title: Ambulatory blood pressure in patients with lacunar stroke: association with total MRI burden of cerebral small vessel disease.
abstract: OBJECTIVE
  Asymptomatic lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces are MRI markers of cerebral small vessel disease (cSVD). Higher blood pressure (BP) levels are associated with the presence of these markers separately, but the association with the total burden of cSVD on brain MRI, expressed by the simultaneous presence of multiple markers of cSVD (a compound score), has not been investigated.
  
  
  METHODS
  We performed 24-hour ambulatory BP monitoring in 122 patients with first-ever lacunar stroke. On brain MRI, we scored the presence of each marker of cSVD. One point was awarded for the presence of each marker, producing a score between 0 and 4. Associations with BP levels were tested with ordinal regression analyses.
  
  
  RESULTS
  Eighteen (15%) patients had no markers of cSVD, and 6 (5%) patients had 4 markers. Most patients (45; 37%) had 2 different markers. After correction for age and sex, higher 24-hour, day, and night systolic (24-hour odds ratio, 1.25; 95% confidence interval, 1.02-1.52 per 10 mm Hg) and diastolic (24-hour odds ratio, 1.32; 95% confidence interval, 1.12-1.56 per 5 mm Hg) BP were all significantly associated with an increasing total burden of cSVD.
  
  
  CONCLUSIONS
  We found a positive association of ambulatory BP levels with total burden of cSVD on brain MRI. With increasing BP levels, there is a piling up of damage in the brain. We suggest that further cSVD studies also consider viewing the total burden in addition to each of the MRI markers separately.
authors: From the Department of Neurology (P.K., R.J.v.O., R.P.W.R., I.L.H.K., J.S.), and Cardiovascular Research Institute Maastricht (CARIM) (R.J.v.O., J.S.), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Pim
authors: P
authors: Klarenbeek
authors: Robert J
authors: RJ
authors: van Oostenbrugge
authors: Rob P W
authors: RP
authors: Rouhl
authors: Iris L H
authors: IL
authors: Knottnerus
authors: Julie
authors: J
authors: Staals
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001921:Brain / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000503:physiopathology*; D013997:Time Factors
keywords: blood pressure monitoring, ambulatory; cerebral microbleeds; cerebral small vessel diseases; enlarged perivascular spaces; lacunar infarcts; white matter lesions