William B White1, Fatima Jalil2, Dorothy B Wakefield3, Richard F Kaplan4, Richard W Bohannon5, Charles B Hall6, Nicola Moscufo7, Douglas Fellows8, Charles R G Guttmann7, Leslie Wolfson3. 1. Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT. Electronic address: wwhite@uchc.edu. 2. Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT. 3. Department of Neurology, University of Connecticut School of Medicine. 4. Department of Psychiatry, University of Connecticut School of Medicine. 5. Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC. 6. Department of Epidemiology, Albert Einstein College of Medicine, Bronx, NY; Department of Population Health, Albert Einstein College of Medicine, Bronx, NY. 7. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 8. Department of Radiology, UMASS Memorial Medical Center, Worcester, MA.
Abstract
BACKGROUND: Subcortical small vessel disease, represented as white matter hyperintensity (WMH) on magnetic resonance images (MRI) is associated with functional decline in older people with hypertension. We evaluated the relationships of clinic and out-of-office blood pressures (BP) with WMH and functional status in older persons. METHODS: Using cross-sectional data from 199 older study participants enrolled in the INFINITY trial, we analyzed the clinic, 24-hour ambulatory, and home BPs and their relationships with WMH burden and mobility and cognitive outcomes. RESULTS: Volume of WMH was associated with clinic and 24-hour ambulatory systolic BP but not home systolic BP. The mobility measure, supine-to-sit time, had a significant association with 24-hour systolic BP and pulse pressure but not with diastolic BP or values obtained by home BP. Cognitive measures of processing speed (Trails Making Test Part A and the Stroop Word Test) were significantly associated with 24-hour systolic BP, but not clinic and home BPs. CONCLUSION: These data demonstrate that ambulatory BP measurements in older people are more strongly associated with WMH and certain measures of functional status compared to home BP measurements. Hence, home BP may not be a useful substitute for ambulatory BP for assessing subcortical small vessel disease and its consequences. Further longitudinal analyses comparing clinic and various types of out-of-office BP measures with small vessel brain disease are needed. Clinicaltrials.gov identifier: NCT01650402.
BACKGROUND:Subcortical small vessel disease, represented as white matter hyperintensity (WMH) on magnetic resonance images (MRI) is associated with functional decline in older people with hypertension. We evaluated the relationships of clinic and out-of-office blood pressures (BP) with WMH and functional status in older persons. METHODS: Using cross-sectional data from 199 older study participants enrolled in the INFINITY trial, we analyzed the clinic, 24-hour ambulatory, and home BPs and their relationships with WMH burden and mobility and cognitive outcomes. RESULTS: Volume of WMH was associated with clinic and 24-hour ambulatory systolic BP but not home systolic BP. The mobility measure, supine-to-sit time, had a significant association with 24-hour systolic BP and pulse pressure but not with diastolic BP or values obtained by home BP. Cognitive measures of processing speed (Trails Making Test Part A and the Stroop Word Test) were significantly associated with 24-hour systolic BP, but not clinic and home BPs. CONCLUSION: These data demonstrate that ambulatory BP measurements in older people are more strongly associated with WMH and certain measures of functional status compared to home BP measurements. Hence, home BP may not be a useful substitute for ambulatory BP for assessing subcortical small vessel disease and its consequences. Further longitudinal analyses comparing clinic and various types of out-of-office BP measures with small vessel brain disease are needed. Clinicaltrials.gov identifier: NCT01650402.
Authors: William B White; Dorothy B Wakefield; Nicola Moscufo; Charles R G Guttmann; Richard F Kaplan; Richard W Bohannon; Douglas Fellows; Charles B Hall; Leslie Wolfson Journal: Circulation Date: 2019-10-14 Impact factor: 29.690
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