van Boxtel M P J, Henskens L H G, Kroon A A, Hofman P A M, Gronenschild E H B M, Jolles J, de Leeuw P W
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
J Hum Hypertens. 2006 Jan;20(1):5-13. doi: 10.1038/sj.jhh.1001934.
Prolonged exposure to elevated blood pressure (BP) can lead to both structural (white matter lesions (WML) or infarctions) and functional changes in the brain. We studied in previously diagnosed essential hypertensive individuals if diurnal BP variation and ambulatory BP (ABP) profile (daytime, night time and 24-h BP averages) were related to evidence of WML, the presence of 'silent' infarcts, and cognitive performance. A group of 86 patients (mean age 57.4+/-10 years, range 40-80) were first screened for hypertension-related organ damage and underwent 24-h ABP monitoring, magnetic resonance imaging (MRI) of the brain, and a comprehensive neurocognitive assessment. Age and ABP profile were related to more periventricular, but not subcortical, WML and to presence of lacunar infarctions on MRI. After correction for demographical group differences, no association was found between night time dipping of BP on the one hand and both WML load and cognitive parameters (verbal memory, sensorimotor speed, cognitive flexibility) on the other. The presence of lacunar infarctions, however, predicted lower performance on verbal memory. Furthermore, daytime and 24-h pulse pressure averages were associated with pWML, whereas systolic BP and mean arterial pressure (MAP) for daytime, night-time and 24-h periods were higher in patients with lacunar infarctions. Notwithstanding the large variability of WML in this sample, the evidence of a connection between diurnal BP variation and early target organ damage in the brain was not convincing. However, the ABP profile may be predictive of cerebral lesion type.
长期暴露于血压（BP）升高会导致大脑结构（白质病变（WML）或梗死）和功能改变。我们在先前诊断为原发性高血压的个体中进行研究，以探讨昼夜血压变化和动态血压（ABP）曲线（白天、夜间和24小时平均血压）是否与WML证据、“无症状”梗死的存在以及认知表现相关。一组86例患者（平均年龄57.4±10岁，范围40 - 80岁）首先接受高血压相关器官损伤筛查，并进行24小时ABP监测、脑部磁共振成像（MRI）以及全面的神经认知评估。年龄和ABP曲线与更多的脑室周围WML相关，但与皮质下WML无关，且与MRI上腔隙性梗死的存在有关。在校正人口统计学组间差异后，未发现夜间血压下降一方面与WML负荷以及另一方面与认知参数（言语记忆、感觉运动速度、认知灵活性）之间存在关联。然而，腔隙性梗死的存在预示着言语记忆表现较低。此外，白天和24小时脉压平均值与pWML相关，而腔隙性梗死患者白天、夜间和24小时的收缩压和平均动脉压（MAP）更高。尽管该样本中WML存在较大变异性，但昼夜血压变化与大脑早期靶器官损伤之间存在联系的证据并不令人信服。然而，ABP曲线可能预测脑病变类型。
