Factors related to enlarged perivascular spaces and lacunes in patients with hypertension

doi:10.16150/j.1671-2870.2021.04.008

Abstract

Abstract:

Objective: To explore the related factors of enlarged perivascular spaces (EPVS) and lacunes in the patients with hypertension, and to provide a basis for the prevention and treatment of cerebral small vessel disease. Methods: A total of 1 070 patients with essential hypertension without stroke history were enrolled, and the data was analyzed retrospectively. All patients received MRI scanning and ambulatory blood pressure monitoring. According to MRI images, they were divided into normal control, EPVS and lacunes groups, respectively. Univariate and multivariate logistic regression were performed among three groups to determine the factors related to EPVS and lacunes. Results: The indexes including age, gender, smoking, diabetes history, antiplatelet drugs, statins, hypertension duration, nocturnal blood pressure dip degree, mean systolic blood pressure, cholesterol, triglyceride, high-density lipoprotein, low density lipoprotein, urea nitrogen, creatinine, homocysteine and carotid plaque were significantly different among EPVS, lacunes and controls groups. Mean high systolic blood pressure and age were independent risk factors for EPVS, while the dipping degree of blood pressure, antiplatelet medicines and statins were independent protective factors for it. High mean systolic blood pressure, old age, smoking, and diabetes were independent risk factors for lacunes, while the dipping degree of nocturnal blood pressure, antiplatelet medicines and statins were independent protective factors for lacunes. Conclusions: For the patients with hypertension, the increase of mean systolic blood pressure and the decrease of nocturnal blood pressure dipping are the risk factors for EPVS and lacunes. Besides controlling mean systolic blood pressure level, the patients with hypertension should also receive chronotherapy to restore the normal nocturnal blood pressure dipping through changing the time of taking medicine.

Key words: Enlarged perivascular spaces, Lacunes, Nocturnal blood pressure dip degree, Chronotherapy, Hypertension

CLC Number:

R541.7

YANG Yang, WU Qinmi, FENG Yulan, ZHANG Bei, FU Yi. Factors related to enlarged perivascular spaces and lacunes in patients with hypertension[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(04): 372-377.

