Association between cerebral microbleeds and hypertension in the Swedish general population “Good Aging in Skåne” study

Elmståhl, Sölve; Ellström, Katarina; Siennicki-Lantz, Arkadiusz; Abul-Kasim, Kasim

doi:10.1111/jch.13606

Cited by 21 publications

(18 citation statements)

References 24 publications

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“…In the middle-aged and elderly individuals in Rotterdam Scan Study (5), hypertension was associated with the presence of CMBs. One Swedish study found that hypertension was the major risk factor for CMBs in the general population (6). Longitudinal community studies (7,8) also demonstrated that baseline hypertension was associated with development of new CMBs.…”

Section: Discussionmentioning

confidence: 99%

“…Cross-sectional (5,6) and longitudinal studies (7,8) revealed that blood pressure (BP) over 140/90 mmHg was a crucial risk factor of CMBs in the general population. Since the Systolic Blood Pressure Intervention Trial (SPRINT) showed that aggressive control of BP resulted in lower rates of major cardiovascular events and mortality (9), cut-off for hypertension was lowered from 140/90 to 130/80 mmHg in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline (10).…”

Section: Introductionmentioning

confidence: 99%

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Incident cerebral microbleeds and hypertension defined by the 2017 ACC/AHA Guidelines

Xia¹,

Wang²,

Yang³

et al. 2021

Ann Transl Med

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Background: The cut-off for hypertension was lowered to blood pressure (BP) over 130/80 mmHg in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline. Whether the new definition of hypertension remains a potent risk factor of cerebral microbleeds (CMBs) is uncertain. We aimed to analyze the relationship between the new definition of hypertension and incident CMBs in a 7-year longitudinal community study.Methods: This study is a sub-study of the Shanghai Aging Study (SAS). A total of 317 participants without stroke or dementia were included at baseline (2009-2011), and were invited to repeated clinical examinations and cerebral magnetic resonance imaging (MRI) at follow-up (2016-2018). CMBs at baseline and followup were evaluated on T2*-weighted gradient recalled echo (GRE) and susceptibility-weighted angiography (SWAN) sequence of MRI. We classified baseline BP into four categories: normal BP, elevated systolic BP, stage 1 hypertension and stage 2 hypertension according to the ACC/AHA guideline. We assessed the associations between BP categories and incident CMBs by generalized linear models.Results: A total of 159 participants (median age, 67 years) completed follow-up examinations with a mean interval of 6.9 years. Both stage 1 and stage 2 hypertension at baseline were significantly related with a higher risk of incident CMBs (IRR 2.77, 95% CI, 1.11-6.91, P=0.028; IRR 3.04, 95% CI, 1.29-7.16, P=0.011, respectively), indicating dose-response effects across BP categories. Participants with ≥5 incident CMBs or incident CMBs in the deep locations all had baseline stage 1 and 2 hypertension.Conclusions: Participants with baseline stage 1 and stage 2 hypertension had a significantly higher risk of incident CMBs in this 7-year longitudinal community cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incident cerebral microbleeds and hypertension defined by the 2017 ACC/AHA Guidelines

Xia¹,

Wang²,

Yang³

et al. 2021

Ann Transl Med

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“…They are closely related and have the same pathological characteristics and often occur in patients with hypertension (8)(9)(10). Although CMBs and WMCs may occur with increased frequency in hypertension (11,12), knowledge of their relationship with the duration of hypertension in patients in different stages of hypertension is limited. Some studies have reported WMCs in subjects displaying CMBs in patients with hypertension (13), but no study has primarily focused on the WMC-CMB relationship in patients with different stages of hypertension.…”

Section: Introductionmentioning

confidence: 99%

White matter changes, duration of hypertension, and age are associated with cerebral microbleeds in patients with different stages of hypertension

Liang¹,

Wang²,

Feng³

et al. 2022

Quant Imaging Med Surg

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Background: We aimed to investigate risk factors for the presence and number of cerebral microbleeds (CMBs) in patients with different stages of hypertension stages, with an emphasis on the relationship between white matter changes (WMCs) and CMBs.Methods: Since 2016, participants aged 40 years or more have been evaluated for the presence of CMBs using enhanced 3D multiecho GE T2*-weighted angiography (ESWAN) sequences. The Mann-Whitney U test and Pearson χ 2 test were used to compare the clinical characteristics between the CMB and no-CMB patient groups. Furthermore, we used Spearman's rank correlation analysis to examine the associations between the degree of CMB severity and other important factors.Results: CMBs were detected in 110 (36.7%) of 300 participants. Among patients with stage 2 hypertension, the majority also had CMBs (61.8%, 68/110). CMBs were positively correlated with age, hypertension stage, duration of hypertension, WMCs, and silent cerebral infarction. Patients with grade 3 WMCs were significantly more likely to have CMBs than those without WMCs; this association was true for both patients with stage 1 and those with stage 2 hypertension. In patients with stage 1 or stage 2 hypertension lasting longer than 20 years, the majority had CMBs (69.0%, 29/42; 69.1%, 47/68). The results of binary logistic regression indicated that a more severe hypertension stage, longer duration of hypertension, aging, having silent cerebral infarction and higher values of WMC increase the likelihood of the occurrence of CMBs.Conclusions: CMBs detected in hypertensive patients were more likely to occur in deep structures, and the grade of WMCs and duration of hypertension were more closely associated with the CMB degree than with age.

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“…patients with frontotemporal dementia, patients with Lewy-body dementia, patients with diagnostic uncertainty, patients with severe psychiatric and behavioral symptoms, and patients with familial disorders) should be given high priority for follow-up in a specialist setting, for example, a memory clinic setting. Vascular risk factors are associated with an increased risk of cognitive decline and dementia [26] and with the rate of progression of dementia and the occurrence of brain pathology such as small vessel disease [27,28], lacunar infarcts [29,30] and microbleeds [31]. Hence, optimal management of vascular risk factors may potentially modify the disease course in dementia.…”

Section: Supplemental Considerations For Systematic Medical Follow-upmentioning

confidence: 99%

“…We believe that systematic management of vascular risk factors is as important in patients with mild to moderate dementia as in patients without dementia as these factors are associated with adverse health outcomes and because an effect is unlikely to differ between patients with and without dementia [26][27][28][29][30][31]. It is the opinion of the authors that the value and attitudes of patients with dementia would not go against treatment, at least for a majority of patients.…”

Section: Justification For Statementmentioning

confidence: 99%

A European Academy of Neurology guideline on medical management issues in dementia

Frederiksen

Cooper

Frisoni

et al. 2020

Euro J of Neurology

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Background and purpose Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow‐up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. Methods A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. Results Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk–benefit ratio should be performed at regular intervals. Regular, preplanned medical follow‐up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non‐pharmacological measures have been proven to be without benefit or in the case of severe self‐harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first‐line therapy (Good Practice statement). Conclusion This GRADE‐based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.

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Association between cerebral microbleeds and hypertension in the Swedish general population “Good Aging in Skåne” study

Cited by 21 publications

References 24 publications

Incident cerebral microbleeds and hypertension defined by the 2017 ACC/AHA Guidelines

Incident cerebral microbleeds and hypertension defined by the 2017 ACC/AHA Guidelines

White matter changes, duration of hypertension, and age are associated with cerebral microbleeds in patients with different stages of hypertension

A European Academy of Neurology guideline on medical management issues in dementia

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