Association between the Severity of Cerebral Small Vessel Disease, Pulsatility of Cerebral Arteries, and Brachial Ankle Pulse Wave Velocity in Patients with Lacunar Infarction

Kim, Dae-Hyun; Choi, Jae-Hyeong; Moon, Jung-Soo; Kim, Hyun-Jung; Cha, Jae‐Kwan

doi:10.1159/000319923

Cited by 25 publications

(24 citation statements)

References 56 publications

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“…However, these variables may not account for changes in pulsatile hemodynamics associated with aging and hypertension. As the impact of arterial stiffness on the brain is realized (24,51), the importance of understanding pulsatile regulatory mechanisms of cerebral hemodynamics will become essential. CrCP and RAP are sensitive to both pulsatile and mean characteristics of the pressure wave.…”

Section: Discussionmentioning

confidence: 99%

“…Despite similar posture-induced changes in mean pressure, PP is reduced in young adults and maintained in older adults during standing (29). Further, within-beat pulsatile characteristics are enhanced by arterial stiffening common to aging and hypertension (24,51), yet their influence on CA has not been thoroughly examined. A comparison of CA in hypertension, through transfer function analysis (TFA) at the cardiac frequency (ϳ1.0 Hz), found that hypertensive older adults retained autoregulatory function (45); however, the TFA approach still relies on dynamic fluctuations of mean pressure and velocity.…”

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confidence: 99%

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Assessing cerebrovascular autoregulation from critical closing pressure and resistance area product during upright posture in aging and hypertension

Robertson

Edgell

Hughson

2014

American Journal of Physiology-Heart and Circulatory Physiology

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Robertson AD, Edgell H, Hughson RL. Assessing cerebrovascular autoregulation from critical closing pressure and resistance area product during upright posture in aging and hypertension. Am J Physiol Heart Circ Physiol 307: H124 -H133, 2014. First published May 23, 2014 doi:10.1152/ajpheart.00086.2014.-Static cerebral autoregulation (sCA) is believed to be resistant to aging and hypertensive pathology. However, methods to characterize autoregulation commonly rely on beat-by-beat mean hemodynamic measures and do not consider within-beat pulse wave characteristics that are impacted by arterial stiffening. We examined the role of critical closing pressure (CrCP) and resistance area product (RAP), two measures derived from the pulse wave, across supine lying, sitting, and standing postures in young adults, normotensive older adults, and older adults with controlled and uncontrolled hypertension (N ϭ 80). Traditional measures of sCA, using both intracranial and extracranial methods, indicated similar efficiency across all groups, but within-beat measures suggested different mechanisms of regulation. At rest, RAP was increased in hypertension compared with young adults (P Ͻ 0.001), but CrCP was similar. In contrast, the drop in CrCP was the primary regulator of change in cerebrovascular resistance upon adopting an upright posture. Both CrCP and RAP demonstrated group-by-posture interaction effects (P Ͻ 0.05), with older hypertensive adults exhibiting a rise in RAP that was absent in other groups. The posturerelated swings in CrCP and RAP were related to changes in both the pulsatile and mean components of arterial pressure, independent of age, cardiac output, and carbon dioxide. Group-by-posture differences in pulse pressure were mediated in part by an attenuated heart rate response in older hypertensive adults (P ϭ 0.002). Examination of pulsatile measures in young, elderly, and hypertensive adults identified unique differences in how cerebral blood flow is regulated in upright posture. middle cerebral artery; carotid arteries; Doppler ultrasound; pulse pressure ORTHOSTATIC INTOLERANCE is a primary contributing factor to hospitalizations of older adults, with syncope being a prevalent trigger for admittance to emergency departments (46). Syncope and falls are often precipitated by symptoms of cerebral hypoperfusion, including dizziness and confusion (39). Even in young adults, cerebral blood flow (CBF) is lower when sitting or standing compared with lying supine (33, 41). Hence, a lower resting CBF, as observed in aging and hypertension (6), increases the risk for transient hypoperfusion in upright postures and emphasizes the need for effective cerebrovascular control. Cerebral autoregulation (CA) characterizes the efficiency in maintaining CBF despite changes in arterial blood pressure (ABP) (48) and is commonly assessed by the change in cerebrovascular resistance (CVR) for a given change in pressure (21,26,48). When considering CVR as the solitary regulator (i.e., CVR ϭ ABP/CBF), CA has proven to be a robust physio...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Assessing cerebrovascular autoregulation from critical closing pressure and resistance area product during upright posture in aging and hypertension

Robertson

Edgell

Hughson

2014

American Journal of Physiology-Heart and Circulatory Physiology

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“…Cerebral autoregulation (CA) maintains a relatively constant CBF, over a wide range of precerebral arterial pressure [2]. With aging, the cardiovascular system undergoes numerous changes, including an increase in the systolic pressure, a decrease in the arterial compliance and changes in the cerebrovascular hemodynamic [3]. The loss of CA may be an important risk factor for stroke.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Valsartan versus Non-RAAS Treatment on Autoregulation of Cerebral Blood Flow

