The relationship between ambulatory blood pressure variability and enlarged perivascular spaces: a cross-sectional study

Yang, Shuna; Qin, Wei; Yang, Lei; Fan, Huimin; Li, Yue; Yin, Ju; Hu, Wenli

doi:10.1136/bmjopen-2016-015719

Cited by 39 publications

(35 citation statements)

References 30 publications

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“…EPVS, also known as Virchow–Robin spaces, are most likely to be identified in T2-weighted MRI and are characterized by punctate or linear signal intensities similar to cerebrospinal fluids. [ 21 22 ]…”

Section: E Nlarged P Erivascular mentioning

confidence: 99%

“…These results support the notion that EPVS in the BG may be a marker of CSVD. [ 22 28 ] The results of a prospective cohort study showed that WM-EPVS was associated with cerebral amyloid angiopathy (CAA) and superficial siderosis. [ 29 ] Conversely, a prospective, multicenter, hospital-based study published by Zhang et al .…”

Section: E Nlarged P Erivascular mentioning

confidence: 99%

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Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Yang

Dong

Lyu

et al. 2018

Chinese Medical Journal

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Objective:Alzheimer's disease and vascular dementia are responsible for more than 80% of dementia cases. These two conditions share common risk factors including hypertension. Cerebral small vessel disease (CSVD) is strongly associated with both hypertension and cognitive impairment. In this review, we identify the pathophysiological changes in CSVD that are caused by hypertension and further explore the relationship between CSVD and cognitive impairment.Data Sources:We searched and scanned the PubMed database for recently published literatures up to December 2017. We used the keywords of “hypertension”, “cerebral small vessel disease”, “white matter lesions”, “enlarged perivascular spaces”, “lacunar infarcts”, “cerebral microbleeds”, and “cognitive impairment” in the database of PubMed.Study Selection:Articles were obtained and reviewed to analyze the hypertension-induced pathophysiological changes that occur in CSVD and the correlation between CSVD and cognitive impairment.Results:In recent years, studies have demonstrated that hypertension-related changes (e.g., small vascular lesions, inflammatory reactions, hypoperfusion, oxidative stress, damage to autoregulatory processes and the blood-brain barrier, and cerebral amyloid angiopathy) can occur over time in cerebral small vessels, potentially leading to lower cognitive function when blood pressure (BP) control is poor or lacking. Both isolated and co-occurrent CSVD can lead to cognitive deterioration, and this effect may be attributable to a dysfunction in either the cholinergic system or the functionality of cortical and subcortical tracts.Conclusions:We explore the currently available evidence about the hypertensive vasculopathy and inflammatory changes that occur in CSVD. Both are vital prognostic indicators of the development of cognitive impairment. Future studies should be performed to validate the relationship between BP levels and CSVD progression and between the numbers, volumes, and anatomical locations of CSVD and cognitive impairment.

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Section: E Nlarged P Erivascular mentioning

confidence: 99%

Section: E Nlarged P Erivascular mentioning

confidence: 99%

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Yang

Dong

Lyu

et al. 2018

Chinese Medical Journal

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“…However, previous studies have shown no association between BP and enlarged centrum semiovale PVS, probably due to differences in responsible pathogenetic mechanisms [12]. On the other hand, the strengths of this study include the population-based design and the unbiased selection of participants.…”

Section: Discussionmentioning

confidence: 97%

Enlarged Basal Ganglia Perivascular Spaces are Associated with Pulsatile Components of Blood Pressure

Brutto

Mera

2018

Eur Neurol

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Background/Aims: Pathogenetic mechanisms involved in enlargement of basal ganglia perivascular spaces (BG-PVSs) are controversial. Here, we assessed whether pulsatile or steady components of blood pressure (BP) are associated with enlarged BG-PVS. Methods: We evaluated the association between BG-PVS and pulsatile and steady components of BP in Atahualpa residents aged ≥60 years, by the use of regression models and receiver operator characteristics (ROC) curve analysis, after taking into account the effect of demographics, cardiovascular risk factors, and other signatures of cerebral small vessel disease (SVD). Results: Of 437 candidates, 363 (83%) were included. MRI showed >10 enlarged BG-PVS in 103 (28%) subjects. In univariate analysis, the association between enlarged BG-PVS and systolic pressure (SP) and pulse pressure (PP) were highly significant, while the association with diastolic pressure (DP) was not. ROC curve analysis showed a higher area under the curve for PP than for DP (p < 0.05). The area under the curve for SP was also higher than that of DP, but not significantly better due to overlapping 95% CI. Conclusion: Enlarged BG-PVS are associated with pulsatile components of BP, although some of the effect is taken away by the strong interaction between BG-PVS and other signatures of SVD.

