Volume 16, Issue S2 e045987
BASIC SCIENCE AND PATHOGENESIS
Free Access

Cerebral small vessel diseases are better associated with ambulatory than office blood pressure measurements

Human neuropathology/imaging-pathologic correlations

Jesus D. Melgarejo

Corresponding Author

Jesus D. Melgarejo

Research Unit of Hypertension and Cardiovascular Science, University of Leuven, Leuven, Belgium

Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela

Correspondence

Jesus D. Melgarejo, Research Unit of Hypertension and Cardiovascular Science, University of Leuven, Leuven, Belgium.

Email: [email protected]

Search for more papers by this author
Jose Gutierrez

Jose Gutierrez

Columbia University Medical Center, New York, NY, USA

Search for more papers by this author
Luis Javier Mena

Luis Javier Mena

Polytechnic University of Sinaloa, Maztlan, Sinaloa, Mexico

Search for more papers by this author
Joseph H. Lee

Joseph H. Lee

Columbia University Irving Medical Center, New York, NY, USA

Search for more papers by this author
Carlos A. Chavez

Carlos A. Chavez

Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela

Search for more papers by this author
Gustavo Calmon

Gustavo Calmon

Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Venezuela

Search for more papers by this author
Egle Silva

Egle Silva

Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Venezuela

Search for more papers by this author
Joseph Douglas Terwilliger

Joseph Douglas Terwilliger

Departments of Psychiatry and Genetics & Development, New York, NY, USA

Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA

Sergievsky Center & Department of Epidemiology, Columbia University Medical Center, New York, NY, USA

Division of Public Health Genomics, National Institute for Health and Welfare, Helsinki, Finland

Search for more papers by this author
Thomas Vanassche

Thomas Vanassche

Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

Search for more papers by this author
Peter Verhamme

Peter Verhamme

Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

Search for more papers by this author
Jan Staessen

Jan Staessen

Research Unit of Hypertension and Cardiovascular Science, University of Leuven, Leuven, Belgium

Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands

Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium

Search for more papers by this author
Zhen-Yu Zhang

Zhen-Yu Zhang

Research Unit of Hypertension and Cardiovascular Science, University of Leuven, Leuven, Belgium

Search for more papers by this author
Gladys E. Maestre

Gladys E. Maestre

Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela

University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA

RGV Alzheimer’s Center (AD-RCMAR), Brownsville, TX, USA

Search for more papers by this author
First published: 07 December 2020

Abstract

Background

Cerebral small vessel diseases (CSVD) is a forerunner of cognitive decline, vascular dementia, Alzheimer’s disease, and stroke. Which BP index is closest associated with CVSD remains unclear. We aimed this study to examine the association of BP levels, measured by the office and ambulatory BP monitoring (ABPM), with CSVDs, and to determine which BP indexes are better associated with CSVDs.

Method

In the Maracaibo Aging Study, 330 participants (73.3% women; mean age, 58.0 years) underwent ABPM, and magnetic resonance brain imaging to assess white matter hyperintensities (WMH), small artery disease (SAD), and silent brain infarcts (SBI), which were divided into total (SBIt), supratentorial (SBIs), and cortical (SBIc). Statistics included multivariable linear and logistic regression. In models including two BP indexes, we uncorrelated these indexes by regressing one index on the other and by using the residual of one BP index.

Result

The prevalence of SAD, SBIt, SBIs, and SBIc was 5.8%, 11.8%, 10.1%, and 6.1%; respectively. Multivariable models showed that office, 24-h, daytime, and nighttime systolic BP (SBP) were significantly associated with WMH, SAD, SBIt, SBIs (P<0.05); all diastolic BP (DBP) indexes were related to WMH, but only nighttime DBP was associated to SAD and SBIs (P<0.05). Adjusted for office SBP, the 24-h, daytime, and nighttime SBP remained significantly associated with WMH (P<0.01), whereas the opposite was for office SBP after adjustment by 24-h or daytime SBP. With adjustment for office or daytime SBP, the association between SDA and SBIt with 24-h and nighttime SBP remained significant (P<0.05); nighttime SBP was additionally related to SBIs. Daytime SBP was not associated with CVSD after adjustments by the office, 24-h, or nighttime SBP. Adjusted for daytime DBP, nighttime DBP were significantly associated with SDA, SBIi, and SBIs (P<0.05).

Conclusion

CSVD was related to 24-h and nighttime BP. Proper control of the ambulatory BP may reduce the risk for CSVD and associated adverse health outcomes.