TY - JOUR
T1 - Diastolic Blood Pressure Is Associated with Regional White Matter Lesion Load
T2 - The Northern Manhattan Study
AU - Caunca, Michelle R.
AU - Simonetto, Marialaura
AU - Cheung, Ying Kuen
AU - Alperin, Noam
AU - Lee, Sang H.
AU - Elkind, Mitchell S.V.
AU - Sacco, Ralph L.
AU - Rundek, Tatjana
AU - Wright, Clinton B.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - American Heart Association
KW - blood pressure
KW - cerebrovascular disease
KW - cognitive aging
KW - white matter
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U2 - 10.1161/STROKEAHA.119.025139
DO - 10.1161/STROKEAHA.119.025139
M3 - Article
C2 - 31910743
AN - SCOPUS:85078565446
SP - 372
EP - 378
JO - Stroke
JF - Stroke
SN - 0039-2499
ER -