Figures/Tables 4

References 23

[1]	Li Q, Yang Y, Reis C, et al. Cerebral Small Vessel Di-sease[J]. Cell Transplant, 2018,27(12):1711-1722. doi: 10.1177/0963689718795148 URL
[2]	Zhu H, Li Z, Lv J, et al. Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis[J]. Neurol Res, 2018,40(5):381-390. doi: 10.1080/01616412.2018.1446283 URL
[3]	Cannistraro RJ, Badi M, Eidelman BH, et al. CNS small vessel disease: a clinical review[J]. Neurology, 2019,92(24):1146-1156. doi: 10.1212/WNL.0000000000007654 pmid: 31142635
[4]	Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications[J]. Lancet Neurol, 2019,18(7):684-696. doi: S1474-4422(19)30079-1 pmid: 31097385
[5]	Silvani A. Sleep disorders, nocturnal blood pressure, and cardiovascular risk: a translational perspective[J]. Auton Neurosci, 2019,218:31-42. doi: 10.1016/j.autneu.2019.02.006 URL
[6]	Bowles NP, Thosar SS, Herzig MX, et al. Chronotherapy for hypertension[J]. Curr Hypertens Rep, 2018,20(11):97. doi: 10.1007/s11906-018-0897-4 pmid: 30267334
[7]	Eriksson MI, Gordin D, Shams S, et al. Nocturnal Blood Pressure Is Associated With Cerebral Small-Vessel Disease in Type 1 Diabetes[J]. Diabetes Care, 2020,43(8):e96-e98.
[8]	Zhang H, Cui Y, Zhao Y, et al. Association of circadian rhythm of blood pressure and cerebral small vessel di-sease in community-based elderly population[J]. J Gerontol A Biol Sci Med Sci, 2019,74(8):1322-1330. doi: 10.1093/gerona/gly212 URL
[9]	Regenhardt RW, Das AS, Lo EH, et al. Advances in understanding the pathophysiology of lacunar stroke: a review[J]. JAMA Neurol, 2018,75(10):1273-1281. doi: 10.1001/jamaneurol.2018.1073 pmid: 30167649
[10]	Wardlaw JM, Benveniste H, Nedergaard M, et al. Perivascular spaces in the brain: anatomy, physiology and pathology[J]. Nat Rev Neurol, 2020,fy16(3):137-153.
[11]	Francis F, Ballerini L, Wardlaw JM. Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: a systematic review and meta-analysis[J]. Int J Stroke, 2019,14(4):359-371. doi: 10.1177/1747493019830321 pmid: 30762496
[12]	Javierre-Petit C, Schneider JA, Kapasi A, et al. Neuropathologic and cognitive correlates of enlarged perivascular spaces in a community-based cohort of older adults[J]. Stroke, 2020,51(9):2825-2833. doi: 10.1161/STROKEAHA.120.029388 pmid: 32757750
[13]	Zhu YC, Tzourio C, Soumaré A, et al. Severity of dilated virchow-robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study[J]. Stroke, 2010,41(11):2483-2490. doi: 10.1161/STROKEAHA.110.591586 URL
[14]	Guo Y, Li Y, Liu X, et al. Assessing the effectiveness of statin therapy for alleviating cerebral small vessel disease progression in people ≥75 years of age[J]. BMC Geriatr, 2020,20(1):292. doi: 10.1186/s12877-020-01682-w URL
[15]	Caplan LR. Lacunar infarction and small vessel disease: pathology and pathophysiology[J]. J Stroke, 2015,17(1):2-6. doi: 10.5853/jos.2015.17.1.2 pmid: 25692102
[16]	Del Brutto OH, Mera RM, Gillman J, et al. Calcifications in the carotid siphon correlate with silent cerebral small vessel disease in community-dwelling older adults: a population-based study in rural Ecuador[J]. Geriatr Gerontol Int, 2016,16(9):1063-1067. doi: 10.1111/ggi.12599 pmid: 26337141
[17]	Song TJ, Kim YD, Yoo J, et al. Association between aortic atheroma and cerebral small vessel disease in patients with ischemic stroke[J]. J Stroke, 2016,18(3):312-320. doi: 10.5853/jos.2016.00171 URL
[18]	Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review[J]. Lancet Neurol, 2007,6(7):611-619. doi: 10.1016/S1474-4422(07)70170-9 pmid: 17582361
[19]	Kloppenborg RP, Nederkoorn PJ, Grool AM, et al. Do lacunar infarcts have different aetiologies? Risk factor profiles of lacunar infarcts in deep white matter and basal ganglia: the second manifestations of ARTerial disease-magnetic resonance study[J]. Cerebrovasc Dis, 2017,43(3-4):161-168. doi: 10.1159/000454782 pmid: 28142144
[20]	Rutten-Jacobs LCA, Markus HS, UK young lacunar stroke DNA study. Vascular risk factor profiles differ between magnetic resonance imaging-defined subtypes of younger-onset lacunar stroke[J]. Stroke, 2017,48(9):2405-2411. doi: 10.1161/STROKEAHA.117.017813 pmid: 28765289
[21]	Smith EE, Saposnik G, Biessels GJ, et al. Prevention of stroke in patients with silent cerebrovascular disease: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2017,48(2):e44-e71.
[22]	Wardlaw JM, Doubal F, Armitage P, et al. Lacunar stroke is associated with diffuse blood-brain barrier dysfunction[J]. Ann Neurol, 2009,65(2):194-202. doi: 10.1002/ana.21549 pmid: 19260033
[23]	Meissner A. Hypertension and the brain: a risk factor for more than heart disease[J]. Cerebrovasc Dis, 2016,42(3-4):255-262. doi: 10.1159/000446082 pmid: 27173592

