03194nas a2200469 4500008004100000022001400041245014600055210006900201260001300270300001400283490000700297520186100304653001602165653000902181653002802190653001902218653002402237653002402261653001102285653001502296653001102311653001702322653001402339653001802353653002502371653003102396653000902427653002402436653001902460653001702479653001702496653001802513100002102531700002002552700001802572700001702590700001702607700002002624700002002644700002402664856003602688 2017 eng d a1524-463600aBlood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults.0 aBlood Pressure and Heart Rate Measures Associated With Increased c2017 Aug a1579-15860 v373 a
OBJECTIVE: In people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings.
APPROACH AND RESULTS: In the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses.
CONCLUSIONS: Elevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.
10aAge Factors10aAged10aAntihypertensive Agents10aBlood Pressure10aCerebral Infarction10aDisease Progression10aFemale10aHeart Rate10aHumans10aHypertension10aIncidence10aLeukoaraiosis10aLongitudinal Studies10aMagnetic Resonance Imaging10aMale10aProspective Studies10aPulsatile Flow10aRisk Factors10aTime Factors10aUnited States1 aLeung, Lester, Y1 aBartz, Traci, M1 aRice, Kenneth1 aFloyd, James1 aPsaty, Bruce1 aGutierrez, Jose1 aLongstreth, W T1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/7466