Prevention of White-Matter Lesions Through Control of Cerebrovascular Risk Factors

2003 ◽  
Vol 15 (S1) ◽  
pp. 147-151 ◽  
Author(s):  
Charles DeCarli
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
Strong Association ◽  
Treatment Strategies ◽  
White Matter Lesions ◽  
Elevated Blood Pressure ◽  
Cerebral White Matter ◽  
Elevated Blood ◽  
Atherosclerotic Vascular Disease

Multiple epidemiological and brain imaging studies show a strong association between elevations in systolic blood pressure and lesions of cerebral white matter. The association between white-matter lesions and systolic blood pressure persists even if individuals are receiving treatment, suggesting that these individuals may be undertreated. In addition, these studies suggest that lesions of cerebral white matter may serve as markers for atherosclerotic vascular disease. Treatment strategies, therefore, should focus on early and aggressive management of elevated blood pressure, but definitions of elevated blood pressure may need to be revised downward to achieve best results.

Association of elevated blood pressure during exercise with cerebral white matter lesions

2018 ◽  
Vol 27 (3) ◽  
pp. 166-172
Author(s):  
Woo-In Yang ◽  
In-Jai Kim ◽  
Mi-Sun Kim ◽  
Sang-Hoon Kim ◽  
Jae-Youn Moon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
White Matter Lesions ◽  
Elevated Blood Pressure ◽  
Cerebral White Matter ◽  
Elevated Blood ◽  
Cerebral White Matter Lesions

scholarly journals Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2618
Author(s):  
Chesney K. Richter ◽  
Ann C. Skulas-Ray ◽  
Trent L. Gaugler ◽  
Stacey Meily ◽  
Kristina S. Petersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Vascular Function ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Lipoprotein Profile ◽  
Cranberry Juice ◽  
Central Systolic Blood Pressure

Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-hr diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.

Abstract 386: Circulating Endothelial Microparticles, Elevated Blood Pressure and Endothelin-1 Mediated Vasoconstrictor Tone

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Collin A Beckstrom ◽  
Tyler D Bammer ◽  
Caitlin Dow ◽  
Grace Lincenberg ◽  
Kyle J Diehl ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Vascular Abnormalities ◽  
Circulating Microparticles ◽  
Eta Receptor ◽  
Clinical Interest ◽  
Eta Receptor Antagonist ◽  
Middle Aged Adults

Clinical interest in circulating microparticles originating from both endothelial cells and platelets has increased due to their putative role in inflammation, endovascular function, angiogenesis and thrombosis. Elevated blood pressure is associated with profound endothelial dysfunction, particularly enhanced endothelin (ET)-1-mediated vasoconstrictor tone. There is some evidence to suggest that circulating microparticles are influenced by blood pressure and may contribute to associated vascular abnormalities. As part of an ongoing study, we are determining: 1) whether circulating endothelial (EMP) and platelet (PMP) microparticles are higher in adults with elevated blood pressure (SBP >130 mmHg) and if so; 2) if these microparticles are associated with ET-1 mediated vasoconstriction. To date, 22 sedentary, non-obese middle-aged adults have been studied: 11 normotensive (age: 55+2 yr; 7 M/4 F; BP: 118/74+3/2 mm Hg) and 11 prehypertensive/hypertensive (age: 55+2 yr; 7 M/4 F; BP: 140/85+2/3 mm Hg). All subjects were free of overt cardiometabolic disease. EMPs and PMPs were measured in platelet-poor plasma by flow cytometry. EMPs were defined as CD31+/CD42b- events and PMPs were defined as CD31+/CD42+ events. Forearm blood flow (FBF: plethysmography) responses to intra-arterial infusion of BQ-123 (100 nmol/min; for 60 min), a selective ETA receptor antagonist. EMPs were ~70% higher (p<0.01) in the prehypertensive/hypertensive (39072+3951 MP/μL) compared with normotensive (22726+2552 MP/μL). There was no difference in EMPs with the elevated blood pressure group between the prehypertensive (n=5) and hypertensive (n=6) adults. PMPs were not significantly different between the groups (503+132 vs 431+80 MP/μL). Resting FBF increased ~40% (p<0.01) in response to BQ-123 in the prehypertensive/hypertensive group only. EMPs were significantly correlated with systolic blood pressure (r=0.68) and peak FBF response to ETA receptor blockade (r=0.61). These initial results indicate that circulating EMPs, but not PMPs, are elevated in prehypertensive/hypertensive adults. Moreover, circulating EMPs are associated with systolic blood pressure and enhanced ET-1 mediated vasoconstrictor tone.

scholarly journals White Matter Lesions and Cognitive Impairment as Silent Cerebral Disease in Hypertension

2006 ◽  
Vol 6 ◽  
pp. 494-501 ◽  
Author(s):  
Cristina Sierra ◽  
Antonio Coca
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
White Matter ◽  
Indirect Evidence ◽  
White Matter Lesions ◽  
Cerebral White Matter ◽  
Cognitive Changes ◽  
Cerebral Disease ◽  
Functional Changes ◽  
Cerebral White Matter Lesions

