Association between Short-Term Blood Pressure Variability and Intracranial Atherosclerotic Plaque Vulnerability: A High-Resolution Magnetic Resonance Imaging Study

Abstract

Aim: short-term blood pressure variability (BPV) as a risk factor of atherosclerosis and cardiovascular events has been investigated. However, its association with atherosclerotic plaque vulnerability remains unknown. The objective of this study was to determine the association between short-term BPV and intracranial atherosclerotic plaque vulnerability.Methods: this is a cross-sectional analysis of 267 ischemic stroke patients with symptomatic intracranial atherosclerosis (mean age, 65±12 years old; 60.3% male), which were prospectively recruited in a comprehensive stroke center. Systolic and diastolic BP SD, CV, and BP variability ratio (BPVR) from 24 hours, daytime, and nighttime were calculated from 24-h ambulatory blood pressure monitoring, intracranial atherosclerotic plaque burden and vulnerability were evaluated by high-resolution magnetic resonance vessel wall imaging. Logistic regression analysis was used to locate the correlation between short-term BPV and plaque vulnerability.Results: a total of 36.3% subjects presented with intraplaque hemorrhage (IPH) in this study. Multivariate logistic regression suggested that nighttime diastolic BP CV and 24-h BPVR were associated with intracranial IPH independently after adjusted for cardiovascular risk factors, odds ratio (OR) and 95% confidence interval (CI) for per SD BPV changes were 1.418 (1.051, 1.914) and 0.731 (0.548, 0.976), respectively, and this association also independent of atherosclerosis burden and 24-h mean systolic BP level. Further subgroup analysis by age and hypertension history demonstrated that the statistical correlation could only establish in the elder, and subjects with hypertension. Conclusion: nighttime diastolic BP CV and 24-h BPVR were associated with intracranial IPH independently, especially in the elderly and subjects with hypertension.studies (1359 subjects) analyzed the effects of shortterm BPV on stroke outcome, and concluded that higher systolic BP SD is associated with stroke prognosis 1) . BP and BPV could possibly induced cardiovascular events by atherosclerosis and vulnerableCopyright©2022 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

Intracranial Carotid Arteriosclerosis Mediates the Association Between Blood Pressure and Cerebral Small Vessel Disease

“…On the other hand, we do not rule out the hypothesis that intimal ICAC might mediate the association between BP and cerebral small vessel disease. It is possible that abnormal circadian BP rhythms, 24 morning surge, 25 or high 24-hour BP variability 26 would destabilize the atherosclerotic plaque localized in the intracranial carotid artery, leading to cerebrovascular complications. This is based on numerous studies implicating the association of these ambulatory BP indexes with carotid plaque presence and vulnerability, and with major cerebrovascular outcomes.…”

“…This is based on numerous studies implicating the association of these ambulatory BP indexes with carotid plaque presence and vulnerability, and with major cerebrovascular outcomes. [24][25][26] Future studies utilizing ambulatory BP and ICAC would provide novel insights regarding the physiopathology of cerebrovascular outcomes in relation to BP dysregulations.…”

Persistent High Pulse Pressure in Acute Non-Cardiogenic Ischemic Stroke as a Predictor of Neurological Deterioration and Recurrence of Ischemic Stroke: ADS Post-Hoc Analysis

“…As a result, chronic elevation of PP may lead to dysfunction of the blood-brain barrier, neurodegeneration, and dementia. Concerning cerebral arteries, another report suggested that 24-h blood pressure fluctuations in ischemic stroke patients are associated with intracranial intraplaque hemorrhage 24) . In our study, carotid artery plaque was noted to be thicker in the high-high group than in the low-low group (Tables 4, 5).…”