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“…Previous studies have confirmed that 24-h ambulatory blood pressure monitoring (ABPM) is more useful to predict the hypertension-related cardiovascular risk than casual clinical blood pressure measurement (9,10), and the 24-h blood pressure variability (BPV) documented by ABPM has been revealed an independent risk factor of the target organ damage caused by hypertension (11). Recent studies have found increased BPV correlates with white matter lesions, microbleed and enlarged perivascular space in the brain (12)(13)(14). The relationship of BPV and the total burden of cSVD has also been explored in some specific population lately (4,5,15), but the impact of BPV on the total cSVD burden has not yet been investigated in inpatients with cerebrovascular disease.…”

Section: Introductionmentioning

confidence: 94%

Twenty-Four-Hour Ambulatory Blood Pressure Variability Associated With Cerebral Small Vessel Disease MRI Burden and Its Progression in Inpatients With Cerebrovascular Disease

et al. 2020

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Background: Lacunar infarcts, white matter lesions, cerebral microbleed, enlarged perivascular space and brain atrophy are regarded as magnetic resonance imaging (MRI) manifestations of cerebral small vessel disease (cSVD). 24-hour blood pressure variability (BPV) has been reported to relate with cerebral small vessel disease, but the impact of 24-h BPV on the total MRI cSVD burden and its progression in inpatients with cerebrovascular disease has not been investigated yet. Methods: We enrolled inpatients with cerebrovascular disease, who underwent the 24-h ambulatory blood pressure monitoring (ABPM) and the brain MRI scan at baseline and had the follow-up brain MRI images stored in the clinical information system of our hospital. BPV was quantified by the calculation of standard deviation (SD), coefficient of variation (CV), weighted standard deviation (wSD) of blood pressure record. We evaluated the total cSVD score on baseline MRI and the MRI followed-up to obtain the total burden of cSVD. The cSVD burden progression was estimated through the comparison of the total cSVD score on the two MRIs. Results: A total of 140 patients with an average age of 65.6 years were finally enrolled, 82.9% (116/140) of whom had one or more cSVD markers. After a median of 4.4 years follow-up, cSVD score progression were found in 50.7% (71/140) of the patients. Both SD and CV of SBP and DBP during 24-h and daytime as well as the SBP wSD differed significantly among different total cSVD score groups. The SBP SD and CV during 24-h and daytime, the SBP SD in nighttime, the DBP SD and CV during the daytime were significantly higher in the cSVD progression group than those in the cSVD no-progression group. The SBP wSD and the DBP wSD were significantly higher in the cSVD progression group than those in the cSVD no-progression group. Logistic regression analyses revealed that daytime SBP SD and SBP wSD were independent risk factors for total cSVD burden [daytime SBP SD: OR = 1.628, 95% CI = 1.105-2.398 Fan et al. BPV Associated With cSVD (per 5 mmHg increase in SD), P = 0.014; SBP wSD: OR = 2.248, 95% CI = 1.564-3.230 (per 5 mmHg increase in wSD), P < 0.001)] and SBP wSD was a significant predictor for cSVD progression [OR = 2.990, 95% CI = 1.053-8.496 (per 5 mmHg increase in wSD), P = 0.040]. Conclusion: Higher BPV were significantly related with total cSVD burden in inpatients with cerebrovascular disease. SBP SD during daytime and SBP wSD were independent risk factor for total cSVD burden and SBP wSD was an predictive factor for cSVD progression.

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The relationship between ambulatory blood pressure variability and enlarged perivascular spaces: a cross-sectional study

Cited by 39 publications

References 30 publications

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Enlarged Basal Ganglia Perivascular Spaces are Associated with Pulsatile Components of Blood Pressure

Twenty-Four-Hour Ambulatory Blood Pressure Variability Associated With Cerebral Small Vessel Disease MRI Burden and Its Progression in Inpatients With Cerebrovascular Disease

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