Although the pathogenesis and clinical significance of cerebral white matter lesions remain controversial, it is well established that age and hypertension are the most important factors related to the presence of these lesions. Hypertension is known to be the most important factor for developing stroke and vascular dementia. In addition, the presence of cerebral white matter lesions is an important prognostic factor for the development of stroke, and also for cognitive impairment and dementia. The mechanisms underlying hypertension-related cognitive changes are complex and are not yet fully understood. Correlations between cerebral white matter lesions and elevated blood pressure provide indirect evidence that structural and functional changes in the brain over time may lead to lowered cognitive functioning when blood pressure control is poor or lacking.Some authors have suggested that the presence of white matter lesions in hypertensive patients could be considered an early marker of brain damage.

scholarly journals Variability in Midlife Systolic Blood Pressure Is Related to Late-Life Brain White Matter Lesions

Stroke ◽  
2002 ◽  
Vol 33 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Richard J. Havlik ◽  
Daniel J. Foley ◽  
Bryan Sayer ◽  
Kamal Masaki ◽  
Lon White ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Lesions ◽  
Late Life ◽  
Brain White Matter

A follow-up study of blood pressure and cerebral white matter lesions

1999 ◽  
Vol 46 (6) ◽  
pp. 827-833 ◽  
Author(s):  
Frank-Erik De Leeuw ◽  
Jan Cees De Groot ◽  
Matthijs Oudkerk ◽  
Jacqueline C. M. Witteman ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
White Matter Lesions ◽  
Cerebral White Matter ◽  
Follow Up Study ◽  
Cerebral White Matter Lesions

scholarly journals Plasma Biomarkers of Angiogenesis Related to Small Vessel Brain Disease in SPRINT

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 670-671
Author(s):  
Nicholas Pajewski ◽  
Fanny Elahi ◽  
Joachim Ix ◽  
Ilya Nasrallah ◽  
Jason Hinman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
White Matter Lesions ◽  
Brain Disease ◽  
Small Vessel ◽  
Cerebral White Matter ◽  
Lesion Volume ◽  
Brain Volumes ◽  
Plasma Biomarkers

Abstract Meta-analyses incorporating the Systolic Blood Pressure Intervention Trial (SPRINT) have shown a reduced incidence of dementia with blood pressure lowering. However, mechanistic explanations for this effect are lacking, apart from slowed progression of cerebral white matter lesions (WML). Here we examine possible biomarkers of angiogenesis related to small vessel brain disease including bFGF, FLT1, PLGF, TIE-2, VEGF, VEGF-C, and VEGF-D. The biomarkers were assayed in plasma at baseline and during follow-up (median follow-up = 3.8 years) in a subgroup of participants 60 to 89 years old from SPRINT (N=517). We modeled changes in each biomarker using robust linear mixed models accounting for treatment group, time since randomization, and kidney function. Participants were 69.8 ± 7.1 (standard deviation) years of age, 42.1% female, with a mean systolic blood pressure (SBP) of 138.2 ± 17.0 mm Hg. At baseline, none of the biomarkers were associated with WML lesion volume or total brain volumes adjusting for age (all p&gt;0.05), while FLT1, PLGF, and TIE-2 were negatively associated with frontal gray matter cerebral blood flow (partial correlations of -0.11, -0.10, and -0.12 respectively, all p&lt;0.05). For both intensive (target SBP&lt;120 mm Hg) and standard (target SBP&lt;140 m Hg) blood pressure control, mean levels for the majority of biomarkers increased during follow-up, with the exceptions of TIE-2 (decreased over follow-up) and VEGF-D (no change). We did not observe significant between-group differences for the change in these plasma biomarkers of angiogenesis comparing intensive to standard blood pressure treatment.

scholarly journals 2017 ACC/AHA blood pressure classification and incident peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) Study

2019 ◽  
Vol 27 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Yifei Lu ◽  
Shoshana H Ballew ◽  
Hirofumi Tanaka ◽  
Moyses Szklo ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Peripheral Artery Disease ◽  
Cox Regression ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Stage 1

Aims The aim of this study was to evaluate the associations of blood pressure categorization based on the 2017 American College of Cardiology and American Heart Association guideline with the risk of peripheral artery disease (PAD). Methods Among 13,113 middle-aged participants, we investigated the associations of 2017 blood pressure categories (systolic <120 and diastolic <80 mmHg (normal if no anti-hypertensive medications; reference), 120–129 and <80 (elevated), 130–139 and/or 80–89 (stage 1 hypertension), and ≥140 and/or ≥90 (stage 2 hypertension)) with incident PAD (hospitalizations with a diagnosis or leg revascularization) using Cox regression models. Analyses were separately conducted in individuals with and without anti-hypertensive medications. Results During a median follow-up of 25.4 years, 466 incident PAD occurred (271 cases in 9858 participants without anti-hypertensive medications). In participants without anti-hypertensive medications, we observed significant hazard ratios of PAD in elevated blood pressure (1.80 (1.28–2.51)) and stage 2 hypertension (2.40 (1.72–3.34)), but not in stage 1 hypertension. Analyzing systolic and diastolic blood pressure separately, higher systolic blood pressure categories showed significant associations with incident PAD in a graded fashion whereas, for diastolic blood pressure, only ≥90 mmHg did. Generally similar patterns were seen among participants on anti-hypertensive medication, while they had higher risk of PAD than those without at each blood pressure category. Conclusions Systolic blood pressure, including the category of 130–139 mmHg, showed stronger associations with incident PAD than did diastolic blood pressure. Consequently, elevated blood pressure conferred similar or even greater risk of PAD than stage 1 hypertension, with implications on how to interpret new blood pressure categories in terms of leg vascular health.

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