Higher Blood Pressure is Associated with Greater White Matter Lesions and Brain Atrophy: A Systematic Review with Meta-Analysis

Background: To summarise and quantify the evidence on the association between Blood pressure (BP), white matter lesions (WMLs), and brain volumes. Method: Electronic databases PubMed, Scopus, and Clarivate were searched in February 2020 using an established methodology and pre-determined search terms. Studies were eligible for inclusion if they reported on the association between BP and WMLs or brain volume in cognitively healthy individuals, while adjusting for age and intra-cranial volume. Results: Searches yielded 7509 articles, of which 52 (26 longitudinal and 33 cross-sectional), were eligible and had a combined sample size of 343,794 individuals. Analyses found that 93.7% of studies reported that higher BP was associated with poorer cerebral health (higher WMLs and lower brain volumes). Meta-analysis of compatible results indicated a dose-dependent relationship with every one standard deviation increase in systolic BP (SBP) above 120 mmHg being associated with a 11.2% (95% CI 2.3, 19.9, p = 0.0128) increase in WMLs and −0.13% (95% CI −0.25, −0.023, p = 0.0183) smaller hippocampal volume. Conclusion: The association between BP and brain volumes appears across the full range of BP measurements and is not limited to hypertensive individuals. Higher BP in community-residing individuals is associated with poorer cerebral health.

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Abstract P191: Association Between Blood Pressure And Brain Volumes Vary By Sex And Age.

Hypertension ◽

10.1161/hyp.78.suppl_1.p191 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Khawlah Alateeq ◽

Erin Walsh ◽

Walter Abhayaratna ◽

Nicolas Cherbuin

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

White Matter ◽

Body Mass ◽

Antihypertensive Medication ◽

Full Range ◽

Age Groups ◽

White Matter Lesions ◽

Hippocampal Volume ◽

Brain Volumes

Objective: To quantify the association between blood pressure (BP) across its full range and brain volumes and white matter lesions (WMLs) while investigating the effects of age, sex, body mass index (BMI), antihypertensive medication, and other risk factors. Methods: UK Biobank participants ( N =36,260) aged 40 to 70 years were included and stratified by sex and age into four groups (age ≤ 45, 46-55, 56-65 and > 65 years old). Multi-level regression analyses were used to assess the association between mean arterial (MAP), systolic (SBP), and diastolic (DBP) blood pressure, and brain volumes segmented using the FreeSufer software (gray matter [GMV], white matter [WMV], left [L] and right hippocampal volume [RHCV]) and WMLs. We also investigated the interaction effects between body mass index (BMI) and antihypertensive medication and BP in predicting brain volumes and WMLs. Results: Every 10-mmHg higher DBP was associated with lower brain volumes (GMV: -1300– -2800) [SE=34–90]; WMV: -903.44– -1171.7[SE=34.66–53.03]; LHCV: -7.7– -14.26 [SE=0.44–0.57]; RHCV: -6.25– -22.64[SE=0.32–0.95]) across all age groups. A similar pattern was detected in both sexes, although it was weaker, in men. Also, every 10-mmHg higher MAP was associated with larger WMLs across all age groups but peaked > 65 years (0.1 [SE=0.002]). Both lower BMI and anti-hypertensive medication appeared to afford a protective effect. Conclusion: Higher BP is associated with worse cerebral health across the full BP range from middle adulthood and across the life course. Therefore, it is important that prevention efforts be directed at younger adults with focus on achieving optimal BP to decrease future risk of developing dementia.

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EXPRESS: Consistency of associations of systolic and diastolic blood pressure with white matter hyperintensities: a meta-analysis

International Journal of Stroke ◽

10.1177/17474930211043364 ◽

2021 ◽

pp. 174749302110433

Author(s):

Imogen Wilkinson ◽

Alastair Webb

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

White Matter ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Meta Analysis ◽

