.8 years, and the mean follow-up period was 4.6 years. The ratio of early diastolic mitral inflow velocity to early diastolic septal mitral annulus velocity (septal E/e') was significantly higher in the large ∆WMH group than in the small and medium ∆WMH groups. On multiple regression analysis, septal E/e' was significantly positively associated with square-root-transformed ∆WMH (β=0.457, P<0.001). Conclusions: Septal E/e' was significantly positively associated with the rate of progression of WMH volume, suggesting that LV diastolic dysfunction is associated with the progression of abnormal brain aging.
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Affiliation(s)
- Kenichiro Nomoto
- Department of Cardiology, Nagoya University Graduate School of MedicineNagoyaJapan,Department of Cardiology, National Center for Geriatrics and GerontologyObuJapan,Department of Cardiology, Inazawa Municipal HospitalInazawaJapan
| | - Akihiro Hirashiki
- Department of Cardiology, Nagoya University Graduate School of MedicineNagoyaJapan,Department of Cardiology, National Center for Geriatrics and GerontologyObuJapan
| | - Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and GerontologyObuJapan
| | - Takahiro Kamihara
- Department of Cardiology, Nagoya University Graduate School of MedicineNagoyaJapan,Department of Cardiology, National Center for Geriatrics and GerontologyObuJapan
| | - Manabu Kokubo
- Department of Cardiology, Nagoya University Graduate School of MedicineNagoyaJapan,Department of Cardiology, National Center for Geriatrics and GerontologyObuJapan
| | - Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and GerontologyObuJapan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and GerontologyObuJapan
| | - Atsuya Shimizu
- Department of Cardiology, Nagoya University Graduate School of MedicineNagoyaJapan,Department of Cardiology, National Center for Geriatrics and GerontologyObuJapan
| | - Hidenori Arai
- Department of Gerontology, National Center for Geriatrics and GerontologyObuJapan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of MedicineNagoyaJapan
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2
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Starmans NL, Wolters FJ, Leeuwis AE, Bron EE, Brunner La Rocca HP, Staals J, Biessels GJ, Kappelle LJ. Twenty-four hour blood pressure variability and the prevalence and the progression of cerebral white matter hyperintensities. J Cereb Blood Flow Metab 2023; 43:801-811. [PMID: 36597406 PMCID: PMC10108197 DOI: 10.1177/0271678x221149937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Blood pressure variability (BPV) is related to cerebral white matter hyperintensities (WMH), but longitudinal studies assessing WMH progression are scarce. Patients with cardiovascular disease and control participants of the Heart-Brain Connection Study underwent 24-hour ambulatory blood pressure monitoring and repeated brain MRI at baseline and after 2 years. Using linear regression, we determined whether different measures of BPV (standard deviation, coefficient of variation, average real variability (ARV), variability independent of the mean) and nocturnal dipping were associated with WMH and whether this association was mediated or moderated by baseline cerebral perfusion. Among 177 participants (mean age: 65.9 ± 8.1 years, 33.9% female), the absence of diastolic nocturnal dipping was associated with higher WMH volume at baseline (β = 0.208, 95%CI: 0.025-0.392), but not with WMH progression among 91 participants with follow-up imaging. None of the BPV measures were associated with baseline WMH. Only 24-hour diastolic ARV was significantly associated with WMH progression (β = 0.144, 95%CI: 0.030-0.258), most profound in participants with low cerebral perfusion at baseline (p-interaction = 0.042). In conclusion, absent diastolic nocturnal dipping and 24-hour diastolic ARV were associated with higher WMH volume. Whilst requiring replication, these findings suggest that blood pressure patterns and variability may be a target for prevention of small vessel disease.
