Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension

Abstract

Background and aims:We aimed to study the relationship between cerebral small vessel disease (cSVD) lesions, as markers of subclinical target organ damage (TOD) in the brain, and incident cardiovascular events (CVE).Methods:Data from the ISSYS (Investigating Silent Strokes in hYpertensives Study), which is a longitudinal and observational study conducted in patients with hypertension aged 50–70 years, and stroke-free at the inclusion. At the baseline visit, participants underwent a clinical interview, a brain MRI, urine and blood sampling collection and vascular testing studies. Therefore, we obtained markers of TOD from the brain [white matter hyperintensities, silent brain infarcts (SBI), cerebral microbleeds and enlarged perivascular spaces (EPVS)], from kidney (microalbuminuria, glomerular filtration) and regarding large vessels [ankle-to-brachial index (ABI), carotid–femoral pulse wave velocity]. Survival analyses were used to assess the relationship between these predictors and the incidence of cardiovascular events (CVE).Results:We followed-up 964 individuals within a median time of 5 years (4.7–5), representing 4377.1 persons-year. We found 73 patients presenting incident CVE, which corresponds to a rate of 8.2%. We found ABI less than 0.9 [hazard ratio, 2.2; 95% confidence interval (CI) 1.17–4.13, P value = 0.014] and SBI (hazard ratio, 2.9; 95% CI 1.47–5.58, P value = 0.002) independently associated with higher risk of incident CVE. The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CVE of 4.72%, according to the integrated discrimination index.Conclusion:Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension.

Association of Blood Pressure With Brain Ages: A Cohort Study of Gray and White Matter Aging Discrepancy in Mid-to-Older Adults From UK Biobank

“…However, the extent to which GM and WM respond differentially to raised BP is difficult to be accurately quantified. Although previous studies 7–9 have incorporated diverse magnetic resonance imaging measures to investigate the associations of hypertension with GM (such as cortical volume and thickness) and WM (such as WM volume, fractional anisotropy), a unified neuroimaging biomarker for comparing GM and WM health simultaneously is still absent.…”