Clinical Importance ◽

Good Control ◽

Intracranial Volume ◽

Standard Deviation Increase

Background: White matter hyperintensities (WMH) are the commonest manifestation of cerebral small vessel disease, associated with stroke, functional impairment and cognitive decline. They are commonly preceded by hypertension, but the magnitude and clinical importance of this association is unclear. Aims: Quantify the relationship between blood pressure and white matter hyperintensities across studies Methods: PubMed and EMBASE were searched for studies reporting associations between concurrent or historic blood pressure and WMH. Beta coefficients from linear models were extracted, whether standardised, unstandardised, unadjusted or adjusted for age, sex and cardiovascular risk factors. Beta-coefficients were combined by fixed and random effects meta-analysis, combining standardised beta-coefficients or unstandardised coefficients measured by consistent methods. Results: 24 of 3,230 papers were eligible, including 50,999 participants. Systolic blood pressure was significantly associated with WMH volume after maximal adjustment (standardised beta 0.096, 95%CI 0.06-0.133, p<0.001, I2=65%), including for concurrent readings (b=0.106, p<0.001) or readings 5 years previously (b=0.077, p<0.001), and for younger or older populations (mean age <65: b=0.114; >65 b=0.069). Unstandardised, adjusted associations were similar for raw WMHV, log-transformed WMHV or WMHV as percentage of intracranial volume. Unadjusted associations with SBP were greater (standardised beta=0.273, 0.262-0.284, p<0.0001). However, whilst associations with DBP were weaker than SBP (standardised beta=0.065, p<0.001), they were minimally affected by adjustment for age. Conclusions: A standard deviation increase in SBP is associated with 10% of a standard deviation increase in WMHV, providing the current best estimate of the potential reduction in progression of WMH expected with good control of blood pressure.

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Blood Pressure Rhythm and Blood Pressure Variability as Risk Factors for White Matter Lesions: A Cross-Sectional Study

Medical Science Monitor ◽

10.12659/msm.933880 ◽

2021 ◽

Vol 28 ◽

Author(s):

Dong Zhang ◽

Mingli He ◽

Qing He ◽

Zeheng Li

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

White Matter ◽

Blood Pressure Variability ◽

White Matter Lesions ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Associations Between Brain Volumes and Cognitive Tests with Hypertensive Burden in UK Biobank

Journal of Alzheimer s Disease ◽

10.3233/jad-210512 ◽

2021 ◽

pp. 1-17

Author(s):

Danielle Newby ◽

Laura Winchester ◽

William Sproviero ◽

Marco Fernandes ◽

Di Wang ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Small Sample ◽

Self Report ◽

Cognitive Tests ◽

Uk Biobank ◽

Cross Sectional ◽

Brain Volumes ◽

Multiple Measures ◽

The Impact

Background: Mid-life hypertension is an established risk factor for cognitive impairment and dementia and related to greater brain atrophy and poorer cognitive performance. Previous studies often have small sample sizes from older populations that lack utilizing multiple measures to define hypertension such as blood pressure, self-report information, and medication use; furthermore, the impact of the duration of hypertension is less extensively studied. Objective: To investigate the relationship between hypertension defined using multiple measures and length of hypertension with brain measure and cognition. Methods: Using participants from the UK Biobank MRI visit with blood pressure measurements (n = 31,513), we examined the cross-sectional relationships between hypertension and duration of hypertension with brain volumes and cognitive tests using generalized linear models adjusted for confounding. Results: Compared with normotensives, hypertensive participants had smaller brain volumes, larger white matter hyperintensities (WMH), and poorer performance on cognitive tests. For total brain, total grey, and hippocampal volumes, those with greatest duration of hypertension had the smallest brain volumes and the largest WMH, ventricular cerebrospinal fluid volumes. For other subcortical and white matter microstructural regions, there was no clear relationship. There were no significant associations between duration of hypertension and cognitive tests. Conclusion: Our results show hypertension is associated with poorer brain and cognitive health however, the impact of duration since diagnosis warrants further investigation. This work adds further insights by using multiple measures defining hypertension and analysis on duration of hypertension which is a substantial advance on prior analyses—particularly those in UK Biobank which present otherwise similar analyses on smaller subsets.

