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Additional predisposing risk factors for atherothrombotic cerebrovascular disease among treated hypertensive
Insights
Low cerebral blood flow (CBF) and smoking predict cerebrovascular disease in hypertensive individuals. This 7-year study highlights key risk factors for stroke and dementia in older adults.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Gerontology
Background:
- Hypertension is a major risk factor for cerebrovascular disease.
- Identifying early predictors in asymptomatic individuals is crucial for prevention.
Purpose of the Study:
- To investigate predictive validities of risk factors for atherothrombotic cerebrovascular disease in neurologically normal elderly hypertensives.
- To assess the relationship between cerebral blood flow (CBF) and cerebrovascular events.
Main Methods:
- Prospective longitudinal study of 107 neurologically normal hypertensive volunteers.
- Mean follow-up of 50.12 months, monitoring for stroke, transient ischemic attacks, and multi-infarct dementia.
- Initial measurement of mean gray matter cerebral blood flow (CBF).
Main Results:
- 23% of participants developed cerebrovascular disease.
- Lower initial CBF (<60.0 ml/100 g/min) was associated with a 50% incidence of cerebrovascular disease.
- Cigarette smoking significantly increased cerebrovascular disease incidence (32.5% vs. 17.2% in non-smokers).
Conclusions:
- Mean gray matter CBF is a sensitive predictor of future cerebrovascular disease in hypertensive individuals.
- Smoking is a significant risk factor for cerebrovascular events in this cohort.
- Early detection of low CBF and smoking cessation are vital for cerebrovascular disease prevention in the elderly hypertensive population.
Abstract:
A 7-year prospective study of a cohort of 107 neurologically normal elderly hypertensive volunteers (mean age, 65.8 +/- 8.3 years) was undertaken to investigate the predictive validities of additional risk factors for atherothrombotic cerebrovascular disease including stroke, transient ischemic attacks, reversible ischemic neurological deficits, and multi-infarct dementia. This longitudinal study has been in progress now for 7 years with a mean follow-up interval of 50.12 +/- 5.76 months. Among 107 formerly symptom-free, normal hypertensive volunteers, 25 (23%) have developed cerebrovascular disease, 7 (6.5%) sustained a stroke, 10 (9.3%) developed multi-infarct dementia, and 18 (16.8%) have transient ischemic attacks. None have suffered intracranial hemorrhage. Mean gray matter cerebral blood flow (CBF) values measured at the initial visit were sensitive predictors of cerebrovascular disease. Eight of 16 hypertensives (50%) with initial CBF values below 60.0 ml/100 g/min now exhibit signs and symptoms of cerebrovascular disease, while 11 of 43 hypertensives (25.6%) with initial CBF values between 60.1 and 69.9 ml/100 g/min and only 6 of 48 (12.5%) with initial CBF levels above 70.0 developed cerebrovascular disease. Incidence of cerebrovascular disease among cigarette smoking hypertensive volunteers (32.5%) was significantly greater than among nonsmokers (17.2%).