Périard¹,

Rey²,

Casagrande³

et al. 2012

Cerebrovasc Dis

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Background: Cerebral autoregulation (CA) is a protective mechanism which maintains the steadiness of the cerebral blood flow (CBF) through a broad range of systemic blood pressure (BP). Acute hypertension has been shown to reduce the cerebrovascular adaptation to BP variations. However, it is still unknown whether CA is impaired in chronic hypertension. This study evaluated whether a strict control of BP affects the CA in patients with chronic hypertension, and compared a valsartan-based regimen to a regimen not inhibiting the renin-angiotensin-aldosterone system (non-RAAS). Methods: Eighty untreated patients with isolated systolic hypertension were randomized to valsartan 320 mg or to a non-RAAS regimen during 6 months. The medication was upgraded to obtain BP <140/90 mm Hg. Continuous recordings of arterial BP and CBF velocity (transcranial Doppler) were performed during periods of 5 minutes, at rest, and at different levels of alveolar CO₂ pressure provided by respiratory maneuvers. The dominant frequency of CBF oscillations was determined for each patient. Dynamic CA was measured as the mean phase shift between BP and CBF by cross-spectral analysis in the medium frequency and in the dominant CBF frequency. Results: Mean ambulatory 24-hour BP fell from 144/87 to 127/79 mm Hg in the valsartan group and from 144/87 to 134/81 mm Hg in the non-RAAS group (p = 0.13). Both groups had a similar reduction in the central BP and in the carotido-femoral pulse wave velocity. The average phase shift between BP fluctuations and CBF response at rest was normal at randomization (1.82 ± 0.08 s), which is considered a preserved autoregulation and increased to 1.91 ± 0.12 s at the end of study (p = 0.45). The comparison of both treatments showed no significant difference (–0.01 ± 0.17 s vs. 0.16 ± 0.16 s, p = 0.45) for valsartan versus non-RAAS groups. The plasmatic level of glycosylated hemoglobin decreased in the valsartan arm compared to the non-RAAS arm (–0.23 ± 0.06 vs. –0.08 ± 0.07%, p = 0.07). Conclusions: In elderly hypertensive men with isolated chronic systolic hypertension, CA seems efficient at baseline and is not significantly affected by 6 months of BP-lowering treatment. This suggests that the preventive effects of BP medication against stroke are not mediated through a restoration of the CA.

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“…In particular, the development of diabetic microangiopathy, including microalbuminuria (12), renal dysfunction (13,14), retinopathy (15), neuropathy (16,17), and evidence of macroangiopathy (18)(19)(20)(21), is individually associated with the progression of arterial stiffness. These pathological complexities in subjects with diabetes might necessitate a review of adequate baPWV thresholds that splice the risks of mortality and morbidity.…”

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confidence: 99%

Brachial-Ankle Pulse Wave Velocity Predicts All-Cause Mortality and Cardiovascular Events in Patients With Diabetes: The Kyushu Prevention Study of Atherosclerosis

et al. 2014

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OBJECTIVEWhether brachial-ankle pulse wave velocity (baPWV), a noninvasive marker for arterial stiffness, is a useful predictive maker for cardiovascular events in subjects with diabetes is not established. In the present cohort study, we evaluated the benefit of baPWV for the prediction of cardiovascular morbidity and mortality in subjects with diabetes. RESEARCH DESIGN AND METHODSA total of 4,272 outpatients with diabetes were enrolled in the Kyushu Prevention Study of Atherosclerosis. Of these, 3,628 subjects, excluding those with an ankle-brachial index of <0.9, were prospectively followed for 3.2 6 2.2 years. The baPWV at baseline was classified by recursive partitioning (RP) for each end point. We plotted the Kaplan-Meier curves for high-and low-baPWV groups, which were designated based on the cutoff points, and calculated Cox proportional hazards models. RESULTSThe elevation of baPWV quartiles was significantly correlated to the incidence of coronary artery events, cerebrovascular events, and all-cause mortality. RP revealed baPWVs of 14 and 24 m/s as statistically adequate cutoff points for cardiovascular events and mortality, respectively. High-baPWV classes showed significantly low event-free ratios in Kaplan-Meier curves for all end points and remained independent risks for all-cause mortality and cerebrovascular events, but not for coronary artery events after adjustments for age, sex, BMI, hypertension, hyperlipidemia, smoking, and hemoglobin A 1c by Cox proportional hazards models. CONCLUSIONSThis large-scale cohort study provided evidence that high baPWV is a useful independent predictor of mortality and cardiovascular morbidity in subjects with diabetes.

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Association between the Severity of Cerebral Small Vessel Disease, Pulsatility of Cerebral Arteries, and Brachial Ankle Pulse Wave Velocity in Patients with Lacunar Infarction

Cited by 25 publications

References 56 publications

Assessing cerebrovascular autoregulation from critical closing pressure and resistance area product during upright posture in aging and hypertension

Assessing cerebrovascular autoregulation from critical closing pressure and resistance area product during upright posture in aging and hypertension

The Effect of Valsartan versus Non-RAAS Treatment on Autoregulation of Cerebral Blood Flow

Brachial-Ankle Pulse Wave Velocity Predicts All-Cause Mortality and Cardiovascular Events in Patients With Diabetes: The Kyushu Prevention Study of Atherosclerosis

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