title: Pulsatile and steady components of blood pressure and subclinical cerebrovascular disease: the Northern Manhattan Study.
abstract: OBJECTIVE
  To assess whether pulse pressure (PP) is associated, independently of mean arterial pressure (MAP), with perivascular spaces (PVS), lacunar lesions presumably ischemic (LPI), and white matter hyperintensity volume (WMHV) seen on brain MRI.
  
  
  METHODS
  Participants in the Northern Manhattan Study had their blood pressure (BP) taken during their baseline enrollment visit and again during a visit for a brain MRI a mean of 7 years later. We assessed small and large PVS, lacunar LPI, and WMHV on MRI. We examined the association of SBP, DBP, MAP, and PP at baseline with subclinical markers of cerebrovascular disease using generalized linear models and adjusting for vascular risk factors.
  
  
  RESULTS
  Imaging and BP data were available for 1009 participants (mean age 68 ± 8 years, 60% women, 60% Hispanic). DBP was associated with lacunar LPI and WMHV, whereas SBP was associated with small and large PVS. Using MAP and PP together disclosed that the effect size for PP was greater for large PVS, whereas the effect of MAP was greater for lacunar LPI and WMHV. The effects of DBP were flat or negative at any degree of SBP higher than 120 mmHg for small and large PVS, whereas a positive association was noted for lacunar LPI and WMHV with any DBP increase over any degree of SBP.
  
  
  CONCLUSIONS
  We report here a segregated association between the pulsatile and steady components of the BP with subclinical markers of cerebrovascular disease. These differential associations may reflect the underlying disease of these biomarkers.
authors.affiliation: aDepartment of Neurology, Columbia University Medical Center bDepartment of Epidemiology, Mailman School of Public Health, Columbia University cDepartment of Biostatistics, Columbia University Medical Center, New York, New York dDepartment of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Gutierrez
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Ken
authors.initials: K
authors.lastname: Cheung
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000502:physiology*; D020520:Brain Infarction / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging
chemical_list: D015415:Biomarkers