Relationships between 24-Hour Blood Pressures, Subcortical Ischemic Lesions, and Cognitive Impairment
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose The most important treatment for subcortical vascular dementia (SVaD) is controlling the blood pressure (BP). However, the few studies that have investigated the relationships between diurnal BP rhythm and subcortical ischemic vascular cognitive impairment have produced inconclusive results. In the study presented here, the 24-hour BP values of three groups of subjects-patients with subcortical vascular mild cognitive impairment (SvMCI), patients with SVaD, and normal controls-were compared using working criteria and 24-hour ambulatory BP (ABP) monitoring. Methods The subjects (42 patients with SVaD, 37 patients with SvMCI, and 30 controls) were selected according to the study’s inclusion/exclusion criteria. All subjects underwent brain magnetic resonance (MR) imaging and MR angiography, detailed neuropsychological testing, and 24-hour ABP monitoring. Results The prevalence of nondippers differed markedly between the control group and both the SVaD and SvMCI groups. Loss of nocturnal dipping was significantly associated with SVaD [odds ratio (OR), 4.827; 95% confidence interval (CI), 1.07-12.05]. Conclusions It was found that SVaD is associated with loss of nocturnal BP dipping combined with increased pulse pressure and systolic BP (SBP) variability. Correction of these factors could therefore be important in the prevention of SVaD, independent of measures used to reduce BP.
Abstract
Background and Purpose The most important treatment for subcortical vascular dementia (SVaD) is controlling the blood pressure (BP). However, the few studies that have investigated the relationships between diurnal BP rhythm and subcortical ischemic vascular cognitive impairment have produced inconclusive results. In the study presented here, the 24-hour BP values of three groups of subjects-patients with subcortical vascular mild cognitive impairment (SvMCI), patients with SVaD, and normal controls-were compared using working criteria and 24-hour ambulatory BP (ABP) monitoring. Methods The subjects (42 patients with SVaD, 37 patients with SvMCI, and 30 controls) were selected according to the study’s inclusion/exclusion criteria. All subjects underwent brain magnetic resonance (MR) imaging and MR angiography, detailed neuropsychological testing, and 24-hour ABP monitoring. Results The prevalence of nondippers differed markedly between the control group and both the SVaD and SvMCI groups. Loss of nocturnal dipping was significantly associated with SVaD [odds ratio (OR), 4.827; 95% confidence interval (CI), 1.07-12.05]. Conclusions It was found that SVaD is associated with loss of nocturnal BP dipping combined with increased pulse pressure and systolic BP (SBP) variability. Correction of these factors could therefore be important in the prevention of SVaD, independent of measures used to reduce BP.
참고문헌 (33)
- O’Brien E, "European Society of Hypertension recommendations for conventional ambulatory and home blood pressure measurement", J Hypertens, 21, pp.821~848 (2003)
- Bowler JV, "Vascular cognitive impairment", J Neurol Neurosurg Psychiatry, 7(5), pp.v35~v44 (2005)
- Liao D, "Presence and severity of cerebral white matter lesions and hypertension, its treatment, and its control. The ARIC study. Atheroscleorosis Risk in Communities Study", Stroke, 27, pp.2262~2270 (1996)
- Guo Z, "Blood pressure and performance on the Mini-Mental State Examination in the very old. Cross-sectional and longitudinal data from the Kungsholmen Project", Am J Epidemiol, 145, pp.1106~1113 (1997)
- Swan GE, "Association of midlife blood pressure to late-life cognitive decline and brain morphology", Neurology, 51, pp.986~993 (1998)
- Dufouil C, "Longitudinal study of blood pressure and white matter hyperintensities: the EVA MRI Cohort", Neurology, 56, pp.921~926 (2001)
- de Leeuw FE, "Hypertension and cerebral white matter lesions in a prospective cohort study", Brain, 125, pp.765~772 (2002)
- Verdecchia P, "Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension", Hypertension, 24, pp.793~801 (1994)
- Kario K, "Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives", Hypertension, 38, pp.852~857 (2001)
- O’Brien E, "Dippers and nondippers", Lancet, 13, pp.397~ (1988)
- Staessen JA, "Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators", JAMA, 282, pp.539~546 (1999)
- Ohkubo T, "Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study", J Hypertens, 20, pp.2183~2189 (2002)
- Yamamoto Y, "The relationship between 24-hour blood pressure readings, subcortical ischemic lesions, and vascular dementia", Cerebrovasc Dis, 19, pp.302~308 (2005)
- van Boxtel MP, "Ambulatory blood pressure, asymptomatic cerebrovascular damage and cognitive function in essential hypertension", J Hum Hypertens, 20, pp.5~13 (2006)
- 구형모, "일상활동평가-복합(Seoul-Instrumental Activities of Daily Living ; S-IADL)의 신뢰도 및 타당도 연구", 신경정신의학, 43(2), pp.189~199 (2004), 대한신경정신의학회
- Hachinski VC, "Cerebral blood flow in dementia", Arch Neurol, 32, pp.632~637 (1975)
- Wahlund LO, "A new rating scale for age-related white matter changes applicable to MRI and CT", Stroke, 32, pp.1318~1322 (2001)
- Kang Y, "Seoul Neuropsychological Screening Battery" (2003), Human Brain Research & Consulting
- Scherr PA, "Relation of blood pressure to cognitive functions in the elderly", Am J Epidemiol, 134, pp.1303~1315 (1991)
- Kuusisto J, "Essential hypertension and cognitive function. The role of hyperinsulinemia", Hypertension, 22, pp.771~779 (1993)
- Kilander L, "Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men", Hypertension, 31, pp.780~786 (1998)
- van der Flier WM, "Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study", Stroke, 36, pp.2116~2120 (2005)
- Birns J, "Blood pressure reduction for vascular risk: is there a price to be paid?", Stroke, 36, pp.1308~1313 (2005)
- Parati G, "Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension", J Hypertens, 5, pp.93~98 (1987)
- Yamamoto Y, "Diminished nocturnal blood pressure decline and lesion site in cerebrovascular disease", Stroke, 26, pp.829~833 (1995)
- Shimada K, "Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension", J Hypertens, 10, pp.875~878 (1992)
- Tohgi H, "Twenty-four-hour variation of blood pressure in vascular dementia of the Binswanger type", Stroke, 22, pp.603~608 (1991)
- Puisieux F, "Relationship between leuko-araiosis and blood pressure variability in the elderly", Eur Neurol, 46, pp.115~120 (2001)
- Ohmine T, "Association between arterial stiffness and cerebral white matter lesions in community-dwelling elderly subjects", Hypertens Res, 31, pp.75~81 (2008)
- Blacher J, "Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease", Hypertension, 32, pp.570~574 (1998)
- Launer LJ, "The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study", JAMA, 274, pp.1846~1851 (1995)
- Cummings JL, "Frontal-subcortical circuits and human behavior", J Psychosom Res, 44, pp.627~628 (1998)
- O’Brien JT, "Cognitive associations of subcortical white matter lesions in older people", Ann N Y Acad Sci, 977, pp.436~444 (2002)