Silent Cerebrovascular Disease and Ambulatory Blood Pressure in the Elderly

Abstract

Silent cerebrovascular disease can be frequently revealed by magnetic resonance imaging (MRI) in asymptomatic elderly subjects. These incidental lesions include lacunae and periventricular hyperintensity (PVH), and are associated with several vascular risk factors including age and blood pressure. The relationship between diurnal blood pressure variations and hypertensive cerebrovascular disease, however, has not been fully understood. We found that ambulatory blood pressure monitoring is superior to casual pressure measurements in predicting these lesions. Furthermore, the absence of a nocturnal blood pressure reduction is associated with greater abnormalities of these MRI lesions. Other factors such as high predicted blood viscosity and low HDL-cholesterol levels were associated with advanced multiple (defined as more than four) lacunar lesions. In particular, left ventricular hypertrophy on ECG had high positive and negative predictive values for the advanced multi-lacunar lesions in the asymptomatic elderly patients with hypertension. The most important questions which remain to be answered, however, is the prognosis of the subjects with these silent cerebrovascular disease. (Hypertens Res 1994; 17 Suppl. I: S55-S58)