Blood Pressure and Progression of Brain Atrophy The SMART-MR Study
Blood Pressure and Progression of Brain Atrophy The SMART-MR Study
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DOI：
10.1001/jamaneurol.2013.217
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发表时间：
2013-08-01
期刊：
影响因子：
29
通讯作者：
Geerlings, Mirjam I.
中科院分区：
文献类型：
--
作者：
Jochemsen, Hadassa M.;Muller, Majon;Geerlings, Mirjam I.
重要性研究表明，高血压和低血压（BP）都可能在脑萎缩的病因学中发挥作用。中年的高血压与以后生活中更多的脑萎缩有关，而对老年人的研究表明，低血压与更多的脑萎缩之间存在联系。然而，未来的证据是有限的，目的研究基线血压和血压随时间的变化与脑萎缩进展的关系。设计动脉疾病的继发表现-磁共振（SMART-MR）研究是一项前瞻性队列研究，基线测量时间为2001-2005年，随访测量时间为2006-2009年。平均随访时间为3.9年。地点：荷兰乌得勒支大学医学中心。（平均[SD]年龄，57 [9]岁; 81%的男性）患有冠状动脉疾病、脑血管疾病、外周动脉疾病或腹主动脉瘤。脑实质分数、皮质灰质分数和心室分数（%ICV）的变化被量化为全局、皮质和皮质下脑萎缩进展的指标。结果多变量调整回归分析显示，基线舒张压（DBP）或平均动脉压较低的患者皮质下萎缩进展更快。低和高DBP之间心室分数变化的平均差异为0.07%（95% CI，0.01-0.14），低和高平均动脉压之间为0.05%（95% CI，0.00-0.10）。此外，在较高的基线血压（舒张压，平均动脉压，或收缩压）的患者，随着时间的推移，那些血压水平下降的皮质下萎缩的进展较低，与那些血压水平上升的患者相比。结论和相关性在明显的动脉疾病的患者，低基线舒张压与皮质下萎缩的进展，无论在后续的BP课程。此外，在基线血压较高的患者中，血压水平随时间下降与皮质下萎缩进展较少相关。这可能意味着血压降低对血压水平较高的患者有益，但对于已经具有低DBP的患者，应谨慎进一步降低血压。
IMPORTANCE Studies have shown that both high and low blood pressure (BP) may play a role in the etiology of brain atrophy. High BP in midlife has been associated with more brain atrophy later in life, whereas studies in older populations have shown a relation between low BP and more brain atrophy. Yet, prospective evidence is limited, and the relation remains unclear in patients with manifest arterial disease.OBJECTIVE To examine the associations of baseline BP and change in BP over time with progression of brain atrophy.DESIGN The Secondary Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) Study is a prospective cohort study with baseline measurements in 2001-2005 and follow-up measurements in 2006-2009. The mean follow-up time was 3.9 years.SETTING University Medical Center Utrecht, the Netherlands.PARTICIPANTS A total of 663 patients (mean [SD] age, 57 [9] years; 81% male) with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysm were included.MAIN OUTCOMES AND MEASURES Using automated segmentation at baseline and follow-up, change in brain parenchymal fraction, cortical gray matter fraction, and ventricular fraction (%ICV) were quantified as indicators of progression of global, cortical, and subcortical brain atrophy.RESULTS Multivariable adjusted regression analysis showed that patients with lower baseline diastolic BP (DBP) or mean arterial pressure had more progression of subcortical atrophy. The mean differences in the change in ventricular fraction between low and high DBP was 0.07% (95% CI, 0.01-0.14) and between low and high mean arterial pressure was 0.05% (95% CI, 0.00-0.10). Furthermore, in patients with higher baseline BP (DBP, mean arterial pressure, or systolic BP), those with declining BP levels over time had less progression of subcortical atrophy compared with those with rising BP levels.CONCLUSIONS AND RELEVANCE In patients with manifest arterial disease, low baseline DBP was associated with more progression of subcortical atrophy, irrespective of the BP course during follow-up. Furthermore, in patients with higher baseline BP, declining BP levels over time were associated with less progression of subcortical atrophy. This could imply that BP lowering is beneficial in patients with higher BP levels, but caution should be taken with further BP lowering in patients who already have a low DBP.