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Age and Diastolic Blood Pressure Play an Important Role in the Progression of White Matter Lesions: A Meta-Analysis

European Neurology ◽

10.1159/000510077 ◽

2020 ◽

Vol 83 (4) ◽

pp. 351-359

Author(s):

Dong Zhang ◽

Yi Tang ◽

Jian Ge ◽

Yumeng Liu ◽

Jing Jin ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Diastolic Blood Pressure ◽

Odds Ratio ◽

Meta Analysis ◽

White Matter Lesions ◽

Microvascular Disease ◽

Related Literature ◽

Mesh Terms ◽

The Relationship

Introduction: White matter lesions (WMLs) are currently considered as a cerebral microvascular disease, and hypertension is considered as its most important risk factor. This study analysis systematically evaluated the effects of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the progression of WMLs. Methods: We searched the MeSH terms: “white matter,” “blood pressure,” “hypertension,” “Leukoencephalopathy,” and “leukoaraiosis” on PubMed and Cochrane from January 2000 to August 2019. A total of 12 closely related literature were included for research. Results: The results of the meta-analysis showed that the increase of both SBP and DBP can promote the progression of WMLs (respectively, odds ratio [OR] = 2.90, 95% confidence interval [CI] 2.86–2.94; OR = 3.13, 95% CI 3.03–3.23). Subgroup analysis found that patients with hypertension aged younger than 70 years are at a greater risk of WML progression when their DBP increased (OR = 4.69, 95% CI 3.31–6.65). Conclusion: The relationship between DBP and WMLs is closer than that of SBP. Also, the risk of WML progression in patients aged under 70 years was higher than that in patients aged over 70 years. Furthermore, when DBP is elevated in patients younger than 70 years of age, the risk of WML progression may be higher. Therefore, it is expected that more researchers will attach importance to the change in DBP and identify the range of blood pressure and strategies that control DBP, thus contributing to delay the progression of WMLs.

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Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation

Hypertension ◽

10.1161/hypertensionaha.120.16025 ◽

2020 ◽

Author(s):

Stefanie Aeschbacher ◽

Steffen Blum ◽

Pascal B. Meyre ◽

Michael Coslovsky ◽

Annina S. Vischer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

White Matter ◽

Linear Trend ◽

Brain Magnetic Resonance Imaging ◽

White Matter Lesions ◽

Brain Lesions ◽

Odds Ratios ◽

Unique Identifier ◽

Cross Sectional

The association of blood pressure (BP) and hypertension with the presence of different types of brain lesions in patients with atrial fibrillation is unclear. BP values were obtained in a multicenter cohort of patients with atrial fibrillation. Systolic and diastolic BP was categorized in predefined groups. All patients underwent brain magnetic resonance imaging and neurocognitive testing. Brain lesions were classified as large noncortical or cortical infarcts, small noncortical infarcts, microbleeds, or white matter lesions. White matter lesions were graded according to the Fazekas scale. Overall, 1738 patients with atrial fibrillation were enrolled in this cross-sectional analysis (mean age, 73 years, 73% males). Mean BP was 135/79 mm Hg, and 67% of participants were taking BP-lowering treatment. White matter lesions Fazekas ≥2 were found in 54%, large noncortical or cortical infarcts in 22%, small noncortical infarcts in 21%, and microbleeds in 22% of patients, respectively. Compared with patients with systolic BP <120 mm Hg, the adjusted odds ratios (95% CI) for Fazekas≥2 was 1.25 (0.94–1.66), 1.41 (1.03–1.93), and 2.54 (1.65–3.95) among patients with systolic BP of 120 to 140, 140 to 160, and ≥160 mm Hg ( P for linear trend<0.001). Per 5 mm Hg increase in systolic and diastolic BP, the adjusted β-coefficient (95% CI) for log-transformed white matter lesions was 0.04 (0.02–0.05), P <0.001 and 0.04 (0.01–0.06), P =0.004. Systolic BP was associated with small noncortical infarcts (odds ratios [95% CI] per 5 mm Hg 1.05 [1.01–1.08], P =0.006), microbleeds were associated with hypertension, but large noncortical or cortical infarcts were not associated with BP or hypertension. After multivariable adjustment, BP and hypertension were not associated with neurocognitive function. Among patients with atrial fibrillation, BP is strongly associated with the presence and extent of white matter lesions, but there is no association with large noncortical or cortical infarcts. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02105844.

