Henskens Léon H, Kroon Abraham A, van Oostenbrugge Robert J, Gronenschild Ed H, Hofman Paul A, Lodder Jan, de Leeuw Peter W
Department of Internal Medicine, Division of General Internal Medicine, Subdivision Vascular Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
J Hypertens. 2009 Jul;27(7):1446-52. doi: 10.1097/HJH.0b013e32832b5204.
High daytime and nighttime blood pressure (BP) levels, and apparently also an abnormal nocturnal BP dip, coincide with a greater extent of cerebral white matter hyperintensities (WMHs). We assessed the relationship between ambulatory BP and volumes of WMH, and distinguished between periventricular and deep WMH because of their supposedly different cause.
A total of 210 hypertensive patients (106 men) without cardiovascular and cerebrovascular disease, with a mean age of 52.5 +/- 12.5 years, and untreated office BP levels of 170 +/- 24/104 +/- 12 mmHg underwent duplicate 24-h ambulatory blood pressure monitoring (off medication) and brain MRI to quantify the WMHs (total, periventricular, and deep) and brain volumes. We performed linear regression analyses to relate the mean 24-h, awake, and asleep BPs, and the relative nocturnal BP dip to the different volumes of WMHs, while adjusting for age, sex, brain volume, and vascular risk factors.
Higher 24-h, awake, and asleep BP levels were continuously, without distinct thresholds, and independently associated with a greater volume of total (all P < 0.001), periventricular (P < 0.001), and, to a lesser extent, deep (P < 0.05) WMHs. Nocturnal BP dipping was not related to the volume of WMHs.
Higher 24-h, daytime, and nighttime BP levels are independently associated with WMH volumes.
白天和夜间血压（BP）水平升高，以及明显异常的夜间血压下降，均与脑白质高信号（WMH）范围扩大相关。我们评估了动态血压与WMH体积之间的关系，并区分了脑室周围和深部WMH，因为它们的病因可能不同。
共有210例无心血管和脑血管疾病的高血压患者（106例男性），平均年龄52.5±12.5岁，未治疗时诊室血压水平为170±24/104±12 mmHg，接受了重复的24小时动态血压监测（未服药）和脑部MRI检查，以量化WMH（总、脑室周围和深部）及脑体积。我们进行了线性回归分析，以将24小时平均、清醒和睡眠时的血压，以及夜间相对血压下降与不同体积的WMH相关联，同时调整年龄、性别、脑体积和血管危险因素。
24小时、清醒和睡眠时较高的血压水平呈持续、无明显阈值且独立地与更大体积的总（所有P<0.001）、脑室周围（P<0.001）以及程度较轻的深部（P<0.05）WMH相关。夜间血压下降与WMH体积无关。
24小时、白天和夜间较高的血压水平独立地与WMH体积相关。
