van Dooren Miesje, Staals Julie, de Leeuw Peter W, Kroon Abraham A, Henskens Léon H, van Oostenbrugge Robert J
Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands;
Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands;
Am J Hypertens. 2014 Aug;27(8):1045-51. doi: 10.1093/ajh/hpu032. Epub 2014 Mar 7.
Brain microbleeds (BMBs) are common in hypertensive patients and are associated with higher blood pressure (BP) levels. Little is known about risk factors for progression of BMBs, in particular the contribution of ambulatory BP levels. We aimed to determine BMB progression and the association with BP levels in a cohort of essential hypertensive patients.
At baseline and after 2 years of follow-up, 193 participants underwent brain magnetic resonance imaging (MRI) and 24-hour ambulatory BP measurement in addition to office BP measurement. The relation between BMB progression and baseline untreated BP characteristics was tested in logistic regression analyses.
Progression of BMBs on follow-up MRI was seen in 12 (6%) participants. Patients with progression were significantly older, and the prevalence as well as total number of BMBs at baseline was greater. With correction for age and sex, baseline 24-hour systolic and diastolic BP and 24-hour pulse pressure significantly predicted progression. Similar results were seen for baseline awake and asleep BP. On additional adjustments for baseline presence of BMBs, the associations remained significant for 24-hour, awake, and asleep systolic BP, awake diastolic BP, and awake and asleep pulse pressure. Office systolic BP was also associated with progression of BMBs, whereas office diastolic BP was not.
High ambulatory BP levels are important and possibly modifiable predictors for progression of BMBs. This warrants further study, with an adequately long follow-up period and early adequate treatment of hypertension.
脑微出血（BMBs）在高血压患者中很常见，且与较高的血压（BP）水平相关。关于BMBs进展的危险因素，尤其是动态血压水平的影响，人们了解甚少。我们旨在确定一组原发性高血压患者中BMBs的进展情况及其与血压水平的关联。
在基线期和随访2年后，193名参与者除进行诊室血压测量外，还接受了脑磁共振成像（MRI）检查和24小时动态血压测量。在逻辑回归分析中测试了BMBs进展与基线未治疗血压特征之间的关系。
12名（6%）参与者在随访MRI中出现了BMBs进展。进展的患者年龄显著更大，基线时BMBs的患病率和总数也更高。校正年龄和性别后，基线24小时收缩压和舒张压以及24小时脉压显著预测进展情况。基线清醒和睡眠血压也有类似结果。在对基线BMBs存在情况进行额外调整后，24小时、清醒和睡眠收缩压、清醒舒张压以及清醒和睡眠脉压的关联仍然显著。诊室收缩压也与BMBs进展相关，而诊室舒张压则不然。
高动态血压水平是BMBs进展的重要且可能可改变的预测因素。这值得进一步研究，要有足够长的随访期并对高血压进行早期充分治疗。
