title: Prevalence and associated factors of silent brain infarcts in a Mediterranean cohort of hypertensives.
abstract: Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean population. This is a cohort study in randomly selected hypertensives, aged 50 to 70 years old, and free of clinical stroke and dementia. On baseline, all participants underwent a brain magnetic resonance imaging to assess prevalence and location of silent infarcts, and data on vascular risk factors, comorbidities, and the presence of subclinical cardiorenal damage (left ventricular hypertrophy and microalbuminuria) were collected. Multivariate analyses were performed to determine SBIs associated factors. A total of 976 patients (49.4% men, mean age 64 years) were enrolled, and 163 SBIs were detected in 99 participants (prevalence 10.1%; 95% CI, 8.4%-12.2%), most of them (64.4%) located in the basal ganglia and subcortical white matter. After adjustment, besides age and sex, microalbuminuria and increasing total cardiovascular risk (assessed by the Framingham-calibrated for Spanish population risk function) were independently associated with SBIs. Male sex increased the odds of having SBIs in 2.5 as compared with females. Our results highlight the importance of considering both global risk assessment and sex differences in hypertension and may be useful to design future preventive interventions of stroke and dementia.
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.). pilar.delgado@vhir.org.
authors: Pilar
authors: P
authors: Delgado
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Iolanda
authors: I
authors: Riba-Llena
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: José L
authors: JL
authors: Tovar
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Carmen I
authors: CI
authors: Jarca
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Xavier
authors: X
authors: Mundet
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Antonio
authors: A
authors: López-Rueda
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Francesc
authors: F
authors: Orfila
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Judit
authors: J
authors: Llussà
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Josep M
authors: JM
authors: Manresa
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: José
authors: J
authors: Alvarez-Sabín
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Cristina
authors: C
authors: Nafría
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: José L
authors: JL
authors: Fernández
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Olga
authors: O
authors: Maisterra
authors: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
authors: Joan
authors: J
authors: Montaner
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D020520:Brain Infarction / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D059906:Neuroimaging; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
keywords: hypertension; stroke