24 시간 혈압 측정과 피질하 허혈성 혈관성 인지장애와의 관계- 예비적 연구-

Abstract

Background: Twenty-four-hour blood pressure (BP) readings have been found to correlate with hypertensive target organ damage. White matter lesions (WML) probably represent manifestations of cerebral hypertensive target organ damage. Recent findings of a linkage between high blood pressure (BP) and later development of dementia have given new prospects on cerebral target-organ damage in hypertension. Little has been studied about the differences in the pattern of 24-hour blood pressure readings between subcortical ischemic vascular cognitive impairment (VCI) and cognitively normal control with hypertension. We aimed to assess the differences in the pattern of 24-hour blood pressure readings in subcortical ischemic VCI compared with cognitively normal controls without subcortical ischemic lesion and delineate the relationship between 24-hour BP measurements and cognitive impairment/WML. Methods: Two subject groups (14 SIVCI patients, 10 normal) participated in this study and were examined with 24-hour BP monitoring. All patients were evaluated by the K-MMSE and Brain MRI. WML were subdivided into periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWH). Results: The patients with subcortical ischemic VCI had significantly greater daytime systolic blood pressure, systolic blood pressure variability, and nondipping status (p< 0.05). Among the patients with subcortical ischemic VCI, absence of dipping status was associated with attention and calculation scores (p< 0.05) and was significantly associated with PVH and DWH (p< 0.05). Conclusion: Non-dipping and reverse-dipping were relatively common in subcortical ischemic VCI patients. A nondipping status appears to be directly associated with decline of attention and WML. This study indicates the need for further studies to investigate whether or not controlling nighttime BP will help reduce the risk for subcortical ischemic VCI.