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Affiliation(s)
- Naomi Lp Starmans
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Annebet E Leeuwis
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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Hirashiki A, Shimizu A, Suzuki N, Nomoto K, Kokubo M, Sugimoto T, Hashimoto K, Sato K, Sakurai T, Murohara T, Washimi Y, Arai H. Exercise Capacity and Frailty Are Associated with Cerebral White Matter Hyperintensity in Older Adults with Cardiovascular Disease. Int Heart J 2022; 63:77-84. [DOI: 10.1536/ihj.21-377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Noriyuki Suzuki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology
| | - Kakeru Hashimoto
- Department of Rehabilitation, National Center for Geriatrics and Gerontology
| | - Kenji Sato
- Department of Rehabilitation, National Center for Geriatrics and Gerontology
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yukihiko Washimi
- Department of Geriatrics and Gerontology, National Center for Geriatrics and Gerontology
| | - Hidenori Arai
- Department of Geriatrics and Gerontology, National Center for Geriatrics and Gerontology
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4
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Chen Y, Lin Y, Bian Y. Cognitive Functional Impairment and Hemodynamic Changes in Patients with Symptomatic Leukoaraiosis. JOURNAL OF BEHAVIORAL AND BRAIN SCIENCE 2022; 12:271-286. [DOI: 10.4236/jbbs.2022.126015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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5
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Xing Y, Sun Y, Wang S, Feng F, Zhang D, Li H. Nocturnal blood pressure rise as a predictor of cognitive impairment among the elderly: a retrospective cohort study. BMC Geriatr 2021; 21:462. [PMID: 34380417 PMCID: PMC8359081 DOI: 10.1186/s12877-021-02406-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background This study investigated the different blood pressure patterns that were evaluated by ambulatory blood pressure monitoring (ABPM) among elderly patients and explored the effect of pressure patterns on cognitive impairment and mortality. Methods A total of 305 elderly participants aged ≥65 years were divided into the cognitive impairment group (CI, n = 130) and the non-cognitive impairment group (NCI, n = 175) according to the MMSE score. All participants underwent ABPM to evaluate possible hypertensive disorder and cerebral MRI for the evaluation of cerebral small vessel disease. Follow-up was performed by telephone or medical records. The primary outcome was all-cause mortality. Secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE). Results Among 305 participants, 130 (42.6%) were identified with cognitive impairment (CI), with average systolic blood pressure (BP) of 127 mmHg and diastolic BP of 66 mmHg. According to ABPM, only 13.1% had a dipper pattern, 45.6% had a nocturnal BP rise, while 41.3% had a non-dipper pattern. Compared with NCI patients, the CI group had significantly higher night-time systolic BP (130.0 ± 18.2 vs. 123.9 ± 15.1, p = 0.011), and more participants had nocturnal BP rise (52.3% vs. 40.6%, p = 0.042). Nocturnal BP rise was associated with greater white matter hyperintensities (WMH) (p = 0.013). After 2.03 years of follow-up, there were 35 all-cause deaths and 33 cases of major adverse cardiac and cerebrovascular events (MACCE). CI was independently associated with all-cause mortality during long-term observation (p < 0.01). Nocturnal BP rise had no significant predictive ability for all-cause mortality in elderly patients (p = 0.178). Conclusions Nocturnal BP rise contributed to greater cognitive impairment in elderly patients. Not nocturnal BP rise, but CI could significantly increase all-cause mortality. Controlling BP based on ABPM is critical for preventing the progression of cognitive dysfunction.
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Affiliation(s)
- Yunli Xing
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, PR China
| | - Ying Sun
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, PR China
| | - Shan Wang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, PR China
| | - Feng Feng
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, PR China
| | - Deqiang Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, PR China
| | - Hongwei Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, PR China. .,Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, PR China.
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6
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Li Y, Hong Z. Exposure to the Chinese famine in early life and self-reported arthritis risk in adulthood. PSYCHOL HEALTH MED 2021; 27:1553-1562. [PMID: 33733970 DOI: 10.1080/13548506.2021.1903052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Evidence shows that undernutrition during early life is associated with an increased risk of chronic diseases in adulthood. We aimed to investigate whether exposure to the Chinese famine in the fetal or infant stage was associated with self-reported arthritis risk in adulthood. A total of 3,622 participants were included in the final analysis. Participants were classified into non-, fetal-, and infant-exposed group. Arthritis was self-reported doctor-diagnosed arthritis. A multivariate logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of arthritis. The prevalence of arthritis was 27.07%, 27.74%, and 34.09% among individuals in non-, fetal-, infant-exposed group, respectively. Infant-exposed group (OR: 1.32; 95% CI: 1.12-1.56) had a higher arthritis risk then non-exposed group after adjustment for gender, age, area, education level, smoking status, drinking status, and physical activity. Participants who experienced severe famine during infant and fetal period had higher (41.46%, OR=1.71 and 32.94%, OR=1.36) arthritis risk than those exposed to less severe famine. Exposure to the Chinese famine in early life was associated with an increased risk of arthritis in adulthood, which was partially influenced by some factors (e.g., gender, area, body mass index, and born in severely affected area or not).
