Midlife blood pressure is associated with the severity of white matter hyperintensities: analysis of the UK Biobank cohort study.
Midlife blood pressure is associated with the severity of white matter hyperintensities: analysis of the UK Biobank cohort study.
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DOI：
10.1093/eurheartj/ehaa756
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发表时间：
2021-02-14
影响因子：
39.3
通讯作者：
Webb AJS
中科院分区：
文献类型：
--
作者：
Wartolowska KA;Webb AJS
白色高信号（WMH）随着年龄和高血压的进展，但暴露于高血压（BP）的关键时期，以及收缩压（SBP）与舒张压（DBP）的相对作用仍不清楚。本研究旨在确定WMH与同期与既往BP之间的关系。UK Biobank是一个前瞻性的基于社区的队列，来自22个中心的40-69奥尔兹，在基线评估后4-12年对超过40 000人的亚组进行磁共振成像。使用线性模型确定WMH负荷（WMH体积通过总白色物质体积标准化并进行logit转换）与同期与既往BP之间的标准化相关性，并调整年龄、性别、心血管危险因素、BP来源、评估中心和自基线以来的时间。确定了中位WMH与正常SBP或DBP之间调整回归稀释偏差的关联，并按年龄和基线BP分层。在37041名具有WMH数据和BP测量值的合格参与者中，WMH与并发SBP的相关性更强[DBP：β = 0.064，95%置信区间（CI）0.050-0.078; SBP：β = 0.076，95% CI 0.062-0.090]，但与既往DBP的相关性最强（DBP：β = 0.087，95% CI 0.064-0.109; SBP：β = 0.045，95% CI 0.022-0.069），尤其是50岁以下（DBP：β = 0.103，95% CI 0.055-0.152; SBP：β = 0.012，95% CI −0.044至0.069）。由于SBP升高的发生率较高，中位WMH增加了1.126（95% CI 1.107-1.146）每10 mmHg常规SBP和1.106（95% CI 1.090-1.122），而SBP升高时，前十分位数中WMH的人群归因分数更大（并发SBP为19.1%;既往SBP为24.4%）。任何血压升高，甚至SBP低于140和DBP低于90 mmHg，特别是需要降压药物时，均与WMH升高相关。WMH与同期和既往血压升高密切相关，严重WMH的人群负荷对SBP最大。然而，在50岁之前，DBP与WMH的相关性更强。WMH的长期预防可能需要控制甚至轻度升高的中年DBP。
White matter hyperintensities (WMH) progress with age and hypertension, but the key period of exposure to elevated blood pressure (BP), and the relative role of systolic BP (SBP) vs. diastolic BP (DBP), remains unclear. This study aims to determine the relationship between WMH and concurrent vs. past BP. UK Biobank is a prospective community-based cohort of 40–69-year olds from 22 centres, with magnetic resonance imaging in a subgroup of over 40 000 people at 4–12 years after baseline assessment. Standardized associations between WMH load (WMH volume normalized by total white matter volume and logit-transformed) and concurrent vs. past BP were determined using linear models, adjusted for age, sex, cardiovascular risk factors, BP source, assessment centre, and time since baseline. Associations adjusted for regression dilution bias were determined between median WMH and usual SBP or DBP, stratified by age and baseline BP. In 37 041 eligible participants with WMH data and BP measures, WMH were more strongly associated with concurrent SBP [DBP: β = 0.064, 95% confidence interval (CI) 0.050–0.078; SBP: β = 0.076, 95% CI 0.062–0.090], but the strongest association was for past DBP (DBP: β = 0.087, 95% CI 0.064–0.109; SBP: β = 0.045, 95% CI 0.022–0.069), particularly under the age of 50 (DBP: β = 0.103, 95% CI 0.055–0.152; SBP: β = 0.012, 95% CI −0.044 to 0.069). Due to the higher prevalence of elevated SBP, median WMH increased 1.126 (95% CI 1.107–1.146) per 10 mmHg usual SBP and 1.106 (95% CI 1.090–1.122) per 5 mmHg usual DBP, whilst the population attributable fraction of WMH in the top decile was greater for elevated SBP (19.1% for concurrent SBP; 24.4% for past SBP). Any increase in BP, even below 140 for SBP and below 90 mmHg for DBP, and especially if requiring antihypertensive medication, was associated with increased WMH. WMH were strongly associated with concurrent and past elevated BP with the population burden of severe WMH greatest for SBP. However, before the age of 50, DBP was more strongly associated with WMH. Long-term prevention of WMH may require control of even mildly elevated midlife DBP.