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Published on: December 16, 2021
Associations between systemic blood pressure parameters and intraplaque hemorrhage in symptomatic intracranial
Xiaowei Song1, Xihai Zhao2,3, David S Liebeskind4
1Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Insights
Systolic blood pressure (SBP) is linked to intraplaque hemorrhage (IPH) in stroke patients with intracranial atherosclerosis, but this association weakens after accounting for plaque burden. Blood pressure variability showed no significant link to IPH.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Intracranial atherosclerosis is a significant cause of stroke.
- The relationship between blood pressure (BP) parameters and intracranial vulnerable plaques, specifically intraplaque hemorrhage (IPH), remains incompletely understood.
- Understanding these associations is crucial for stroke risk stratification and management.
Purpose of the Study:
- To investigate the associations between systemic blood pressure parameters, including their variability, and the presence of intraplaque hemorrhage (IPH) in patients with intracranial atherosclerosis.
- To determine if systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), along with their variability, correlate with IPH in this patient cohort.
Main Methods:
- Retrospective analysis of high-resolution MRI data from a comprehensive stroke center.
- Vessel wall imaging was used to assess atherosclerotic plaque burden and identify IPH.
- Blood pressure parameters (SBP, DBP, PP) and their variability (SD, CV) from the first week of admission were collected and analyzed.
- Logistic regression analysis was employed to evaluate correlations between BP parameters and IPH, adjusting for confounders and cardiovascular risk factors.
Main Results:
- Systolic blood pressure (SBP) and pulse pressure (PP) were associated with multiple plaques and severe luminal stenosis after adjusting for confounders.
- SBP showed an association with IPH after adjusting for cardiovascular risk factors (OR=1.021, 95% CI: 1.003-1.038).
- This association between SBP and IPH was no longer significant after further correction for plaque burden (OR=1.014, 95% CI: 0.996-1.032).
- No significant associations were found between blood pressure variability and atherosclerotic plaque burden or IPH.
Conclusions:
- Systolic blood pressure (SBP) is associated with intraplaque hemorrhage (IPH) in stroke patients with intracranial atherosclerosis, particularly after accounting for cardiovascular risk factors.
- The association between SBP and IPH is attenuated when atherosclerotic plaque burden is considered, suggesting plaque burden may mediate this relationship.
- Blood pressure variability does not appear to be associated with IPH or plaque burden in this study, warranting further investigation into its role in intracranial atherosclerosis.
Abstract:
The associations between blood pressure parameters and intracranial vulnerable plaques have not been fully elucidated. The purpose of this study was to investigate the associations between systemic blood pressure parameters, as well as their variability, and intraplaque hemorrhage (IPH) in stroke patients with intracranial atherosclerosis. We retrospectively analyzed the high-resolution MRI data set of intracranial atherosclerosis from a comprehensive stroke center. The atherosclerotic plaque burden and presence of IPH in each vessel were obtained from vessel wall imaging. Blood pressure parameters in the first week of admission were used. The systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and their variability (standard deviation [SD] and coefficient of variation [CV]) were compared between the IPH (+) and IPH (-) groups. Logistic regression analysis was used to demonstrate the correlations between different blood pressure parameters and IPH. The results indicated that SBP and PP were associated with multiple plaques and severe luminal stenosis after adjusting for confounders, with OR = 1.071, 95% CI: (1.044-1.098) and OR = 1.039, 95% CI: (1.019-1.060) for SBP and OR = 1.058, 95% CI: (1.027-1.089) and OR = 1.044, 95% CI: (1.019-1.070) for PP, respectively. SBP was associated with IPH after adjusting for cardiovascular risk factors, with OR = 1.021, 95% CI: (1.003-1.038), but not after correcting for plaque burden, with OR = 1.014, 95% CI: (0.996-1.032). No associations between blood pressure variability and atherosclerotic plaque burden or IPH were detected in this study. In conclusion, SBP is associated with IPH after adjusting for cardiovascular risk factors but not after further correction for atherosclerotic plaque burden. The association between blood pressure variability and intracranial atherosclerosis requires further study.