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Affiliation(s)
- Yaru Li
- Department of Nutrition, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongxin Hong
- Department of Nutrition, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Komori T, Hoshide S, Tabei KI, Tomimoto H, Kario K. Quantitative evaluation of white matter hyperintensities in patients with heart failure using an innovative magnetic resonance image analysis method: Association with disrupted circadian blood pressure variation. J Clin Hypertens (Greenwich) 2021; 23:1089-1092. [PMID: 33538394 PMCID: PMC8678785 DOI: 10.1111/jch.14204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Abstract
White matter hyperintensities (WMHs) are risk factors for future cognitive impairment and are associated with an abnormal circadian blood pressure (BP) rhythm in patients with hypertension. However, whether this association exists in patients with heart failure (HF) is unclear. We performed a cross‐sectional study of hospitalized patients with HF who underwent ambulatory BP monitoring and brain magnetic resonance imaging (MRI). A non‐dipper BP pattern was defined as a < 10% nocturnal BP decline. WMHs on brain MRI scans were quantitated using a novel image analysis software (FUSION: FUsed Software for Imaging Of Nervous system). We enrolled 28 hospitalized patients with HF (age: 70.0 ± 9.8 years, 64.3% men). In the brain MRI analysis, the non‐dipper group had higher WMH volume (18.9 ± 19.8 vs. 7.7 ± 8.3 mL, P = .047) and percentage of WMH/total brain volume (1.31 ± 1.28% vs. 0.55 ± 0.58%, P = .04) than the dipper group. In conclusion, using the newly developed MRI analysis software, we successfully quantitatively measured the volume of WMHs and found that the WMH volume increased 2.4 times in patients with a non‐dipper pattern of nocturnal BP compared with those with a normal dipper pattern.
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Affiliation(s)
- Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ken-Ichi Tabei
- Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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8
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Associations of Blood Pressure and Carotid Flow Velocity with Brain Volume and Cerebral Small Vessel Disease in a Community-Based Population. Transl Stroke Res 2020; 12:248-258. [PMID: 32737795 DOI: 10.1007/s12975-020-00836-7] [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: 02/10/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI). We previously demonstrated that high blood pressure (BP) and low carotid flow velocity were associated with cerebrovascular disease. However, their associations with brain volume and CSVD remain to be determined. A total of 721 adults (≥ 50 years) from the community-based I-Lan Longitudinal Aging Study were included. Flow velocities at the common (CCA) and internal carotid artery (ICA), including peak systolic velocity (PSV) and end-diastolic velocity (EDV), were measured with Doppler ultrasound. We further detected the presence of CSVD including lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. General linear regression and logistic regression analysis were exploited to evaluate the association between carotid flow velocity, BP, brain volume, and CSVD. The mean of white matter, gray matter, and WMH volume were 422.2 cm3, 546.9 cm3, and 2.61 cm3, respectively. The proportion of lacune and microbleed were 11.1% and 14.2%, respectively. The CSVD score were negatively associated with gray (r = - 0.121, p < .01) and white matter volume (r = 0.058, p = 0.12), but positively associated with systolic BP (beta = 1.02, p = 0.0017). EDV at common carotid artery associated positively with white matter volume (beta = 1.013, p = 0.0064) and negatively predicted the presence CSVD (odds ratio [OR] = 0.93, p = 0.0023). In the ordinal logistic regression analysis adjusting for age, sex, total intracranial volume education, low-density lipoprotein cholesterol, and fasting glucose, compared with hypertensive subjects with low EDV, normotensive subjects with low, middle, and high EDV had an odds ratio of 0.656 (0.327-1.318), 0.429 (0.261-0.705), and 0.272 (0.147-0.502) for CSVD score, respectively. High SBP and low carotid flow velocities were independently associated with brain volume and CSVD. These associations may be involved in the pathophysiology of cognitive function decline.
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9
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Jiménez-Balado J, Riba-Llena I, Maisterra O, Pizarro J, Palasí A, Pujadas F, Mundet X, Vinyoles E, Delgado P. Ambulatory Blood Pressure Levels in the Prediction of Progression of Cerebral Small Vessel Disease. J Am Geriatr Soc 2020; 68:2232-2239. [PMID: 32511756 DOI: 10.1111/jgs.16568] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to study the value of ambulatory blood pressure monitoring (ABPM) in predicting the global progression of cerebral small vessel disease (cSVD). DESIGN Longitudinal cohort study. SETTING Data from the population-based Investigating Silent Strokes in Hypertensives study. PARTICIPANTS Individuals with hypertension who were 50 to 70 years of age and stroke free at baseline. In baseline and follow-up visits, patients underwent magnetic resonance imaging and ABPM. MEASUREMENTS Ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were studied as continuous variables and dichotomized according to good or poor control on the basis of 125/75 (24 hours), 130/80 (day), and 110/65 (night) mm Hg cutoff values. Whole cSVD progression was qualitatively scored with 1 point when an incident lesion (incident lacunar infarcts, deep cerebral microbleeds, white matter hyperintensities, and basal ganglia enlarged perivascular spaces) was detected. The score ranged from 0 to 4. RESULTS We followed up 233 participants with a median age of 65 years within 4 years. A total of 61 (26.2%) and 23 (9.9%) subjects showed cSVD progression in one and two or more markers, respectively. Baseline ambulatory SBP and DBP and nighttime pulse pressure (PP) values were positively correlated with the number of incident cSVD lesions. Interestingly, patients without incident lesions showed greater differences between office and ambulatory BP, thus suggesting an increased white coat effect. Poor DBP control, nighttime PP, and DBP white coat effect were independently associated with cSVD progression. The inclusion of these metrics in a clinical model resulted in a significant increase in the prediction of incident lesions (integrated discrimination improvement = 9.09%; P value <.001). CONCLUSION ABPM may help assess cSVD risk of progression, especially by the identification of poor BP control, masked hypertension, and increased nighttime PP. J Am Geriatr Soc 68:2232-2239, 2020.
