Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People

White, William Β.; Wolfson, Leslie; Wakefield, Dorothy; Hall, Charles B.; Campbell, Patrick; Moscufo, Nicola; Schmidt, Julia A.; Kaplan, Richard F.; Pearlson, Godfrey D.

doi:10.1161/circulationaha.111.037036

Cited by 101 publications

(101 citation statements)

References 33 publications

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“…Approximately two-thirds of individuals over 75 years of age have detectable WMHs using MRI of the brain. 54 The lower limit of detection of WMH by experts in neuroradiology is approximately 0.2 to 0.3% of intracranial contents, and 0.5% is easily visible to the naked eye based on our experience. 8,54,65 Our cohort studies have demonstrated an increase of WMH volume from 0.99 to 1.47 to 1.7% of the intracranial contents volume from baseline to 2 and 4 years respectively.…”

Section: 58mentioning

confidence: 72%

“…54 The lower limit of detection of WMH by experts in neuroradiology is approximately 0.2 to 0.3% of intracranial contents, and 0.5% is easily visible to the naked eye based on our experience. 8,54,65 Our cohort studies have demonstrated an increase of WMH volume from 0.99 to 1.47 to 1.7% of the intracranial contents volume from baseline to 2 and 4 years respectively. 8,54 This increase was even present in participants with normal mobility throughout the study period.…”

Section: 58mentioning

confidence: 72%

“…[53][54][55][56] Large arterial and small vessel disease of the cerebral circulation share risk factors (e.g., hypertension and diabetes) and may coexist in individuals as noted earlier.…”

Section: The Importance Of Blood Pressure As a Risk Factor For Cerebrmentioning

confidence: 91%

“…In our past work in this area, we have evaluated the progression of WMH over 2 and 4 years in a cohort of 95 patients 75 to 90 years (mean baseline age, 82 years) who had office and ambulatory BP and volumetric MRI. 54,65 Neither clinic BP nor changes in clinic BP predicted progression of WMH, while the 24 hours ambulatory BP and changes in ambulatory BP significantly correlated with both WMH volume (p < 0.04) and changes in WMH (p < 0.003). 54 Further analyses demonstrated associations for WMH and mobility indexes with level of systolic BP based on tertiles of the cohort -i.e., those in the higher (24 hours systolic BP = 144 mm Hg) ambulatory BP group showed increases in WMH and slower mobility compared with the middle tertile (ambulatory systolic BP = 130 mm Hg) ( Table 2).…”

Section: 58mentioning

confidence: 92%

“…54,65 Neither clinic BP nor changes in clinic BP predicted progression of WMH, while the 24 hours ambulatory BP and changes in ambulatory BP significantly correlated with both WMH volume (p < 0.04) and changes in WMH (p < 0.003). 54 Further analyses demonstrated associations for WMH and mobility indexes with level of systolic BP based on tertiles of the cohort -i.e., those in the higher (24 hours systolic BP = 144 mm Hg) ambulatory BP group showed increases in WMH and slower mobility compared with the middle tertile (ambulatory systolic BP = 130 mm Hg) ( Table 2). Furthermore, gait speed in the Unpublished data from our cohort study 54 ; WMH: White matter hyperintensity lesions; m/s: meters/second; Significant values are bold typeface higher ambulatory BP group decreased 0.15 m/second more than that in the low BP group and while this difference appears small, it represents a between-group change after only 2 years of observation.…”

Section: 58mentioning

confidence: 92%

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Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

Gupta¹,

White²,

Ram³

2016

Hypertension Journal

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Several potential vascular risk factors exist for the development and accumulation of small vessel disease of the brain and stroke in older people. In older people followed up for several years, we and others have reported that white matter hyperintensity lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in neurologic function. In this article, we review blood pressure (BP) as a risk factor for the development and pathogenesis of small vessel disease and stroke in older persons. The research efforts have focused on ambulatory BP measurements, which have proven to be a stronger indicator than clinic pressures for the progression of small vessel disease in older people as well as the development of stroke. Based on relations among 24 hours systolic BP levels, the accrual of small vessel disease, and relations with cognitive function and mobility, we have designed the INFINITY trial, a novel interventional study that uses ambulatory BP to guide antihypertensive therapy addressed at improving functional decline.

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Section: 58mentioning

confidence: 72%

Section: 58mentioning

confidence: 72%

“…[53][54][55][56] Large arterial and small vessel disease of the cerebral circulation share risk factors (e.g., hypertension and diabetes) and may coexist in individuals as noted earlier.…”

Section: The Importance Of Blood Pressure As a Risk Factor For Cerebrmentioning

confidence: 91%

Section: 58mentioning

confidence: 92%

Section: 58mentioning

confidence: 92%

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Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

Gupta¹,

White²,

Ram³

2016

Hypertension Journal

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The Diagnosis and Management of Mild Cognitive Impairment

Langa

Levine

2014

JAMA

1,039

785

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Importance Cognitive decline is a common and feared aspect of aging. Mild Cognitive Impairment (MCI) is defined as the “symptomatic pre-dementia stage” on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living. Objective To present evidence on the diagnosis,treatment, and prognosis of MCI, and to provide physicians with an evidence-based framework for caring for older MCI patients and their caregivers. Evidence Acquisition We searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database through July 2014. Relevant references from retrieved articles were also evaluated. Findings The prevalence of MCI in adults aged ≥65 years is 10- 20%; risk increases with age, and men appear to be at higher risk than women. In older MCI patients, clinicians shouldconsider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk of developing dementia compared withthe general population, there is currently substantial variation in risk estimates (from <5% to 20% annual conversion rates), depending on the population studied.Current research is aimed at improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia. Conclusions and Relevance Cognitive decline and MCI have important implications for patients and their families, and will require that primary care clinicians be skilled in identifying and managing this common disorder as the number of older adults increases in coming decades. Current evidence supports aerobic exercise, mental activity, and cardiovascular risk factor control in patients with MCI.

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A Multifunctional Flexible Tactile Sensor Based on Resistive Effect for Simultaneous Sensing of Pressure and Temperature

Zhu,

Luo,

Cai

et al. 2023

Advanced Science

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Flexible tactile sensors with multifunctional sensing functions have attracted much attention due to their wide applications in artificial limbs, intelligent robots, human‐machine interfaces, and health monitoring devices. Here, a multifunctional flexible tactile sensor based on resistive effect for simultaneous sensing of pressure and temperature is reported. The sensor features a simple design with patterned metal film on a soft substrate with cavities and protrusions. The decoupling of pressure and temperature sensing is achieved by the reasonable arrangement of metal layers in the patterned metal film. Systematically experimental and numerical studies are carried out to reveal the multifunctional sensing mechanism and show that the proposed sensor exhibits good linearity, fast response, high stability, good mechanical flexibility, and good microfabrication compatibility. Demonstrations of the multifunctional flexible tactile sensor to monitor touch, breathing, pulse and objects grabbing/releasing in various application scenarios involving coupled temperature/pressure stimuli illustrate its excellent capability of measuring pressure and temperature simultaneously. These results offer an effective tool for multifunctional sensing of pressure and temperature and create engineering opportunities for applications of wearable health monitoring and human‐machine interfaces.

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Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People

Cited by 101 publications

References 33 publications

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

The Diagnosis and Management of Mild Cognitive Impairment

A Multifunctional Flexible Tactile Sensor Based on Resistive Effect for Simultaneous Sensing of Pressure and Temperature

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