Association of Blood Pressure Lowering Intensity With White Matter Network Integrity in Patients With Cerebral Small Vessel Disease.

Autor:	Pflanz CP; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Egle MS; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., O'Brien JT; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Morris RG; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Barrick TR; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Blamire AM; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Ford GA; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Tozer D; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.)., Markus HS; From the Stroke Research Group (C.P.P., M.S.E., D.T., H.S.M.), Department of Clinical Neuroscience, University of Cambridge; Department of Psychiatry (J.T.O.B.), University of Cambridge; Kings College Institute of Psychiatry (R.G.M.), Psychology and Neurosciences, London, UK; Molecular and Clinical Science Research Institute (T.R.B.), St George's, University of London, UK; Magnetic Resonance Centre (A.M.B.), Institute of Cellular Medicine, Newcastle University, UK; and Oxford University Hospitals NHS Foundation Trust & University of Oxford (G.A.F.). hsm32@medschl.cam.ac.uk.
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2022 Oct 25; Vol. 99 (17), pp. e1945-e1953. Date of Electronic Publication: 2022 Aug 17.
DOI:	10.1212/WNL.0000000000201018
Abstrakt:	Background and Objectives: Diffusion tensor imaging (DTI) networks integrate damage from a variety of pathologic processes in cerebral small vessel disease (SVD) and may be a sensitive marker to detect treatment effects. We determined whether brain network analysis could detect treatment effects in the PRESERVE trial data set, in which intensive vs standard blood pressure (BP) lowering was compared. The primary end point of DTI had not shown treatment differences. Methods: Participants with lacunar stroke were randomized to standard (systolic 130-140 mm Hg) or intensive (systolic ≤ 125 mm Hg) BP lowering and followed for 2 years with MRI at baseline and at 2 years. Graph theory-based metrics were derived from DTI data to produce a measure of network integrity weighted global efficiency and compared with individual MRI markers of DTI, brain volume, and white matter hyperintensities. Results: Data were available in 82 subjects: standard n = 40 (mean age 66.3 ± 1.5 years) and intensive n = 42 (mean age 69.6 ± 1.0 years). The mean (SD) systolic BP was reduced by 13(14) and 23(23) mm Hg in the standard and intensive groups, respectively ( p < 0.001 between groups). Significant differences in diffusion network metrics were found, with improved network integrity (weighted global efficiency, p = 0.002) seen with intensive BP lowering. In contrast, there were no significant differences in individual MRI markers including DTI histogram metrics, brain volume, or white matter hyperintensities. Discussion: Brain network analysis may be a sensitive surrogate marker in trials in SVD. This work suggests that measures of brain network efficiency may be more sensitive to the effects of BP control treatment than conventional DTI metrics. Trial Registration Information: The trial is registered with the ISRCTN Registry (ISRCTN37694103; doi.org/10.1186/ISRCTN37694103) and the NIHR Clinical Research Network (CRN 10962; public-odp.nihr.ac.uk/QvAJAXZfc/opendoc.htm?document=crncc_users%5Cfind%20a%20clinical%20research%20study.qvw&lang=en-US&host=QVS%40crn-prod-odp-pu&anonymous=true). Classification of Evidence: This study provides Class II evidence that intensive BP lowering in patients with SVD results in improved brain network function when assessed by DTI-based brain network metrics. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
Databáze:	MEDLINE
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