变量	对照组(n=317)	EPVS组(n=395)	腔隙灶组(n=358)	P值
年龄(岁,$\bar{x}±s$)	57±11	69±12	66±13	<0.001
男性	135(42.6)	190(48.1)	187(52.2)	0.002
吸烟	48(15.1)	75(19.0)	84(23.5)	0.006
糖尿病	46(14.5)	143(36.2)	120(33.5)	<0.001
抗血小板药	55(17.4)	24(6.1)	21(6.2)	<0.001
他汀类药物	63(19.9)	36(9.1)	48(13.4)	0.001
病程(年,$\bar{x}±s$)	7.5±7.3	13.8±10.5	12.9±10.9	<0.001
夜间血压下降幅度(%, M, IQR)	8.4(1.2~15.7)	5.2(-6.1 ~15.3)	5.7(-7.0~15.6)	<0.001
平均收缩压(mmHg,$\bar{x}±s$)	127.6±14.7	135.8±17.6	132.1±16.7	<0.001
胆固醇(mmol/L,$\bar{x}±s$)	4.6±1.1	4.4±1.2	4.4±1.1	0.007
甘油三酯(mmol/L, M, IQR)	1.4(1.0~1.9)	1.5(1.1~2.2)	1.6(1.2~2.3)	0.007
HDL(mmol/L,$\bar{x}±s$)	1.3±0.8	1.1±0.3	1.2±0.4	<0.001
LDL(mmol/L,$\bar{x}±s$)	2.9±0.9	2.8±0.9	2.7±0.9	<0.001
尿素氮(mmol/L, M, IQR)	5.1(4.2~6.5)	5.5(4.9~6.9)	5.2(4.4~6.2)	0.013
肌酐(mmol/L, M, IQR)	62.0(51.0~77.8)	72.0(59.0~88.0)	73.0(59.0~84.0)	<0.001
同型半胱氨酸(μmol/L, M, IQR)	10.5(8.8~13.9)	12.2(10.0~15.6)	11.8(10.1~14.8)	<0.001
颈动脉斑块	74(23.4)	262(66.3)	193(53.9)	<0.001

因素	EPVS组与对照组		腔隙灶组与对照组
因素	OR值	P值	OR值	P值
年龄增大	1.051	<0.001	1.061	<0.001
男性	1.250	0.142	1.474	0.012
吸烟	1.090	<0.001	1.551	0.001
糖尿病	3.343	<0.001	2.970	<0.001
使用抗血小板药	0.316	<0.001	0.310	<0.001
使用他汀类药物	0.404	<0.001	0.624	0.024
夜间血压下降幅度大	0.109	<0.001	0.111	<0.001
平均收缩压	1.028	<0.001	1.014	0.004
胆固醇	0.880	0.057	0.848	0.023
甘油三酯	1.067	0.205	1.113	0.057
高密度脂蛋白	0.437	<0.001	0.666	0.019
尿素氮	0.967	<0.001	0.950	<0.001
肌酐	1.013	<0.001	1.011	<0.001
同型半胱氨酸	1.075	0.006	1.056	0.030
有颈动脉斑块	6.453	<0.001	3.837	<0.001

因素	OR值	95%置信区间	P值
夜间血压下降幅度大	0.098	0.034~0.287	0.030
平均收缩压	1.024	1.010~1.034	0.016
年龄增大	1.070	1.059~1.082	<0.001
使用抗血小板药	0.297	0.183~0.482	0.012
使用他汀类药物	0.261	0.173~0.394	0.001

因素	OR值	95%置信区间	P值
夜间血压下降幅度大	0.155	0.075~0.321	<0.001
平均收缩压	1.014	1.008~1.020	0.021
年龄增大	1.070	1.061~1.080	<0.001
使用抗血小板药	0.228	0.161~0.324	<0.001
使用他汀类药物	0.571	0.427~0.763	0.053
吸烟	3.561	2.773~4.572	<0.001
糖尿病	2.385	1.902~2.989	<0.001