Abstract
Background and Purpose: Ambulatory blood pressure variability (ABPV), ABP, and carotid intima-media thickness (IMT) are closely associated with white matter hyperintensities (WMH), and few studies focused on establishing effective models based on ABP, ABPV, and IMT to predict the WMH burden. We aimed to evaluate the value of a predictive model based on the metrics of ABP, ABPV, and IMT, which were independently associated with the WMH burden.Methods: We retrospectively enrolled 140 hypertensive inpatients for physical examinations in Shanghai East Hospital, Tongji University School of Medicine between February 2018 and January 2019. The basic clinical information of all subjects was recorded, and we also collected the metrics of ABP, ABPV, and IMT. Patients with Fazekas scale grade ≥2 were classified into heavy burden of WMH group. Then, we analyzed the association between all characteristics and the WMH burden. Multivariate analysis was performed to assess whether the metrics of ABP, ABPV, and IMT were independently associated with WMH, and we used receiver operating characteristic (ROC) to evaluate the value of predictive model based on the metrics of ABP, ABPV, and IMT.Results: Higher WMH grade was associated with increasing age, diabetes mellitus, higher total cholesterol (TC), higher low-density lipoprotein (LDL), higher IMT, higher 24-h systolic blood pressure (SBP), higher daytime SBP, higher nocturnal SBP, 24-h and daytime standard deviation (SD) of SBP, and 24-h SBP weight SD; 24-h SBP, 24-h SBP-SD, and IMT were independently related to the burden of WMH even after adjusting for the clinical variables. In addition, we also established a model that has a higher predictive capacity using 24-h SBP, 24-h SBP-SD, and IMT in the ROC analysis to assess the WMH burden in hypertensive patients.Conclusions: Higher 24-h SBP, higher 24-h SBP-SD, and larger IMT were independently associated with a greater burden of WMH among elderly primary hypertension Asian patients. Establishing a model based on these factors might provide a new approach for enhancing the accuracy of diagnosis of WMH using metrics in 24-h ABPM and carotid ultrasound.
Highlights
White matter hyperintensities (WMH), named white matter lesions, are commonly observed in the elderly, usually detected on magnetic resonance imaging (MRI) with hyperintense signal appearances on T2-weighted MRI (Fazekas et al, 1993)
We investigated the association of the ambulatory blood pressure (ABP), ABP variability (ABPV), and Intima-media thickness (IMT) metrics with the burden of WMH, we evaluated the value of predictive model based on the metrics of ABP, ABPV, and IMT, which were independently associated with the WMH burden
According to the MRI images, 94 patients were classified into 0–1 WMH grades, and 46 patients were classified into 2–3 WMH grades
Summary
White matter hyperintensities (WMH), named white matter lesions, are commonly observed in the elderly, usually detected on magnetic resonance imaging (MRI) with hyperintense signal appearances on T2-weighted MRI (Fazekas et al, 1993). A recent study has shown that increased IMT is independently associated with a heavier burden of WMH among elderly and Hispanic people (Della-Morte et al, 2018). To our knowledge, only a few studies focused on establishing effective models based on ABP, ABPV, and IMT to predict the burden of WMH among Asian primary hypertension patients. Ambulatory blood pressure variability (ABPV), ABP, and carotid intima-media thickness (IMT) are closely associated with white matter hyperintensities (WMH), and few studies focused on establishing effective models based on ABP, ABPV, and IMT to predict the WMH burden. We aimed to evaluate the value of a predictive model based on the metrics of ABP, ABPV, and IMT, which were independently associated with the WMH burden
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