From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.).
Stroke. 2017 Jul;48(7):1842-1848. doi: 10.1161/STROKEAHA.117.017207. Epub 2017 Jun 8.
This study aimed to evaluate the effect of a nurse-led multidomain cardiovascular intervention on white matter hyperintensity (WMH) progression and incident lacunar infarcts in community-dwelling elderly with hypertension.
The preDIVA trial (Prevention of Dementia by Intensive Vascular Care) was an open-label, cluster-randomized controlled trial in community-dwelling individuals aged 70 to 78 years. General practices were assigned by computer-generated randomization to 6-year nurse-led, multidomain intensive vascular care or standard care. Of 3526 preDIVA participants, 195 nondemented participants with a systolic blood pressure ≥140 mm Hg were consecutively recruited to undergo magnetic resonance imaging at 2 to 3 and 5 to 6 years after baseline. WMH volumes were measured automatically, lacunar infarcts assessed visually, blinded to treatment allocation.
One hundred and twenty-six participants were available for longitudinal analysis (64 intervention and 62 control). Annual WMH volume increase in milliliter was similar for intervention (mean=0.73, SD=0.84) and control (mean=0.70, SD=0.59) participants (adjusted mean difference, -0.08 mL; 95% confidence interval, -0.30 to 0.15; =0.50). Analyses suggested greater intervention effects with increasing baseline WMH volumes ( for interaction=0.03). New lacunar infarcts developed in 6 (9%) intervention and 2 (3%) control participants (odds ratio, 2.2; 95% confidence interval, 0.4-12.1; =0.36).
Nurse-led vascular care in hypertensive community-dwelling older persons did not diminish WMH accumulation over 3 years. However, our results do suggest this type of intervention could be effective in persons with high WMH volumes. There was no effect on lacunar infarcts incidence but numbers were low.
URL: http://www.isrctn.com/ISRCTN29711771. Unique identifier: ISRCTN29711771.
本研究旨在评估护士主导的多领域心血管干预对高血压社区居住老年人脑白质高信号（WMH）进展和腔隙性梗死事件的影响。
preDIVA 试验（通过强化血管护理预防痴呆）是一项针对 70 至 78 岁社区居住个体的开放性、群组随机对照试验。采用计算机生成的随机化方法将全科医生诊所分配到 6 年的护士主导的多领域强化血管护理或标准护理。在 3526 名 preDIVA 参与者中，连续招募了 195 名基线后 2 至 3 年和 5 至 6 年时无痴呆且收缩压≥140mmHg 的非痴呆参与者进行磁共振成像检查。WMH 体积采用自动测量，腔隙性梗死采用盲法评估。
126 名参与者可进行纵向分析（干预组 64 名，对照组 62 名）。干预组（平均=0.73，标准差=0.84）和对照组（平均=0.70，标准差=0.59）参与者的每年 WMH 体积增加量相似（调整平均差异，-0.08 毫升；95%置信区间，-0.30 至 0.15；=0.50）。分析表明，随着基线 WMH 体积的增加，干预效果更大（交互作用=0.03）。6 名（9%）干预参与者和 2 名（3%）对照组参与者出现新的腔隙性梗死（比值比，2.2；95%置信区间，0.4-12.1；=0.36）。
在高血压社区居住的老年人中，护士主导的血管护理并未在 3 年内减少 WMH 的积累。然而，我们的结果确实表明，这种类型的干预措施可能对 WMH 体积较高的患者有效。该干预措施对腔隙性梗死的发生率没有影响，但数量较低。
网址：http://www.isrctn.com/ISRCTN29711771。唯一识别码：ISRCTN29711771。
