J Clin Neurol.  2019 Apr;15(2):159-167. 10.3988/jcn.2019.15.2.159.

Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients

• Chang Y
• Lee SA
• Lee SH
• Lee EH
• Kim YJ
• Song TJ

• KMID: 2467729
• DOI: http://doi.org/10.3988/jcn.2019.15.2.159

Abstract

BACKGROUND AND PURPOSE
An interarm blood pressure difference (IABD) is independently related to the occurrence of cardiovascular disease and mortality. Cerebral small-vessel diseases (SVDs) are important risk factors for stroke, cognitive dysfunction, and mortality. We aimed to determine whether IABD is related to cerebral SVDs.
METHODS
This study included 1,205 consecutive noncardioembolic ischemic stroke patients as confirmed by brain MRI and simultaneously measured the bilateral brachial blood pressures. We investigated cerebral SVDs based on high-grade white-matter hyperintensities (HWHs), presence of cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs) on brain MRI.
RESULTS
In multivariate logistic regression, an interarm systolic blood pressure difference (IASBD) ≥10 mm Hg was independently related to the existence of HWHs [odds ratio (OR)=1.94, 95% CI=1.32-2.84, p=0.011] and had a tendency to be associated with the presence of HPVSs (OR=1.45, 95% CI=0.49-2.23, p=0.089) and ALIs (OR=1.42, 95% CI=0.96-2.11, p=0.052), but not with the presence of CMBs (OR=1.09, 95% CI=0.73-1.61, p=0.634). In multivariate linear regression adjusted for age, sex, and variables with p<0.1 in the univariate analysis, IASBD ≥10 mm Hg and interarm diastolic blood pressure difference ≥10 mm Hg were significantly correlated with an increased total burden of SVDs (β=0.080 and p=0.006, and β=0.065 and p=0.023, respectively).
CONCLUSIONS
This study found that IABD ≥10 mm Hg was associated with the presence and increased burden of cerebral SVDs in noncardioembolic stroke patients. This suggests that IABD ≥10 mm Hg could be a useful indicator of the presence and burden of cerebral SVDs in stroke patients.

Keyword

asymptomatic lacunar infarctions; cerebral microbleeds; cerebral small-vessel diseases; interarm blood pressure difference; white-matter hyperintensities

MeSH Terms

Blood Pressure*
Brain
Cardiovascular Diseases
Humans
Linear Models
Logistic Models
Magnetic Resonance Imaging
Mortality
Risk Factors
Stroke*
Stroke, Lacunar

Figure

• 

  Fig. 1 Flowchart of participants according to the applied inclusion and exclusion criteria. ABI: ankle-brachial index.

• 

  Fig. 2 Examples of cerebral small-vessel diseases. The arrows indicate high-grade white-matter hyperintensities (A), cerebral microbleeds (B), high-grade perivascular spaces (C), and an asymptomatic lacunar infarctions (D).

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