Anthony G Chesebro1, Jesus D Melgarejo1, Reinier Leendertz1, Kay C Igwe1, Patrick J Lao1, Krystal K Laing1, Batool Rizvi1, Mariana Budge1, Irene B Meier1, Gustavo Calmon1, Joseph H Lee1, Gladys E Maestre1, Adam M Brickman2. 1. From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville. 2. From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville. amb2139@columbia.edu.
Abstract
OBJECTIVE: To test the hypotheses that hypertension and nocturnal blood pressure are related to white matter hyperintensity (WMH) volume, an MRI marker of small vessel cerebrovascular disease, and that WMH burden statistically mediates the association of hypertension and dipping status with memory functioning, we examined the relationship of hypertension and dipping status on WMH volume and neuropsychological test scores in middle-aged and older adults. METHODS: Participants from the community-based Maracaibo Aging Study received ambulatory 24-hour blood pressure monitoring, structural MRI, and neuropsychological assessment. Four hundred thirty-five participants (mean ± SD age 59 ± 13 years, 71% women) with available ambulatory blood pressure, MRI, and neuropsychological data were included in the analyses. Ambulatory blood pressure was used to define hypertension and dipping status (i.e., dipper, nondipper, and reverse dipper based on night/day blood pressure ratio <0.9, 0.9-1, and >1, respectively). Outcome measures included regional WMH and memory functioning derived from a neuropsychological test battery. RESULTS: The majority of the participants (59%) were hypertensive. Ten percent were reverse dippers, and 40% were nondippers. Reverse dipping in the presence of hypertension was associated with particularly elevated periventricular WMH volume (F 2,423 = 3.78, p = 0.024) and with lowered memory scores (F 2,423 = 3.911, p = 0.021). Periventricular WMH volume mediated the effect of dipping status and hypertension on memory (β = -4.1, 95% confidence interval -8.7 to -0.2, p < 0.05). CONCLUSION: Reverse dipping in the presence of hypertension is associated with small vessel cerebrovascular disease, which, in turn, mediates memory functioning. These results point toward reverse dipping as a marker of poor nocturnal blood pressure control, particularly among hypertensive individuals, with potentially pernicious effects on cerebrovascular health and associated cognitive function.
OBJECTIVE: To test the hypotheses that hypertension and nocturnal blood pressure are related to white matter hyperintensity (WMH) volume, an MRI marker of small vessel cerebrovascular disease, and that WMH burden statistically mediates the association of hypertension and dipping status with memory functioning, we examined the relationship of hypertension and dipping status on WMH volume and neuropsychological test scores in middle-aged and older adults. METHODS:Participants from the community-based Maracaibo Aging Study received ambulatory 24-hour blood pressure monitoring, structural MRI, and neuropsychological assessment. Four hundred thirty-five participants (mean ± SD age 59 ± 13 years, 71% women) with available ambulatory blood pressure, MRI, and neuropsychological data were included in the analyses. Ambulatory blood pressure was used to define hypertension and dipping status (i.e., dipper, nondipper, and reverse dipper based on night/day blood pressure ratio <0.9, 0.9-1, and >1, respectively). Outcome measures included regional WMH and memory functioning derived from a neuropsychological test battery. RESULTS: The majority of the participants (59%) were hypertensive. Ten percent were reverse dippers, and 40% were nondippers. Reverse dipping in the presence of hypertension was associated with particularly elevated periventricular WMH volume (F 2,423 = 3.78, p = 0.024) and with lowered memory scores (F 2,423 = 3.911, p = 0.021). Periventricular WMH volume mediated the effect of dipping status and hypertension on memory (β = -4.1, 95% confidence interval -8.7 to -0.2, p < 0.05). CONCLUSION: Reverse dipping in the presence of hypertension is associated with small vessel cerebrovascular disease, which, in turn, mediates memory functioning. These results point toward reverse dipping as a marker of poor nocturnal blood pressure control, particularly among hypertensive individuals, with potentially pernicious effects on cerebrovascular health and associated cognitive function.
