Abstract
Background and ObjectivesThe study aims to test the hypotheses that a higher burden of cerebral small vascular disease (CSVD) predicts major adverse cardiac and cerebrovascular events (MACCE) in patients with hypertension (HTN) and that abnormal blood pressure variability (BPV) pattern aggravates total CSVD burden.MethodsWe retrospectively reviewed patients with HTN prospectively selected between February 2015 and February 2019 from three participating centers. Patients were included if they had HTN for over 1 year and had at least one MRI feature of CSVD. Independent predictors were found using multivariate logistic regression.ResultsAmong the 908 patients who finally enrolled in the study, the number of CSVD markers (OR = 1.940; 95% CI = 1.393–2.703; P < 0.001) independently predicted MACCE with acceptable predictive value (C-statistic = 0.730; 95% CI = 0.669–0.791; P < 0.001). An abnormal BPV pattern was identified as an independent risk factor for increased CSVD burden. Among them, reverse-dipper subtype demonstrated the most significant relationship (OR = 1.725; 95% CI = 1.129–2.633; P = 0.012).ConclusionTotal CSVD burden predicts an increased risk of composite MACCE independently. An abnormal BPV pattern is associated with a higher burden of CSVD.
Highlights
Among the 908 patients who enrolled in the study, the number of Cerebral small vascular disease (CSVD) markers (OR = 1.940; 95% CI = 1.393–2.703; P < 0.001) independently predicted major adverse cardiac and cerebrovascular events (MACCE) with acceptable predictive value (C-statistic = 0.730; 95% CI = 0.669–0.791; P < 0.001)
An abnormal blood pressure variability (BPV) pattern was identified as an independent risk factor for increased CSVD burden
An abnormal BPV pattern is associated with a higher burden of CSVD
Summary
Cerebral small vascular disease (CSVD) is one of the most prevalent cerebral vascular pathologies encountered by the middle-aged and elderly people, with a prevalence ranging from 5% in people aged over 50 to almost 100% among people aged over 90 years (Cannistraro et al, 2019). The symptoms of CSVD can be clinically silent, the disease is responsible for 45–50% of all-cause dementia worldwide, as well as about a quarter of ischemic strokes and most hemorrhagic strokes (Cannistraro et al, 2019; Wardlaw et al, 2019) It is associated with unfavorable prognosis after stroke, including worsened functional and cognitive recovery (Appleton et al, 2020), increased stroke recurrence (Lau et al, 2017), and increased mortality (Song et al, 2017). We aimed to test the hypotheses that a higher CSVD burden predicts an unfavorable prognosis in HTN patients and that an abnormal BPV pattern aggravates the total CSVD burden. The study aims to test the hypotheses that a higher burden of cerebral small vascular disease (CSVD) predicts major adverse cardiac and cerebrovascular events (MACCE) in patients with hypertension (HTN) and that abnormal blood pressure variability (BPV) pattern aggravates total CSVD burden
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