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AVERAGE DAILY BLOOD PRESSURE, NOT OFFICE BLOOD PRESSURE, DETERMINES THE PROGRESSION OF CEREBROVASCULAR DISEASE AND FUNCTIONAL DECLINE IN OLDER PERSONS
E490 JACC April 5, 2011 Volume 57, Issue 14
GENERAL CARDIOLOGY: HYPERTENSION, PREVENTION AND LIPIDS AVERAGE DAILY BLOOD PRESSURE, NOT OFFICE BLOOD PRESSURE, DETERMINES THE PROGRESSION OF CEREBROVASCULAR DISEASE AND FUNCTIONAL DECLINE IN OLDER PERSONS ACC Oral Contributions Ernest N. Morial Convention Center, Room 243 Monday, April 04, 2011, 5:15 p.m.-5:30 p.m.
Session Title: New Insights in Hypertension Abstract Category: 16. Hypertension Presentation Number: 917-5 Authors: William B. White, Leslie Wolfson, Charles Guttman, Nicola Moscufo, Dorothy Wakefield, Richard Kaplan, Godfrey Pearlson, University of Connecticut School of Medicine, Farmington, CT, Harvard Medical School, Boston, MA Background. Vascular risk factors, including systolic BP (SBP) are associated with white matter lesions (WML) in the brain but predictors of WML progression are poorly understood. We prospectively evaluated the 2-year progression of WML with mobility and cognitive function in older people. Methods. 77 subjects 75-90 years of age had office and ambulatory BP and volumetric magnetic resonance imaging (MRI) 2 years apart under similar conditions. T1-and T2-weighted brain images were acquired to determine total volume of WML (tWML), expressed as a fraction of the intracranial contents (%). Mobility assessments included stair descent time, gait velocity and walk time. Cognitive testing assessed executive function and speed of processing. Regression analyses examined the relations among BP, tWML, and function controlling for age and LDL cholesterol. Results. At 2 years, clinic SBP did not predict the progression of WML volume or functional parameters (Table). In contrast, 24-hour systolic SBP at 2 years significantly predicted both WML volume and change in WML volume as well as declines in executive function, processing speed and walk time. Conclusions. These data demonstrate for the first time that 24-hour systolic BP but not office SBP predicts tWML progression in older people, a finding associated with cognitive decline and impaired mobility. These data suggest that an intervention using 24-hour SBP as the target could reduce progression of cerebrovascular disease. RELATIONS AMONG CHANGES IN CLINIC AND 24-HOUR SYSTOLIC BLOOD PRESSURE WITH WHITE MATTER LESION VOLUME, MOBILITY AND COGNITIVE FUNCTION AT 24 MONTHS Parameters at 24 months Magnetic Resonance Imaging Total WML (%) Change in WML (%) Mobility Tinetti Gait Stair descent time Maximal Gait Velocity Walk time Cognitive Function Trail Making Test Part B Stroop Color and Word Test CalCAP Simple Reaction Time * adjusted for age and serum cholesterol
24-hour Ambulatory SBP R2 (p-value for SBP)*
Clinic SBP R2 (p-value for SBP)*
0.167 (0.001) 0.151 (0.002)
0.025 (0.49) 0.019 (0.62)
0.097 (0.07) 0.055 (0.32) 0.048 (0.26) 0.079 (0.056)
0.081 (0.21) 0.061 (0.95) 0.090 (0.14) 0.032 (0.66)
0.127 (0.047) 0.348 (0.019) 0.100 (0.03)
0.086 (0.75) 0.291 (0.32) 0.040 (0.91)
GENERAL CARDIOLOGY: HYPERTENSION, PREVENTION AND LIPIDS AVERAGE DAILY BLOOD PRESSURE, NOT OFFICE BLOOD PRESSURE, DETERMINES THE PROGRESSION OF CEREBROVASCULAR DISEASE AND FUNCTIONAL DECLINE IN OLDER PERSONS ACC Oral Contributions Ernest N. Morial Convention Center, Room 243 Monday, April 04, 2011, 5:15 p.m.-5:30 p.m.
Session Title: New Insights in Hypertension Abstract Category: 16. Hypertension Presentation Number: 917-5 Authors: William B. White, Leslie Wolfson, Charles Guttman, Nicola Moscufo, Dorothy Wakefield, Richard Kaplan, Godfrey Pearlson, University of Connecticut School of Medicine, Farmington, CT, Harvard Medical School, Boston, MA Background. Vascular risk factors, including systolic BP (SBP) are associated with white matter lesions (WML) in the brain but predictors of WML progression are poorly understood. We prospectively evaluated the 2-year progression of WML with mobility and cognitive function in older people. Methods. 77 subjects 75-90 years of age had office and ambulatory BP and volumetric magnetic resonance imaging (MRI) 2 years apart under similar conditions. T1-and T2-weighted brain images were acquired to determine total volume of WML (tWML), expressed as a fraction of the intracranial contents (%). Mobility assessments included stair descent time, gait velocity and walk time. Cognitive testing assessed executive function and speed of processing. Regression analyses examined the relations among BP, tWML, and function controlling for age and LDL cholesterol. Results. At 2 years, clinic SBP did not predict the progression of WML volume or functional parameters (Table). In contrast, 24-hour systolic SBP at 2 years significantly predicted both WML volume and change in WML volume as well as declines in executive function, processing speed and walk time. Conclusions. These data demonstrate for the first time that 24-hour systolic BP but not office SBP predicts tWML progression in older people, a finding associated with cognitive decline and impaired mobility. These data suggest that an intervention using 24-hour SBP as the target could reduce progression of cerebrovascular disease. RELATIONS AMONG CHANGES IN CLINIC AND 24-HOUR SYSTOLIC BLOOD PRESSURE WITH WHITE MATTER LESION VOLUME, MOBILITY AND COGNITIVE FUNCTION AT 24 MONTHS Parameters at 24 months Magnetic Resonance Imaging Total WML (%) Change in WML (%) Mobility Tinetti Gait Stair descent time Maximal Gait Velocity Walk time Cognitive Function Trail Making Test Part B Stroop Color and Word Test CalCAP Simple Reaction Time * adjusted for age and serum cholesterol
24-hour Ambulatory SBP R2 (p-value for SBP)*
Clinic SBP R2 (p-value for SBP)*
0.167 (0.001) 0.151 (0.002)
0.025 (0.49) 0.019 (0.62)
0.097 (0.07) 0.055 (0.32) 0.048 (0.26) 0.079 (0.056)
0.081 (0.21) 0.061 (0.95) 0.090 (0.14) 0.032 (0.66)
0.127 (0.047) 0.348 (0.019) 0.100 (0.03)
0.086 (0.75) 0.291 (0.32) 0.040 (0.91)