Abstract
Introduction
Recent guidelines suggest that a blood pressure cutoff of 130/80 mmHg should be used to define arterial hypertension. This contrasts with the previously accepted cutoff of 140/90 mmHg.
Aim
Using the Atahualpa Project cohort, we aimed to assess the cutoff that better correlates with signatures of cerebral small vessel disease (SVD), which are related to arterial hypertension.
Methods
Of 437 Atahualpa residents aged ≥ 60 years, 363 (83%) underwent brain MRI and blood pressure determinations. Using logistic regression models, we evaluated the association between SVD and the two different cutoffs, after adjusting for demographics and cardiovascular risk factors. Using receiver operator characteristics curve analysis, we calculated sensitivity, specificity, and the area under the curve for the predictive value of the two cutoffs for detecting signatures of SVD.
Results
A comparison between the old and new cutoffs showed no differences in the ability to predict subjects with white matter hyperintensities, deep cerebral microbleeds or basal ganglia perivascular spaces. However, the new cutoff improved the identification of individuals with lacunar infarctions, which went from no association using the old cutoff (p = 0.097) to a significant association using the new cutoff (p = 0.036). The new cutoff was more sensitive but less specific than the old cutoff for identifying signatures of cerebral SVD. Areas under the curve were non-significantly higher for the old than for the new cutoffs for all the lesions of interest.
Conclusions
The new blood pressure cutoff is consistently more sensitive but less specific than the old cutoff for detecting signatures of cerebral SVD. The most striking effect of the new cutoff is the improvement in the identification of lacunar infarctions.
Similar content being viewed by others
References
Blanco PJ, Muller LO, Spence JD. Blood pressure gradients in cerebral arteries: a clue to pathogenesis of cerebral small vessel disease. Stroke Vasc Neurol. 2017;2:108–17.
Yannoutsos A, Dreyfuss Tbiana C, Safar ME, Blacher J. Optimal blood pressure target in stroke prevention. Curr Opin Neurol. 2017;30:8–14.
Coca A, Monteagudo E, Doménech M, Camafort M, Sierra C. Can the treatment of hypertension in the middle-aged prevent dementia in the elderly? High Blood Press Cardiovasc Prev. 2016;23:97–104.
Abraham HM, Wolfson L, Moscufo N, Guttmann CR, Kaplan RF, White WB. Cardiovascular risk factors and small vessel disease of the brain: blood pressure, white matter lesions, and functional decline in older persons. J Cereb Blood Flow Metab. 2016;36:132–42.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2017. https://doi.org/10.1161/HYP.0000000000000065.
Del Brutto OH, Peñaherrera E, Ochoa E, Santamaría M, Zambrano M, Del Brutto VJ. Door-to-door survey of cardiovascular health, stroke, and ischemic heart disease in rural coastal Ecuador—the Atahualpa Project: methodology and operational definitions. Int J Stroke. 2014;9:367–71.
Del Brutto OH, Mera RM, Castillo PR, Del Brutto VJ. Key findings from the Atahualpa Project: what should we learn? Expert Rev Neurother. 2018;18:5–8.
Del Brutto OH, Mera RM, Del Brutto VJ, Zambrano M, Lama J. White matter hyperintensities of presumed vascular origin: a population-based study in rural Ecuador (The Atahualpa Project). Int J Stroke. 2015;10:372–5.
Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–38.
Pantoni L, Basile AM, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H, et al. Impact of age-related cerebral white matter changes on the transition to disability: the LADIS study: rationale, design and methodology. Neuroepidemiology. 2005;24:51–62.
Gregoire SM, Chaudhary UJ, Brown MM, Yousty TA, Kallis C, Jager HR, et al. The microbleed anatomical rating scale (MARS). Neurology. 2009;73:1759–66.
Doubal FN, MacLullich AMJ, Ferguson KJ, Dennis MS, Wardlaw JM. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke. 2010;41:450–4.
Pergola PE, White CL, Graves JW, Coffey CS, Tonarelli SB, Hart RG, et al. Reliability and validity of blood pressure measurement in the secondary prevention of small subcortical strokes study. Blood Press Monit. 2007;12:1–8.
Del Brutto OH, Santamaría M, Ochoa E, Peñaherrera E, Santibáñez R, Pow-Chon-Long F, et al. Population-based study of cardiovascular health in Atahualpa, a rural village of coastal Ecuador. Int J Cardiol. 2013;168:1618–20.
Del Brutto OH, Mera RM, Zambrano M. The influence of age in the relationship between cerebral small vessel disease and edentulism. The Atahualpa Project. Eur Neurol. 2016;76:112–6.
ticular document, Benavente O, Coffey CS, Conwit R, Hart RG, McClure LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507–15.
Peralta CA, McClure LA, Scherzer R, Odden MC, White CL, Shlipak M, et al. Effect of intensive versus usual blood pressure control on kidney function among individuals with prior lacunar stroke: a post hoc analysis of the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial. Circulation. 2016;133:584–91.
Antza C, Doundoulakis I, Stabouli S, Kotsis V. Comparison among recommendations for the management of arterial hypertension issued by last US, Canadian, British and European guidelines. High Blood Press Cardiovasc Prev. 2017. https://doi.org/10.1007/s40292-017-0236-x.
Ferri C, Ferri L, Desideri G. Management of hypertension in the elderly and frail elderly. High Blood Press Cardiovasc Prev. 2017;24:1–11.
Kiselev AR, Posnenkova OM, Belova OA, Romanchuk SV, Popova YV, Prokhorov MD, et al. Impact of clinical factors on the achievement of target blood pressure in hypertensive patients from Ivanovo region of Russia: data of 2015. High Blood Press Cardiovasc Prev. 2017;24:425–34.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was partially supported by Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
Conflict of interest
All authors report no conflicts of interest to disclose.
Ethical approval
The study was approved by the Institutional Review Board of Hospital-Clínica Kennedy, Guayaquil, Ecuador (FWA 00006867).
Informed consent
All subjects signed an informed consent form before enrollment.
Rights and permissions
About this article
Cite this article
Del Brutto, O.H., Mera, R.M. Neuroimaging Signatures of Cerebral Small Vessel Disease at Blood Pressure Cutoff Levels of 130/80 and 140/90 mmHg: A Population-Based Study in Community-Dwellers Aged ≥ 60 Years. High Blood Press Cardiovasc Prev 25, 203–208 (2018). https://doi.org/10.1007/s40292-018-0254-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40292-018-0254-3