The Association of Nocturnal Blood Pressure Patterns and Other Influencing Factors With Lacunes and Enlarged Perivascular Spaces in Hypertensive Patients

Abstract

PurposeNocturnal blood pressure dipping patterns have been associated with an increased risk of Cerebral Small Vessel Disease (CSVD), which has not been well-studied. This study is aimed to explore the association of dipping patterns and other factors with lacunes and enlarged perivascular spaces (EPVS) in patients with hypertension.MethodsWe enrolled a total of 1,322 patients with essential hypertension in this study. Magnetic resonance imaging (MRI) scans and 24-h ambulatory blood pressure (BP) monitoring were completed. Nocturnal BP decline was calculated, and then dipping patterns were classified. Patients were classified into four groups according to the performance of lacunes and EPVS in the MRI scan for statistical analysis.Results(1) Nocturnal BP decline showed independent negative correlation with both lacunes and EPVS while mean systolic BP (mSBP) level showed an independent positive correlation with them (P < 0.05). (2) The frequency of reverse-dippers in the control group was significantly lower than that in other groups; the frequency of non-dippers in the lacunes group and EPVS group was significantly lower than that in the control group; the frequency of extreme-dippers in the EPVS group was significantly higher than that in the mixed (lacunes with EPVS) group (P < 0.05).ConclusionsBoth mSBP and dipping patterns might play an important role in developing lacunes and EPVS in patients with hypertension.

Asymptomatic cerebral small vessel disease in adults with low cardiovascular risk

“…In the current investigation, the presence of PVS was very frequent in individuals with all levels of CV risk (including LR patients), and considering that more than 75% of them were hypertensive, this would support the effect of hypertension on the glymphatic system, expressed through the demonstration of enlarged PVS 29. Very recently Gao et al also reported the frequent occurrence of PVS in a very large cohort of individuals without neurological involvement 30…”

“…29 Very recently Gao et al also reported the frequent occurrence of PVS in a very large cohort of individuals without neurological involvement. 30 More severe WMH (Fazekas 2-3) were encountered in one third of the patients included in this investigation, being significantly more frequent and severe in the M/HR group. It is important to emphasise that these more severe WMH scores were also present in 14% of LR patients.…”

Unraveling the Predictors of Enlarged Perivascular Spaces: A Comprehensive Logistic Regression Approach in Cerebral Small Vessel Disease

“…The studies by Klarenbeek et al and Gao et al support this notion. 16 , 17 The significant correlation with lipoprotein a suggests a role for lipid metabolism abnormalities in the development of EPVS. This may relate to atherosclerosis and vascular inflammation, 18 , 19 known risk factors for cerebrovascular disease.…”