title: Progression of brain microbleeds in essential hypertensive patients: a 2-year follow-up study.
abstract: BACKGROUND
  Brain microbleeds (BMBs) are common in hypertensive patients and are associated with higher blood pressure (BP) levels. Little is known about risk factors for progression of BMBs, in particular the contribution of ambulatory BP levels. We aimed to determine BMB progression and the association with BP levels in a cohort of essential hypertensive patients.
  
  
  METHODS
  At baseline and after 2 years of follow-up, 193 participants underwent brain magnetic resonance imaging (MRI) and 24-hour ambulatory BP measurement in addition to office BP measurement. The relation between BMB progression and baseline untreated BP characteristics was tested in logistic regression analyses.
  
  
  RESULTS
  Progression of BMBs on follow-up MRI was seen in 12 (6%) participants. Patients with progression were significantly older, and the prevalence as well as total number of BMBs at baseline was greater. With correction for age and sex, baseline 24-hour systolic and diastolic BP and 24-hour pulse pressure significantly predicted progression. Similar results were seen for baseline awake and asleep BP. On additional adjustments for baseline presence of BMBs, the associations remained significant for 24-hour, awake, and asleep systolic BP, awake diastolic BP, and awake and asleep pulse pressure. Office systolic BP was also associated with progression of BMBs, whereas office diastolic BP was not.
  
  
  CONCLUSIONS
  High ambulatory BP levels are important and possibly modifiable predictors for progression of BMBs. This warrants further study, with an adequately long follow-up period and early adequate treatment of hypertension.
authors.affiliation: Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; miesjevandooren@hotmail.com.
authors.forename: Miesje
authors.initials: M
authors.lastname: van Dooren
authors.affiliation: Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands;
authors.forename: Julie
authors.initials: J
authors.lastname: Staals
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Internal Medicine, Subdivision Vascular Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Peter W
authors.initials: PW
authors.lastname: de Leeuw
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Internal Medicine, Subdivision Vascular Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.affiliation: Department of Internal Medicine, Subdivision Vascular Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Léon H
authors.initials: LH
authors.lastname: Henskens
authors.affiliation: Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands;
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000473:pathology*; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence
keywords: ambulatory blood pressure monitoring; blood pressure; brain microbleeds; essential hypertension; hypertension; magnetic resonance imaging.