Effects of systolic blood pressure on white-matter integrity in young adults in the Framingham Heart Study: a cross-sectional study.
Effects of systolic blood pressure on white-matter integrity in young adults in the Framingham Heart Study: a cross-sectional study.
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DOI：
10.1016/s1474-4422(12)70241-7
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发表时间：
2012-12
期刊：
影响因子：
--
通讯作者：
DeCarli C
中科院分区：
文献类型：
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作者：
Maillard P;Seshadri S;Beiser A;Himali JJ;Au R;Fletcher E;Carmichael O;Wolf PA;DeCarli C
先前的研究已经确定了年龄和血管危险因素对老年人脑损伤的影响。我们的目的是确定高血压对大脑的影响是否早在50岁时就很明显。在对弗雷明汉心脏研究第三代的调查中，我们在2009年接触了所有参与者，询问他们是否愿意接受MRI。同意的患者接受临床评估和脑MRI，包括t1加权和弥散张量成像，以获得分数各向异性、平均扩散率和灰质体积的估计。所有图像都被共同注册到一个共同的最小变形模板中，用于基于体素的线性回归，将分数各向异性、平均扩散率和灰质体积与年龄和收缩压相关，并对潜在的混杂因素进行调整。在2009年6月至2010年6月期间，第三代队列（平均年龄39.2岁，标准差8.4）的4095名参与者中，579名（14.1%）接受了脑部MRI检查。年龄与几乎所有脑白质体素的分数各向异性降低和平均扩散率增加有关。年龄也与灰质体积减少独立相关。收缩压升高与区域分数各向异性降低和平均弥漫性增加呈线性相关，尤其是在胼胝体前部、额枕下束和从丘脑投射到额上回的纤维中。它还与灰质体积减少密切相关，特别是在颞叶内侧表面的Brodmann 's区48和颞中回的Brodmann 's区21。我们的研究结果表明，细微的血管性脑损伤在生活中不知不觉地发展，甚至在年轻人中也有明显的影响。这些发现强调了早期和最佳控制血压的必要性。美国国立卫生研究院和国立心肺血液研究所；国家老龄研究所；以及国家神经疾病和中风研究所。
Previous studies have identified effects of age and vascular risk factors on brain injury in elderly individuals. We aimed to establish whether the effects of high blood pressure in the brain are evident as early as the fifth decade of life. In an investigation of the third generation of the Framingham Heart Study, we approached all participants in 2009 to ask whether they would be willing to undergo MRI. Consenting patients underwent clinical assessment and cerebral MRI that included T1-weighted and diffusion tensor imaging to obtain estimates of fractional anisotropy, mean diffusivity, and grey-matter volumes. All images were coregistered to a common minimum deformation template for voxel-based linear regressions relating fractional anisotropy, mean diffusivity, and grey-matter volumes to age and systolic blood pressure, with adjustment for potential confounders. 579 (14·1%) of 4095 participants in the third-generation cohort (mean age 39·2 years, SD 8·4) underwent brain MRI between June, 2009 and June, 2010. Age was associated with decreased fractional anisotropy and increased mean diffusivity in almost all cerebral white-matter voxels. Age was also independently associated with reduced grey-matter volumes. Increased systolic blood pressure was linearly associated with decreased regional fractional anisotropy and increased mean diffusivity, especially in the anterior corpus callosum, the inferior fronto-occipital fasciculi, and the fibres that project from the thalamus to the superior frontal gyrus. It was also strongly associated with reduced grey-matter volumes, particularly in Brodmann’s area 48 on the medial surface of the temporal lobe and Brodmann’s area 21 of the middle temporal gyrus. Our results suggest that subtle vascular brain injury develops insidiously during life, with discernible effects even in young adults. These findings emphasise the need for early and optimum control of blood pressure. National Institutes of Health and National Heart, Lung, and Blood Institute; National Institute on Aging; and National Institute of Neurological Disorders and Stroke.