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Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure
K Shimada1, A Kawamoto, K Matsubayashi
1Department of Medicine and Geriatrics, Kochi Medical School, Japan.
Insights
Ambulatory blood pressure monitoring better predicts latent cerebrovascular disease in elderly individuals than casual pressure measurements. This finding highlights the importance of continuous blood pressure monitoring for detecting early signs of vascular changes.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebrovascular disease is a significant concern in the elderly.
- The relationship between blood pressure monitoring methods and subclinical cerebrovascular changes requires further investigation.
Purpose of the Study:
- To compare the predictive value of average daily blood pressure versus casual blood pressure for detecting cerebrovascular disease.
- To investigate the association between magnetic resonance imaging (MRI) findings suggestive of vascular etiology and different blood pressure measurements.
Main Methods:
- The study included 73 elderly individuals (mean age 70 ± 6 years), both normotensive and hypertensive.
- Brain MRI was used to assess lacunae and periventricular hyperintensities.
- Noninvasive ambulatory blood pressure monitoring (24-hour, awake, asleep) and office blood pressure measurements were recorded.
Main Results:
- Lacunae and periventricular hyperintensities were correlated with advancing age.
- Cerebrovascular MRI abnormalities were associated with average ambulatory blood pressure, particularly during sleep, but not with office blood pressure.
- Subgroup analysis showed MRI abnormalities aligned with 24-hour blood pressure levels, not clinic pressures.
Conclusions:
- Ambulatory blood pressure monitoring is superior to casual measurements in identifying latent cerebrovascular disease in seemingly healthy elderly individuals.
- Subclinical cerebrovascular changes are common in the elderly and may be better detected by continuous blood pressure monitoring.
Abstract:
Does the average daily blood pressure correlate with hypertensive cerebrovascular disease better than the casual pressure, as has been reported in other target organ involvement? We investigated the associations of two abnormal findings on brain magnetic resonance imaging suggestive of a vascular etiology, low intense foci (lacunae), and periventricular hyperintense lesions on T1- and T2-weighted images, with both office and average daily blood pressure values in a population of 73 healthy normotensive and hypertensive elderly individuals (70 +/- 6 years old). Lacunae were detected in 34 subjects (47%); the number per subject ranged from 0 to 19 and was significantly correlated with advancing age. Furthermore, these changes were supposedly related to the average of noninvasive ambulatory (24-hour and during awake and asleep periods) pressure recordings but not to office pressures. The grade of periventricular hyperintensity was also significantly associated with advancing age and the average of ambulatory systolic pressure recordings, particularly during sleep, but not with office blood pressure. In comparisons of normotensive, "office hypertensive," and hypertensive subgroups, abnormalities on magnetic resonance imaging were appropriate to the level of the 24-hour blood pressure measurements but not to that of clinic pressure. In hypertensive patients, the presence of electrocardiographic evidence of left ventricular hypertrophy was also associated with greater abnormalities on magnetic resonance imaging. We conclude that ambulatory blood pressure monitoring is superior to casual pressure measurements in predicting latent cerebrovascular disease, which is unexpectedly common in apparently healthy elderly subjects.