Lever-Megina Carla Geovanna, Cavero-Redondo Iván, Saz-Lara Alicia, Moreno-Herráiz Nerea, Rescalvo-Fernández Elena, Otero-Luis Iris
CarVasCare Research Group, Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16001, Cuenca, Spain.
Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, 3460000, Talca, Chile.
Hypertens Res. 2025 Jan;48(1):314-326. doi: 10.1038/s41440-024-01963-6. Epub 2024 Oct 25.
Cerebral microbleeds are associated with events that are among the highest mortality and disability events combined worldwide, as well as with hypertensive vasculopathy. The aim of the present study was to investigate the relationship between a marker of hypertensive vasculopathy, arterial stiffness assessed by pulse wave velocity, and cerebral microbleeds. A systematic review and meta-analysis was performed using PubMed, Scopus, and Web of Science, according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Cochrane Collaboration Handbook statements. Data extraction, quality assessment and statistical analyses were performed following pre-established criteria. Twenty-one studies involving 18,436 participants were included. Higher levels of pulse wave velocity were associated with a higher presence of cerebral microbleeds p-OR = 1.26 (95% CI; 1.09-1.45), with considerable heterogeneity; even adjusting for potential confounding variables p-OR = 1.12 (95% CI, 1.05-1.20), with substantial heterogeneity. Only the percentage of women was related to p-OR in the adjusted model. Sensitivity analyses confirmed the robustness of our results. Adjusted models showed publication bias. Higher levels of arterial stiffness are associated with greater presence of cerebral microbleeds. This phenomenon may be caused by damage to the brain under higher blood flow loads, in turn due to age-induced reversal of the stiffness gradient between large and small vessels. As the world's population is undergoing demographic ageing, our results underline the importance of establishing pulse wave velocity as a cardiovascular marker for early screening and delaying the onset of the characteristic signs of both diseases.
脑微出血与全球范围内死亡率和致残率最高的事件以及高血压性血管病相关。本研究的目的是探讨高血压性血管病的一个标志物，即通过脉搏波速度评估的动脉僵硬度与脑微出血之间的关系。根据流行病学观察性研究的荟萃分析（MOOSE）和Cochrane协作手册声明，使用PubMed、Scopus和Web of Science进行了系统评价和荟萃分析。按照预先设定的标准进行数据提取、质量评估和统计分析。纳入了21项涉及18436名参与者的研究。较高的脉搏波速度与较高的脑微出血发生率相关，比值比为1.26（95%置信区间：1.09 - 1.45），存在相当大的异质性；即使对潜在的混杂变量进行调整后，比值比仍为1.12（95%置信区间，1.05 - 1.20），异质性依然显著。在调整模型中，只有女性比例与比值比相关。敏感性分析证实了我们结果的稳健性。调整后的模型显示存在发表偏倚。较高的动脉僵硬度与较多的脑微出血相关。这种现象可能是由于较高血流负荷下对大脑的损伤所致，而这又是由于年龄导致的大血管和小血管之间僵硬度梯度逆转引起的。随着世界人口的老龄化，我们的结果强调了将脉搏波速度确立为心血管标志物以进行早期筛查和延缓这两种疾病特征性体征发作的重要性。
