Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China.
Department of Neurology, The affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China,
Eur Neurol. 2020;83(4):351-359. doi: 10.1159/000510077. Epub 2020 Sep 9.
White matter lesions (WMLs) are currently considered as a cerebral microvascular disease, and hypertension is considered as its most important risk factor. This study analysis systematically evaluated the effects of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the progression of WMLs.
We searched the MeSH terms: "white matter," "blood pressure," "hypertension," "Leukoencephalopathy," and "leukoaraiosis" on PubMed and Cochrane from January 2000 to August 2019. A total of 12 closely related literature were included for research.
The results of the meta-analysis showed that the increase of both SBP and DBP can promote the progression of WMLs (respectively, odds ratio [OR] = 2.90, 95% confidence interval [CI] 2.86-2.94; OR = 3.13, 95% CI 3.03-3.23). Subgroup analysis found that patients with hypertension aged younger than 70 years are at a greater risk of WML progression when their DBP increased (OR = 4.69, 95% CI 3.31-6.65).
The relationship between DBP and WMLs is closer than that of SBP. Also, the risk of WML progression in patients aged under 70 years was higher than that in patients aged over 70 years. Furthermore, when DBP is elevated in patients younger than 70 years of age, the risk of WML progression may be higher. Therefore, it is expected that more researchers will attach importance to the change in DBP and identify the range of blood pressure and strategies that control DBP, thus contributing to delay the progression of WMLs.
脑白质病变（WML）目前被认为是一种脑微血管疾病，高血压被认为是其最重要的危险因素。本研究系统分析了收缩压（SBP）和舒张压（DBP）对 WML 进展的影响。
我们在 PubMed 和 Cochrane 上使用 MeSH 术语“white matter”、“blood pressure”、“hypertension”、“Leukoencephalopathy”和“leukoaraiosis”进行搜索，检索时间为 2000 年 1 月至 2019 年 8 月。共纳入 12 篇密切相关的文献进行研究。
荟萃分析结果表明，SBP 和 DBP 的升高均能促进 WML 的进展（分别为，优势比[OR] = 2.90，95%置信区间[CI] 2.86-2.94；OR = 3.13，95% CI 3.03-3.23）。亚组分析发现，年龄小于 70 岁的高血压患者，DBP 升高时 WML 进展的风险更高（OR = 4.69，95% CI 3.31-6.65）。
DBP 与 WML 的关系比 SBP 更密切。此外，70 岁以下患者的 WML 进展风险高于 70 岁以上患者。而且，当 70 岁以下患者的 DBP 升高时，WML 进展的风险可能更高。因此，预计将有更多的研究人员重视 DBP 的变化，并确定血压范围和控制 DBP 的策略，从而有助于延缓 WML 的进展。
