Interarm differences in systolic blood pressure and the risk of dementia and subclinical brain injury

Pase, Matthew P.; Beiser, Alexa; Aparicio, Hugo J.; DeCarli, Charles; Vasan, Ramachandran S.; Murabito, Joanne M.; Seshadri, Sudha

doi:10.1016/j.jalz.2015.09.006

Cited by 11 publications

(14 citation statements)

References 47 publications

(60 reference statements)

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“…Thus, our study has revealed that IASBD and IADBD are variously related to the presence and burden of cerebral SVDs. In the recent Framingham Heart Study, a high IABD was associated with an increased risk of Alzheimer's disease and subclinical brain injury 27. The results of the present study are in line with those of that previous population-based study, and they provide additional information on stroke subjects.…”

Section: Discussionsupporting

confidence: 91%

Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients

Lee

et al. 2019

J Clin Neurol

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Background and Purpose An interarm blood pressure difference (IABD) is independently related to the occurrence of cardiovascular disease and mortality. Cerebral small-vessel diseases (SVDs) are important risk factors for stroke, cognitive dysfunction, and mortality. We aimed to determine whether IABD is related to cerebral SVDs. Methods This study included 1,205 consecutive noncardioembolic ischemic stroke patients as confirmed by brain MRI and simultaneously measured the bilateral brachial blood pressures. We investigated cerebral SVDs based on high-grade white-matter hyperintensities (HWHs), presence of cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs) on brain MRI. Results In multivariate logistic regression, an interarm systolic blood pressure difference (IASBD) ≥10 mm Hg was independently related to the existence of HWHs [odds ratio (OR)=1.94, 95% CI=1.32–2.84, p =0.011] and had a tendency to be associated with the presence of HPVSs (OR=1.45, 95% CI=0.49–2.23, p =0.089) and ALIs (OR=1.42, 95% CI=0.96–2.11, p =0.052), but not with the presence of CMBs (OR=1.09, 95% CI=0.73–1.61, p =0.634). In multivariate linear regression adjusted for age, sex, and variables with p <0.1 in the univariate analysis, IASBD ≥10 mm Hg and interarm diastolic blood pressure difference ≥10 mm Hg were significantly correlated with an increased total burden of SVDs (β=0.080 and p =0.006, and β=0.065 and p =0.023, respectively). Conclusions This study found that IABD ≥10 mm Hg was associated with the presence and increased burden of cerebral SVDs in noncardioembolic stroke patients. This suggests that IABD ≥10 mm Hg could be a useful indicator of the presence and burden of cerebral SVDs in stroke patients.

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Section: Discussionsupporting

confidence: 91%

Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients

Lee

et al. 2019

J Clin Neurol

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“…Another issue is the role of genetic variants in determining susceptibility to vascular risk and lifestyle changes. 62, 66, 67 …”

Section: Do Temporal Trends In Vascular Risk Factors Contribute To Thmentioning

confidence: 99%

“…For example, many studies report that the association of vascular risk factors with dementia is dependent on the APOE e4 allele. 62, 63 …”

Section: Figurementioning

confidence: 99%

Role of Improved Vascular Health in the Declining Incidence of Dementia

Pase

Satizabal

Seshadri

2017

Stroke

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“… 31 Recent data suggest that IAD may also be associated prospectively with greater cognitive decline. 37 38 …”

Section: Introductionmentioning

confidence: 99%

Associations between interarm differences in blood pressure and cardiovascular disease outcomes: protocol for an individual patient data meta-analysis and development of a prognostic algorithm

et al. 2017

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IntroductionIndividual cohort studies in various populations and study-level meta-analyses have shown interarm differences (IAD) in blood pressure to be associated with increased cardiovascular and all-cause mortality. However, key questions remain, such as follows: (1) What is the additional contribution of IAD to prognostic risk estimation for cardiovascular and all-cause mortality? (2) What is the minimum cut-off value for IAD that defines elevated risk? (3) Is there a prognostic value of IAD and do different methods of IAD measurement impact on the prognostic value of IAD? We aim to address these questions by conducting an individual patient data (IPD) meta-analysis.Methods and analysisThis study will identify prospective cohort studies that measured blood pressure in both arms during recruitment, and invite authors to contribute IPD datasets to this collaboration. All patient data received will be combined into a single dataset. Using one-stage meta-analysis, we will undertake multivariable time-to-event regression modelling, with the aim of developing a new prognostic model for cardiovascular risk estimation that includes IAD. We will explore variations in risk contribution of IAD across predefined population subgroups (eg, hypertensives, diabetics), establish the lower limit of IAD that is associated with additional cardiovascular risk and assess the impact of different methods of IAD measurement on risk prediction.Ethics and disseminationThis study will not include any patient identifiable data. Included datasets will already have ethical approval and consent from their sponsors. Findings will be presented to international conferences and published in peer reviewed journals, and we have a comprehensive dissemination strategy in place with integrated patient and public involvement.PROSPERO registration numberCRD42015031227.

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Interarm differences in systolic blood pressure and the risk of dementia and subclinical brain injury

Cited by 11 publications

References 47 publications

Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients

Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients

Role of Improved Vascular Health in the Declining Incidence of Dementia

Associations between interarm differences in blood pressure and cardiovascular disease outcomes: protocol for an individual patient data meta-analysis and development of a prognostic algorithm

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