Midlife blood pressure is associated with the severity of white matter hyperintensities: analysis of the UK Biobank cohort study
| Autor: | Wartolowska, Karolina Agnieszka, Webb, Alastair John Stewart |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Regression dilution Population 030204 cardiovascular system & hematology Imaging 03 medical and health sciences Magnetic resonance imaging 0302 clinical medicine Diastolic blood pressure Internal medicine White matter hyperintensities Medicine AcademicSubjects/MED00200 education education.field_of_study business.industry Clnical Research Hyperintensity Confidence interval Small vessel disease Blood pressure Hypertension Attributable risk Cohort Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | European Heart Journal |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehaa756 |
| Popis: | Aims White matter hyperintensities (WMH) progress with age and hypertension, but the key period of exposure to elevated blood pressure (BP), and the relative role of systolic BP (SBP) vs. diastolic BP (DBP), remains unclear. This study aims to determine the relationship between WMH and concurrent vs. past BP. Methods and results UK Biobank is a prospective community-based cohort of 40–69-year olds from 22 centres, with magnetic resonance imaging in a subgroup of over 40 000 people at 4–12 years after baseline assessment. Standardized associations between WMH load (WMH volume normalized by total white matter volume and logit-transformed) and concurrent vs. past BP were determined using linear models, adjusted for age, sex, cardiovascular risk factors, BP source, assessment centre, and time since baseline. Associations adjusted for regression dilution bias were determined between median WMH and usual SBP or DBP, stratified by age and baseline BP. In 37 041 eligible participants with WMH data and BP measures, WMH were more strongly associated with concurrent SBP [DBP: β = 0.064, 95% confidence interval (CI) 0.050–0.078; SBP: β = 0.076, 95% CI 0.062–0.090], but the strongest association was for past DBP (DBP: β = 0.087, 95% CI 0.064–0.109; SBP: β = 0.045, 95% CI 0.022–0.069), particularly under the age of 50 (DBP: β = 0.103, 95% CI 0.055–0.152; SBP: β = 0.012, 95% CI −0.044 to 0.069). Due to the higher prevalence of elevated SBP, median WMH increased 1.126 (95% CI 1.107–1.146) per 10 mmHg usual SBP and 1.106 (95% CI 1.090–1.122) per 5 mmHg usual DBP, whilst the population attributable fraction of WMH in the top decile was greater for elevated SBP (19.1% for concurrent SBP; 24.4% for past SBP). Any increase in BP, even below 140 for SBP and below 90 mmHg for DBP, and especially if requiring antihypertensive medication, was associated with increased WMH. Conclusions WMH were strongly associated with concurrent and past elevated BP with the population burden of severe WMH greatest for SBP. However, before the age of 50, DBP was more strongly associated with WMH. Long-term prevention of WMH may require control of even mildly elevated midlife DBP. |
| Databáze: | OpenAIRE |
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