Takami Takeshi, Yamano Shigeru, Okada Sadanori, Sakuma Mio, Morimoto Takeshi, Hashimoto Hiroshi, Somekawa Satoshi, Saito Yoshihiko
Department of Internal Medicine, Clinic Jingumae, Kashihara, Japan.
Vasc Health Risk Manag. 2012;8:169-76. doi: 10.2147/VHRM.S30507. Epub 2012 Mar 14.
Blood pressure (BP), age, and reduced renal function are major risk factors for white-matter lesions (WMLs) in the general population. However, it remains unclear whether or not the BP itself or other parameters related to the BP are associated with WMLs in hypertensive patients with well-controlled BP. We investigated the relationships of the presence of WMLs with the central systolic BP (cSBP) and estimated glomerular filtration rate (eGFR) in treated hypertensive patients.
We studied 185 hypertensive patients with median duration of hypertension, 10.0 years, whose BP is controlled to SBP and diastolic BP (DBP) of 139 ± 17 and 79 ± 10 mmHg, respectively. We measured cSBP and brain magnetic resonance imaging (MRI) was examined within 2 weeks after last BP and biological measurements.
Patients with higher-grade WMLs, as assessed by the presence of Scheltens deep white-matter hyperintensity (SDWMH) in the frontal (grade 0-2 vs 3-6) and parietal areas (grade 0-2 vs 3-6) where small arteries are affected at earlier stage of hypertension, as well as that of Fazekas deep white-matter hyperintensity (FDWMH) (grade 2-3 vs 0-1) and Fazekas periventricular hyperintensity (FPVH) (grade 1-3 vs 0) were older, had higher serum creatinine levels, a longer duration of hypertension, and lower eGFR values. The grade of the WMLs was not associated with either the cSBP or the brachial SBP. In logistic regression analyses after adjustment for age, sex, cSBP, and hypertension duration, showed significant association between eGFR and WMLs. The patients with lower eGFR (<60 mL/minute/1.73 m(2)) tended to have higher grade WMLs. The odds ratio was 2.87 for FDWMH (P = 0.017), 1.99 for FPVH (P = 0.131), and 2.33 for SDWMH in the parietal area (P = 0.045).
Presence of WMLs was associated with eGFR, but not with either the brachial SBP or cSBP in hypertensive patients with well-controlled BP.
在普通人群中，血压（BP）、年龄和肾功能减退是脑白质病变（WMLs）的主要危险因素。然而，在血压控制良好的高血压患者中，血压本身或与血压相关的其他参数是否与WMLs相关仍不清楚。我们研究了经治疗的高血压患者中WMLs的存在与中心收缩压（cSBP）和估计肾小球滤过率（eGFR）之间的关系。
我们研究了185例高血压患者，高血压中位病程为10.0年，其血压分别控制在收缩压（SBP）139±17 mmHg和舒张压（DBP）79±10 mmHg。我们测量了cSBP，并在最后一次血压测量和生物学检测后的2周内进行了脑磁共振成像（MRI）检查。
通过Scheltens深部脑白质高信号（SDWMH）在额叶（0 - 2级与3 - 6级）和顶叶区域（0 - 2级与3 - 6级）的存在来评估，其中小动脉在高血压早期阶段受到影响，以及Fazekas深部脑白质高信号（FDWMH）（2 - 3级与0 - 1级）和Fazekas脑室周围高信号（FPVH）（1 - 3级与0级）来评估，WMLs分级较高的患者年龄更大，血清肌酐水平更高，高血压病程更长，eGFR值更低。WMLs的分级与cSBP或肱动脉收缩压均无关。在对年龄、性别、cSBP和高血压病程进行调整后的逻辑回归分析中，eGFR与WMLs之间存在显著关联。eGFR较低（<60 mL/分钟/1.73 m²）的患者往往有更高分级的WMLs。FDWMH的优势比为2.87（P = 0.017），FPVH为1.99（P = 0.131），顶叶区域SDWMH为2.33（P = 0.045）。
在血压控制良好的高血压患者中，WMLs的存在与eGFR相关，但与肱动脉收缩压或cSBP均无关。
