title: Short-Term Blood Pressure Variability Relates to the Presence of Subclinical Brain Small Vessel Disease in Primary Hypertension.
abstract: Blood pressure (BP) variability is associated with stroke risk, but less is known about subclinical cerebral small vessel disease (CSVD). We aimed to determine whether CSVD relates to short-term BP variability independently of BP levels and also, whether they improve CSVD discrimination beyond clinical variables and office BP levels. This was a cohort study on asymptomatic hypertensives who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. Office and average 24-hour, daytime and nighttime BP levels, and several metrics of BP variability (SD, weighted SD, coefficient of variation, and average real variability [ARV]) were calculated. Definition of CSVD was based on the presence of lacunar infarcts and white matter hyperintensity grades. Multivariate analysis and integrated discrimination improvement were performed to assess whether BP variability and levels were independently associated with CSVD and improved its discrimination. Four hundred eighty-seven individuals participated (median age, 64; 47% women). CSVD was identified in 18.9%, related to age, male sex, diabetes mellitus, use of treatment, ambulatory BP monitoring-defined BP levels, and ARV of systolic BP at any period. The highest prevalence (33.7%) was found in subjects with both 24-hour BP levels and ARV elevated. BP levels at any period and ARV (24 hours and nocturnal) emerged as independent predictors of CSVD, and discrimination was incrementally improved although not to a clinically significant extent (integrated discrimination improvement, 5.31%, 5.17% to 5.4%). Ambulatory BP monitoring-defined BP levels and ARV of systolic BP relate to subclinical CSVD in hypertensive individuals.
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Josefina
authors.initials: J
authors.lastname: Filomena
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Riba-Llena
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Tovar
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mundet
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Castañé
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vilar
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Rueda
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Jiménez-Baladó
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Cartanyà
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
authors.affiliation: From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology, Neurovascular Section (J.M.), Vall d'Hebron University Hospital, Barcelona, Spain. pilar.delgado@vhir.org.
authors.forename: Pilar
authors.initials: P
authors.lastname: Delgado
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D001921:Brain / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: blood pressure; blood pressure monitoring, ambulatory; cerebral small vessel diseases; stroke; stroke, lacunar