血压变异性与卒中风险有关，但鲜有研究是关于亚临床脑小血管疾病(CSVD)的。对此，西班牙学者开展了一项研究，结果表明，在原发性高血压患者中，动态血压监测下的血压水平和收缩压的平均真实变异性(ARV)与高血压患者的亚临床CSVD有关。论文近期在线发表于《高血压》(Hypertension)杂志。

        该队列研究纳入了487例无症状的高血压的患者(中位年龄：64岁，女性：47%)，受试者均接受了脑磁共振成像检查和24小时动态血压监测。计算其诊室和平均24小时血压、日间和夜间血压水平以及若干血压变异性指标。以基于腔隙性梗死和白质高信号的出现定义为CSVD。利用多变量分析和综合识别改善评估短期血压变异性和水平是否与CSVD独立相关，以及是否能改善CSVD的识别力。

        结果显示，CSVD识别率为18.9%，与年龄、性别、糖尿病、应用治疗措施、动态血压监测和任何时期收缩压的ARV有关。患病率最高(33.7%)的见于24小时血压水平和ARV均增加的受试者。任何时期的血压水平和ARV是CSVD的独立预测因素，而且虽然未达到临床显著性，但识别力呈渐进式改善(综合识别力改善了5.31%)。

        参考文献：Josefina Filomena, et al. HYPERTENSIONAHA.115.05440Published online before print June 22, 2015,doi: 10.1161/HYPERTENSIONAHA.115.05440

Short-Term Blood Pressure Variability Relates to the Presence of Subclinical Brain Small Vessel Disease in Primary Hypertension
1. Josefina Filomena*,
2. Iolanda Riba-Llena*,
3. Ernest Vinyoles,
4. José L. Tovar,
5. Xavier Mundet,
6. Xavier Castañé,
7. Andrea Vilar,
8. Antonio López-Rueda,
9. Joan Jiménez-Baladó,
10. Anna Cartanyà,
11. Joan Montaner,
12. Pilar Delgado,
13. on behalf of ISSYS Investigators
+Author Affiliations
1. 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.
1. Correspondence to Pilar Delgado, Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Passeig Vall d’Hebron, no. 119-129, CP 08035 Barcelona, Spain. E-mail pilar.delgado@vhir.org
1. ↵* J.F. and I.R.-L. contributed equally to this study.
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.