Ambulatory Blood Pressure in Patients With Lacunar Stroke

Abstract

Background and Purpose-Asymptomatic lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces are MRI markers of cerebral small vessel disease (cSVD). Higher blood pressure (BP) levels are associated with the presence of these markers separately, but the association with the total burden of cSVD on brain MRI, expressed by the simultaneous presence of multiple markers of cSVD (a compound score), has not been investigated. Methods-We performed 24-hour ambulatory BP monitoring in 122 patients with first-ever lacunar stroke. On brain MRI, we scored the presence of each marker of cSVD. One point was awarded for the presence of each marker, producing a score between 0 and 4. Associations with BP levels were tested with ordinal regression analyses. Results-Eighteen (15%) patients had no markers of cSVD, and 6 (5%) patients had 4 markers. Most patients (45; 37%) had 2 different markers. After correction for age and sex, higher 24-hour, day, and night systolic (24-hour odds ratio, 1.25; 95% confidence interval, 1.02-1.52 per 10 mm Hg) and diastolic (24-hour odds ratio, 1.32; 95% confidence interval, 1.12-1.56 per 5 mm Hg) BP were all significantly associated with an increasing total burden of cSVD. Conclusions-We found a positive association of ambulatory BP levels with total burden of cSVD on brain MRI. With increasing BP levels, there is a piling up of damage in the brain. We suggest that further cSVD studies also consider viewing the total burden in addition to each of the MRI markers separately.

Perivascular spaces on 7 Tesla brain MRI are related to markers of small vessel disease but not to age or cardiovascular risk factors

“…PVS counts were not (CSO PVS) or weakly (BG PVS) related to age and blood pressure. This is contrary to results from previous studies [11][12][13][14][15][16]28,29 performed with regular field strength MRI, which have often shown associations of PVS with age or cardiovascular risk factors. Probably, the relatively large PVS on routine clinical MRI have different associations with age and cardiovascular risk factors than the small PVS on 7T.…”

Chronic Kidney Disease in Patients With Lacunar Stroke

“…22,23 Briefly, lacune was identified as a round or ovoid hyperintense lesions, of between 3 and 15 mm in diameter, on T2-weighted images with a surrounding rim of hyperintensity on FLAIR and not compatible with the clinical stroke. 19 WMH were rated using the modified Fazekas scale 24 on FLAIR images, and further volumetric information of WMH were assessed by commercially available software.…”

“…22,25 An ordinal score ranging from 0 to 4 was constructed to reflect the total cSVD burden. One point was awarded for each of the following items: moderate to extensive (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) …”

“…Positive associations of decreased cognitive function and higher ambulatory blood pressure levels to accumulation of MRI markers have already been demonstrated. 22,23 Further studies on cSVD are now also needed to take into account the total SVD load, avoiding over-reliance on just one feature as in most previous studies.…”

Subjective Cognitive Failures in Patients With Hypertension Are Related to Cognitive Performance and Cerebral Microbleeds

“…In both areas, only the most affected hemisphere was rated on 1 slice only, using a semiquantitative scale (mildmoderate-extensive). 27 Presence of perivascular spaces was indicated if moderate or extensive perivascular spaces were present in that area. WMH were defined as hyperintense areas in the periventricular and deep white matter on both T2-weighted and FLAIR images.…”