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Cardiovascular Responses to Muscle Stretching: A Systematic Review and Meta-analysis

International Journal of Sports Medicine ◽

10.1055/a-1312-7131 ◽

2021 ◽

Author(s):

Ewan Thomas ◽

Marianna Bellafiore ◽

Ambra Gentile ◽

Antonio Paoli ◽

Antonio Palma ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cardiovascular System ◽

Vascular Function ◽

Meta Analysis ◽

Random Effect ◽

Cardiovascular Responses ◽

Qualitative Description ◽

Cross Sectional ◽

Quantitative Synthesis

AbstractThe aim of this study will be to review the current body of literature to understand the effects of stretching on the responses of the cardiovascular system. A literature search was performed using the following databases: Scopus, NLM Pubmed and ScienceDirect. Studies regarding the effects of stretching on responses of the cardiovascular system were investigated. Outcomes regarded heart rate(HR), blood pressure, pulse wave velocity (PWV of which baPWV for brachial-ankle and cfPWV for carotid-femoral waveforms), heart rate variability and endothelial vascular function. Subsequently, the effects of each outcome were quantitatively synthetized using meta-analytic synthesis with random-effect models. A total of 16 studies were considered eligible and included in the quantitative synthesis. Groups were also stratified according to cross-sectional or longitudinal stretching interventions. Quality assessment through the NHLBI tools observed a “fair-to-good” quality of the studies. The meta-analytic synthesis showed a significant effect of d=0.38 concerning HR, d=2.04 regarding baPWV and d=0.46 for cfPWV. Stretching significantly reduces arterial stiffness and HR. The qualitative description of the studies was also supported by the meta-analytic synthesis. No adverse effects were reported, after stretching, in patients affected by cardiovascular disease on blood pressure. There is a lack of studies regarding vascular adaptations to stretching.

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Longitudinal association between CRP levels and risk of psychosis: a meta-analysis of population-based cohort studies

npj Schizophrenia ◽

10.1038/s41537-021-00161-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Emanuele F. Osimo ◽

Luke Baxter ◽

Jan Stochl ◽

Benjamin I. Perry ◽

Stephen A. Metcalf ◽

...

Keyword(s):

Cohort Studies ◽

Meta Analysis ◽

Random Effect ◽

Population Based ◽

Continuous Variable ◽

Cross Sectional ◽

Standard Deviation Increase ◽

Suspected Infection ◽

Longitudinal Association ◽

Incident Cases

AbstractMeta-analyses of cross-sectional studies suggest that patients with psychosis have higher circulating levels of C-reactive protein (CRP) compared with healthy controls; however, cause and effect is unclear. We examined the prospective association between CRP levels and subsequent risk of developing a psychotic disorder by conducting a systematic review and meta-analysis of population-based cohort studies. Databases were searched for prospective studies of CRP and psychosis. We obtained unpublished results, including adjustment for age, sex, body mass index, smoking, alcohol use, and socioeconomic status and suspected infection (CRP > 10 mg/L). Based on random effect meta-analysis of 89,792 participants (494 incident cases of psychosis at follow-up), the pooled odds ratio (OR) for psychosis for participants with high (>3 mg/L), as compared to low (≤3 mg/L) CRP levels at baseline was 1.50 (95% confidence interval [CI], 1.09–2.07). Evidence for this association remained after adjusting for potential confounders (adjusted OR [aOR] = 1.31; 95% CI, 1.03–1.66). After excluding participants with suspected infection, the OR for psychosis was 1.36 (95% CI, 1.06–1.74), but the association attenuated after controlling for confounders (aOR = 1.23; 95% CI, 0.95–1.60). Using CRP as a continuous variable, the pooled OR for psychosis per standard deviation increase in log(CRP) was 1.11 (95% CI, 0.93–1.34), and this association further attenuated after controlling for confounders (aOR = 1.07; 95% CI, 0.90–1.27) and excluding participants with suspected infection (aOR = 1.07; 95% CI, 0.92–1.24). There was no association using CRP as a categorical variable (low, medium or high). While we provide some evidence of a longitudinal association between high CRP (>3 mg/L) and psychosis, larger studies are required to enable definitive conclusions.

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