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Affiliation(s)
- Joan Jiménez-Balado
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iolanda Riba-Llena
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Pizarro
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Palasí
- Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Pujadas
- Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Mundet
- Primary Healthcare University Research Institute IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ernest Vinyoles
- Primary Healthcare University Research Institute IDIAP Jordi Gol, CAP La Mina, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Yang K, Zhu X, Feng Y, Shen F, Chen J, Fu N, Sun J, Fu Y. Abnormal blood pressure circadian rhythms are relevant to cerebral infarction and Leukoaraiosis in hypertensive patients. BMC Neurol 2020; 20:36. [PMID: 31992235 PMCID: PMC6988318 DOI: 10.1186/s12883-020-1626-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients. METHODS A retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI). RESULTS A total of 1267 patients were enrolled. Lower nocturnal blood pressure (BP) decreases were observed in ACI patients than in controls (3.3% vs 8.2%, P<0.001). Reverse-dipper pattern (RD) and non-dipper pattern (ND) were found to be independent risk factors for ACI. In ACI patients, both RD and ND BP circadian rhythms were revealed to be independent risk factors for moderate-severe leukoaraiosis. In addition, in SCI patients, RD (OR = 1.7, 95% CI, 0.9-3.0; P = 0.047) or extreme-dipper pattern (ED) (OR = 2.9, 95% CI, 1.2-7.0; P = 0.015) were found to be independent risk factors for moderate-severe leukoaraiosis. Moreover, the greater the severity of leukoaraiosis was, the higher the ratio of abnormal BP circadian rhythms. CONCLUSION RD and ND BP circadian rhythms might not only be relevant to the onset of ACI but also correlate with the severity of leukoaraiosis. Thus, when modulating BP with antihypertensive drugs, the BP circadian rhythms, and not merely the BP level, should warrant more attention.
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Affiliation(s)
- Kang Yang
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China
| | - Xiaodong Zhu
- Department of Neurology, The First Hospital of Jiaxing, Zhejiang, 314000, China
| | - Yulan Feng
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Fanxia Shen
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China
| | - Jie Chen
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China
| | - Ningzhen Fu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jialan Sun
- Department of Neurology, Pu Dong District Gonli hospital, Shanghai, 200120, China
| | - Yi Fu
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China.
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11
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Gottesman RF. To INFINITY and Beyond: What Have We Learned and What Is Still Unknown About Blood Pressure Lowering and Cognition? Circulation 2019; 140:1636-1638. [PMID: 31710528 DOI: 10.1161/circulationaha.119.042827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Rebecca F Gottesman
- Departments of Neurology and Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD
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12
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Bian Y, Wang JC, Sun F, Sun ZY, Lin YJ, Liu Y, Zhao B, Liu L, Luo XG. Assessment of cerebrovascular reserve impairment using the breath-holding index in patients with leukoaraiosis. Neural Regen Res 2019; 14:1412-1418. [PMID: 30964067 PMCID: PMC6524493 DOI: 10.4103/1673-5374.251332] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43–93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People’s Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
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Affiliation(s)
- Ying Bian
- Department of Neurology, the First Affiliated Hospital of China Medical University; Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Jin-Chun Wang
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Feng Sun
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Zi-Yi Sun
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China
| | - Yu-Jiao Lin
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Yang Liu
- Department of Neurology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bin Zhao
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Li Liu
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Xiao-Guang Luo
- Department of Neurology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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13
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Deng M, Chen DW, Dong YF, Lu P, Zhan BM, Xu JQ, Ji XX, Li P, Cheng XS. Independent association between age and circadian systolic blood pressure patterns in adults with hypertension. J Clin Hypertens (Greenwich) 2017; 19:948-955. [PMID: 28736895 DOI: 10.1111/jch.13057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/29/2017] [Accepted: 06/04/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Ming Deng
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Da-Wei Chen
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Yi-Fei Dong
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
- Key Laboratory of Molecular Biology in Jiangxi Province; Nanchang China
| | - Peng Lu
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Bi-Ming Zhan
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Jian-Qing Xu
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Xi-Xin Ji
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Ping Li
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
| | - Xiao-Shu Cheng
- Department of Cardiovascular Medicine; The Second Affiliated Hospital of Nanchang University; Nanchang China
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