Uncontrolled hypertension associates with subclinical cerebrovascular health globally: a multimodal imaging study
Uncontrolled hypertension associates with subclinical cerebrovascular health globally: a multimodal imaging study
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DOI：
10.1007/s00330-020-07218-5
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发表时间：
2020-09-14
影响因子：
5.9
通讯作者：
Yang, Junwei
中科院分区：
文献类型：
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作者：
Liu, Wenjin;Huang, Xiaoqin;Yang, Junwei
目的本研究旨在通过综合多模式成像方法分析高血压控制与亚临床脑血管健康之间的关系。方法选择200例无心血管疾病史的老年男性高血压患者。使用标准方法测量门诊血压（BP）。使用磁共振成像在以下四个方面评价脑血管健康：通过血管壁成像确定颅内动脉粥样硬化;使用定制开发的技术评价血管稀疏（定义为血管造影术上不易辨别的血管）。脑血流（CBF）和白色高信号（WMH）分别采用动脉自旋标记成像和液体衰减反转恢复成像进行评估。结果共189例受试者进行了MRI扫描。平均年龄为64.9（+/- 7.2）岁。对于颅内动脉粥样硬化，不受控制的高血压和颅内斑块的存在之间有显著的相关性。当分别分析收缩压和舒张压时，两者的相关性仍然显著。对于血管稀疏，不受控制的高血压与血管造影中可辨别的血管分支较少或血管长度较短相关。进一步的分析显示，这是由于不受控制的舒张压，而不是不受控制的收缩压。不受控制的高血压与CBF降低之间存在相关性，这也主要是由不受控制的舒张压引起的。我们还发现，不受控制的舒张压，而不是不受控制的收缩压，与WMH体积增加。结论未控制的高血压与全球亚临床脑血管损伤相关，小动脉和中大动脉均受影响。
Objectives The study aimed to analyze the association between hypertension control and subclinical cerebrovascular health using a comprehensive multimodal imaging approach. Methods The study included 200 hypertensive older males without previous cardiovascular diseases. Clinic blood pressure (BP) was measured using a standard approach. Cerebrovascular health was evaluated using magnetic resonance imaging in the following four aspects: Intracranial atherosclerosis as determined by vessel wall imaging; Vascular rarefaction (defined as less discernible vessels on angiography) was evaluated using a custom-developed technique. Cerebral blood flow (CBF) and white matter hyperintensity (WMH) were assessed using arterial spin-labeling imaging and fluid-attenuated inversion recovery imaging, respectively. Results A total of 189 subjects had MRI scans. The mean age was 64.9 (+/- 7.2) years. For intracranial atherosclerosis, there was a significant association between uncontrolled hypertension and presence of intracranial plaque. When systolic and diastolic BP were analyzed separately, the association remained significant for both. For vascular rarefaction, uncontrolled hypertension was associated with less discernible vessel branches or shorter vessel length on angiography. Further analysis revealed that this is due to uncontrolled diastolic BP, but not uncontrolled systolic BP. There was an association between uncontrolled hypertension and reduced CBF, which was also mainly driven by uncontrolled diastolic BP. We also found that uncontrolled diastolic BP, but not uncontrolled systolic BP, was associated with increased WMH volume. Conclusions Uncontrolled hypertension was associated with subclinical cerebrovascular injury globally, with both small and medium-to-large arteries being affected.