Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea.
J Hum Hypertens. 2022 Jan;36(1):14-23. doi: 10.1038/s41371-021-00490-y. Epub 2021 Feb 15.
We investigated ambulatory blood pressure (BP) monitoring (ABPM) profiles and magnetic resonance imaging (MRI) findings of cerebral small-vessel disease (cSVD) in older adults with cognitive complaints who were grouped as follows: subjective cognitive decline, mild cognitive impairment, and dementia of Alzheimer's type. Group comparisons and correlation analyses among demographic characteristics, cognitive and MRI findings, and ABPM profiles were performed. Furthermore, multivariate logistic regression analyses for dependent variables of (1) dementia or not and (2) MRI criteria of subcortical vascular dementia (SVaD) or not were conducted with independent variables of dichotomized ABPM profiles. A total of 174 subjects (55 males and 119 females) were included: mean age 75.36 ± 7.13 years; Mini-Mental State Examination (MMSE) score 20.51 ± 6.23. No MRI and ABPM findings except medial temporal atrophy were different between three groups. Twenty-four-hour systolic BP (sBP) was correlated with MMSE score (r = -0.182; p = 0.022) and the severity of white matter hyperintensity (WMH) (r = 0.157; p = 0.048). A higher daytime sBP was associated with dementia (odds ratio (OR): 3.734; 95% confidence interval (CI): 1.041-13.390; p = 0.043) and MRI finding of SVaD (OR: 10.543; 95% CI: 1.161-95.740; p = 0.036). Although there were no differences in ABPM profiles between three groups, a higher BP-especially a higher sBP-correlated with cognitive dysfunction and severity of WMH in older adults. Only higher daytime sBP was an independent predictor for dementia and MRI findings of SVaD. Among various ABPM profiles in this study, a higher BP, especially a higher sBP, may be considered the most important for clinical and MRI findings of cSVD.
我们研究了有认知主诉的老年患者的动态血压（ABPM）监测（ABPM）谱和脑小血管疾病（cSVD）的磁共振成像（MRI）结果，这些患者被分为以下几组：主观认知下降、轻度认知障碍和阿尔茨海默病型痴呆。对人口统计学特征、认知和 MRI 结果以及 ABPM 谱进行组间比较和相关性分析。此外，对（1）痴呆或非痴呆和（2）MRI 皮质下血管性痴呆（SVaD）标准或非 MRI 标准的因变量进行多元逻辑回归分析，自变量为二分 ABPM 谱。共纳入 174 例患者（55 例男性，119 例女性），平均年龄 75.36±7.13 岁，简易精神状态检查（MMSE）评分 20.51±6.23。除内侧颞叶萎缩外，三组间 MRI 和 ABPM 检查结果无差异。24 小时收缩压（sBP）与 MMSE 评分（r=-0.182，p=0.022）和白质高信号（WMH）严重程度（r=0.157，p=0.048）相关。日间 sBP 升高与痴呆（优势比（OR）：3.734；95%置信区间（CI）：1.041-13.390；p=0.043）和 MRI 皮质下血管性痴呆（OR：10.543；95% CI：1.161-95.740；p=0.036）有关。虽然三组 ABPM 谱无差异，但较高的血压，尤其是 sBP，与老年人认知功能障碍和 WMH 严重程度相关。只有日间 sBP 较高是痴呆和 MRI 皮质下血管性痴呆的独立预测因素。在本研究的各种 ABPM 谱中，较高的血压，尤其是较高的 sBP，可能被认为是 cSVD 的临床和 MRI 结果最重要的因素。