Authors: Adam M Brickman; Laura B Zahodne; Vanessa A Guzman; Atul Narkhede; Irene B Meier; Erica Y Griffith; Frank A Provenzano; Nicole Schupf; Jennifer J Manly; Yaakov Stern; José A Luchsinger; Richard Mayeux Journal: Neurobiol Aging Date: 2014-07-21 Impact factor: 4.673
Authors: Adam M Brickman; Nicole Schupf; Jennifer J Manly; José A Luchsinger; Howard Andrews; Ming X Tang; Christiane Reitz; Scott A Small; Richard Mayeux; Charles DeCarli; Truman R Brown Journal: Arch Neurol Date: 2008-08
Authors: Ludovica Griffanti; Mark Jenkinson; Sana Suri; Enikő Zsoldos; Abda Mahmood; Nicola Filippini; Claire E Sexton; Anya Topiwala; Charlotte Allan; Mika Kivimäki; Archana Singh-Manoux; Klaus P Ebmeier; Clare E Mackay; Giovanna Zamboni Journal: Neuroimage Date: 2017-03-15 Impact factor: 6.556
Authors: Hazel Mae A Abraham; Leslie Wolfson; Nicola Moscufo; Charles R G Guttmann; Richard F Kaplan; William B White Journal: J Cereb Blood Flow Metab Date: 2016-01 Impact factor: 6.200
Authors: M P J van Boxtel; L H G Henskens; A A Kroon; P A M Hofman; E H B M Gronenschild; J Jolles; P W de Leeuw Journal: J Hum Hypertens Date: 2006-01 Impact factor: 3.012
Authors: Koki Nakanishi; Zhezhen Jin; Shunichi Homma; Mitchell S V Elkind; Tatjana Rundek; Joseph E Schwartz; Tetz C Lee; Aylin Tugcu; Mitsuhiro Yoshita; Charles DeCarli; Clinton B Wright; Ralph L Sacco; Marco R Di Tullio Journal: Eur Heart J Cardiovasc Imaging Date: 2019-07-01 Impact factor: 6.875
Authors: C DeCarli; D G Murphy; M Tranh; C L Grady; J V Haxby; J A Gillette; J A Salerno; A Gonzales-Aviles; B Horwitz; S I Rapoport Journal: Neurology Date: 1995-11 Impact factor: 9.910
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: JAMA Date: 2003-05-14 Impact factor: 56.272
Authors: Fernando Castro; Jesús Melgarejo; Carlos A Chavez; Gabriel A de Erausquin; Joseph D Terwilliger; Joseph H Lee; Gladys E Maestre Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.472
Authors: Jesus D Melgarejo; Daniel C Aguirre-Acevedo; Ciro Gaona; Carlos A Chavez; Gustavo E Calmón; Eglé R Silva; Gabriel A de Erausquin; Mario Gil; Luis J Mena; Joseph D Terwilliger; Humberto Arboleda; Nikolaos Scarmeas; Joseph H Lee; Gladys E Maestre Journal: J Alzheimers Dis Date: 2020 Impact factor: 4.472
Authors: Anthony G Chesebro; Jesus D Melgarejo; Reinier Leendertz; Kay C Igwe; Patrick J Lao; Krystal K Laing; Batool Rizvi; Mariana Budge; Irene B Meier; Gustavo Calmon; Joseph H Lee; Gladys Maestre; Adam M Brickman Journal: Neurology Date: 2021-07-06 Impact factor: 11.800
Authors: Jesus D Melgarejo; Gladys E Maestre; Jose Gutierrez; Lutgarde Thijs; Luis J Mena; Ciro Gaona; Reinier Leendertz; Joseph H Lee; Carlos A Chávez; Gustavo Calmon; Egle Silva; Dongmei Wei; Joseph D Terwilliger; Thomas Vanassche; Stefan Janssens; Peter Verhamme; Daniel Bos; Zhen-Yu Zhang Journal: Front Neurol Date: 2022-07-14 Impact factor: 4.086
Authors: Jennifer Cable; Eva Schernhammer; Erin C Hanlon; Céline Vetter; Jonathan Cedernaes; Nour Makarem; Hassan S Dashti; Ari Shechter; Christopher Depner; Ashley Ingiosi; Christine Blume; Xiao Tan; Elie Gottlieb; Christian Benedict; Eve Van Cauter; Marie-Pierre St-Onge Journal: Ann N Y Acad Sci Date: 2021-08-02 Impact factor: 6.499