Background and Purpose- Few studies have examined the separate contributions of systolic blood pressure and diastolic blood pressures (DBP) on subclinical cerebrovascular disease, especially using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines. Furthermore, associations with region-specific white matter hyperintensity volume (WMHV) are underexplored. Methods- Using data from the NOMAS (Northern Manhattan Study), a prospective cohort study of stroke risk and cognitive aging, we examined associations between systolic blood pressure and DBP, defined by the 2017 American College of Cardiology/American Heart Association guidelines, with regional WMHV. We used a linear mixed model approach to account for the correlated nature of regional brain measures. Results- The analytic sample (N=1205; mean age 64±8 years) consisted of 61% women and 66% Hispanics/Latinos. DBP levels were significantly related to WMHV differentially across regions (P for interaction<0.05). Relative to those with DBP 90+ mm Hg, participants with DBP <80 mm Hg had 13% lower WMHV in the frontal lobe (95% CI, -21% to -3%), 11% lower WMHV in the parietal lobe (95% CI, -19% to -1%), 22% lower WMHV in the anterior periventricular region (95% CI, -30% to -14%), and 16% lower WMHV in the posterior periventricular region (95% CI, -24% to -6%). Participants with DBP 80 to 89 mm Hg also exhibited about 12% (95% CI, -20% to -3%) lower WMHV in the anterior periventricular region and 9% (95% CI, -18% to -0.4%) lower WMHV in the posterior periventricular region, relative to participants with DBP 90≥ mm Hg. Post hoc pairwise t tests showed that estimates for periventricular WMHV were significantly different from estimates for temporal WMHV (Holms stepdown-adjusted P<0.05). Systolic blood pressure was not strongly related to regional WMHV. Conclusions- Lower DBP levels, defined by the 2017 American College of Cardiology/American Heart Association guidelines, were related to lower white matter lesion load, especially in the periventricular regions relative to the temporal region.

中文翻译：

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舒张压与区域白质病变负荷相关：曼哈顿北部研究。


背景和目的-很少有研究检查收缩压和舒张压 (DBP) 对亚临床脑血管疾病的单独贡献，特别是使用 2017 年美国心脏病学会/美国心脏协会血压指南。此外，与区域特异性白质高信号体积（WMHV）的关联尚未得到充分探索。方法-使用来自 NOMAS（北曼哈顿研究）的数据，这是一项关于中风风险和认知老化的前瞻性队列研究，我们检查了收缩压和 DBP 之间的关联，该关联由 2017 年美国心脏病学会/美国心脏协会指南定义，并与区域WMHV。我们使用线性混合模型方法来解释区域大脑测量的相关性。结果 - 分析样本（N=1205；平均年龄 64±8 岁）由 61% 的女性和 66% 的西班牙裔/拉丁裔组成。 DBP 水平与不同地区的 WMHV 显着相关（交互作用 P<0.05）。相对于 DBP 90+ mm Hg 的参与者，DBP <80 mm Hg 的参与者的额叶 WMHV 降低 13%（95% CI，-21% 至 -3%），顶叶 WMHV 降低 11%（95 % CI，-19% 至 -1%），前室周围区域 WMHV 降低 22%（95% CI，-30% 至 -14%），后室周围区域 WMHV 降低 16%（95% CI， -24% 至 -6%）。 DBP 80 至 89 mm Hg 的参与者的前脑室周围区域 WMHV 也降低约 12%（95% CI，-20% 至 -3%），并降低 9%（95% CI，-18% 至 -0.4%）相对于 DBP 90≥ mm Hg 的参与者，后脑室周围区域的 WMHV。事后配对 t 检验显示，脑室周围 WMHV 的估计值与颞部 WMHV 的估计值显着不同（Holms 降压调整后的 P<0.1）。05）。收缩压与局部 WMHV 没有很强的相关性。结论 - 2017 年美国心脏病学会/美国心脏协会指南定义的较低 DBP 水平与较低的白质病变负荷相关，尤其是相对于颞区的脑室周围区域。