Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure.

Abstract

Does the average daily blood pressure correlate with hypertensive cerebrovascular disease better than the casual pressure, as has been reported in other target organ involvement? We investigated the associations of two abnormal findings on brain magnetic resonance imaging suggestive of a vascular etiology, low intense foci (lacunae), and periventricular hyperintense lesions on T,-and Tj-weighted images, with both office and average daily blood pressure values in a population of 73 healthy normotensive and hypertensive elderly individuals (70 ± 6 years old). Lacunae were detected in 34 subjects (47%); the number per subject ranged from 0 to 19 and was significantly correlated with advancing age. Furthermore, these changes were supposedly related to the average of noninvasive ambulatory (24-hour and during awake and asleep periods) pressure recordings but not to office pressures. The grade of periventricular hyperintensity was also significantly associated with advancing age and the average of ambulatory systolic pressure recordings, particularly during sleep, but not with office blood pressure. In comparisons of normotensive, "office hypertensive," and hypertensive subgroups, abnormalities on magnetic resonance imaging were appropriate to the level of the 24-hour blood pressure measurements but not to that of clinic pressure. In hypertensive patients, the presence of electrocardiographic evidence of left ventricular hypertrophy was also associated with greater abnormalities on magnetic resonance imaging. We conclude that ambulatory blood pressure monitoring is superior to casual pressure measurements in predicting latent cerebrovascular disease, which is unexpectedly common in apparently healthy elderly subjects. {Hypertension 1990;16:692-699) I t is well known that pressures measured in the office or clinic may not be representative of the patient's blood pressure throughout the day. 1The correlations between target organ damage and different measures of blood pressure have been compared in several studies. 2^ In the heart, ambulatory blood pressure measurements have given better correlations than clinic readings with left ventricular hypertrophy as evaluated by electrocardiogram, chest x-ray, and echocardiography.4 -7 Hypertensive retinopathy 48 was also found to correlate more closely with ambulatory pressures than with casual pressures. These results suggest that the adverse effects of blood pressure on the heart and peripheral vessels (including the optic fundi) depend on the average level of pressure over time. To date, however, there

Clinical Correlates of Ambulatory BP Monitoring among Patients with CKD

“…At the same time, parameters derived from ambulatory BP monitoring (ABPM) have been reported to serve as predicting factors for various organ failures (11)(12)(13)(14)(15). In particular, the association between circadian variations in BP and cardiovascular events has been studied from various approaches (12,(16)(17)(18)(19)(20).…”

Guidelines for Hypertension in the Elderly. 1999 Revised Version.

“…In an MRI study of elderly hypertensive patients in Japan, cerebral micro-infarct (lacuna infarct) was demonstrated frequently in the cases with an elevated mean value of 24-h blood pressure (26). These studies suggested that the mean value of 24-h blood pressure is more useful than random blood pressure values for the evaluation of prognosis of hypertension.…”

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

“…The prognosis has been poor in non-dippers and risers. 109,[134][135][136][137] In non-dippers and risers, hypertensive target organ damage, such as asymptomatic lacunar infarction, left ventricular hypertrophy and microalbuminuria, are observed more frequently than in dippers. 135,136,138 Prospective studies have shown that the risk of cardiovascular diseases is higher in non-dippers than in dippers.…”

“…109,[134][135][136][137] In non-dippers and risers, hypertensive target organ damage, such as asymptomatic lacunar infarction, left ventricular hypertrophy and microalbuminuria, are observed more frequently than in dippers. 135,136,138 Prospective studies have shown that the risk of cardiovascular diseases is higher in non-dippers than in dippers. 109,[136][137][138] According to the results of the Ohasama study, the risk of cardiovascular diseases is high in non-dippers even if they are normotensive.…”