The Study On The Relationship Between Blood Pressure Variability And Total Magnetic Resonance Imaging Load Of Cerebral Small Vascular Diseases

Objective:Lacunar infarcts,white matter lesions,cerebral microbleeds and enlarged perivascular spaces are the typical magnetic resonance imaging(MRI)marks of cerebral small vascular disease(CSVD).Hypertension is the most important interventionable risk factor for CSVD,which is closely related to the occurrence and development of CSVD.At present,there are few studies on whether the twenty-four hours ambulatory blood pressure variability(ABPV)is related to the occurrence and development of CSVD and whether the parameters of blood pressure variability(BPV)are risk factors for the total MRI load of CSVD.In this paper,we analyzed the relationship between the twenty-four hours ABPV and the total MRI load of CSVD by monitoring the twenty-four hours ambulatory blood pressure of patients with CSVD,as to explore the relationship between BPV and CSVD.Methods:From January 2020 to November 2020,we collected 164 inpatients with CSVD which were diagnosed by cranial magnetic resonance examination in the Department of Cerebrovascular Disease and Neurology,the Second Affiliated Hospital of Kunming Medical University.According to the University of Edinburgh clinical brain science center proposed total MRI load rating standard for CSVD,164 patients was divided into five groups,33 cases in group 0,50 cases in group 1,38 cases in group 2,29 cases in group 3,and 14 cases in group 4.All patients were examined by twenty-four hours ambulatory blood pressure,and the blood pressure level,BPV in different groups were analyzed,including twenty-four hours mean systolic blood pressure(24hmSBP),twenty-four hours mean diastolic blood pressure(24hmDBP),standard deviation of 24 hours systolic blood pressure(24hSBP-SD),standard deviation of 24 hours diastolic blood pressure(24hDBP-SD),daytime mean systolic blood pressure(dmSBP),nighttime mean systolic blood pressure(nmSBP),daytime mean diastolic blood pressure(dmDBP),nighttime mean diastolic blood pressure(nmDBP),standard deviation of daytime systolic blood pressure(dSBP-SD),standard deviation of nighttime systolic blood pressure(nSBP-SD),standard deviation of daytime diastolic blood pressure(dDBP-SD),standard deviation of nighttime diastolic blood pressure(nDBP-SD),weighted SD of systolic blood pressure(SBPwSD)and weighted SD of diastolic blood pressure(DBPwSD).To analyze the clinical data of five groups,including name,gender,age,history of diabetes mellitus,history of hypertension and history of hyperlipidemia.After admission,fasting venous blood was collected and sent to the Laboratory Department of the Second Affiliated Hospital of Kunming Medical University for the detection of serum homocysteine level,blood lipid and other related biochemical indicators.We used the SPSS 22.0 statistical software to analyze the collected data,in which the measurement data conforming to normal distribution were expressed as mean±standard deviation(x±s),One-way ANOVA or Welch test was used for comparison between groups,and Tukey-Kramer or Games-Howell test was used for pair comparison between groups.And the measurement data that did not meet the normal distribution were expressed as the median(25th percentile-75th percentile)(M(Q25-Q75)).The comparison between groups was performed by non-parametric test(Kruskal--Wallis H test),and the post-test(Dunn·s test)of Kruskal-Wallis H test after adjusting P values by Bonferroni correction method was used for Pair comparison among all groups.The frequency and percentage were used to express the counts,and comparisons between groups were performed by either the chi-square test(test)or Fisher’s exact probability test.Spearman correlation analysis was used to evaluate the correlation between blood pressure,BPV and the total MRI load of CSVD.Risk factors were analyzed by ordered logistic regression analysis,independent variables with P<0.05 in univariate analysis were selected into the model of ordered logistic regression for analysis,P<0.05 was considered as statistically significant.Results:There were significant differences in age,hypertension composition ratio,serum Hcy level,24hmSBP,24hSBP-SD,SBP wSD,dmSBP,dSBP-SD,nmSBP,nmDBP and nSBP-SD among different groups(P<0.05).There were differences in gender,hyperlipidemia,smoking history,drinking history,antihypertensive drug type,BMI,serum uric acid,glycated hemoglobin,serum TC,TG,HDL-C and LDL-C levels among the five groups,but there was no statistical significance(P>0.05).Spearman correlation analysis showed that 24hmSBP,24hSBP-SD,SBPwSD,DBPwSD,dmSBP,dSBP-SD,nmSBP,nmDBP and nSBP-SD were positively correlated with the total MRI load of CSVD(r=0.175-0.429,all P<0.05),while other diastolic blood pressure levels and variability were not significantly correlated with the total load of CSVD.Oorderly logistic regression analysis of the possible risk factors for total load of CSVD showed that age(P<0.001),serum Hcy level(P<0.05)and 24hSBP-SD(P<0.05)were independent risk factors for the total MRI load of CSVD.Conclusions:1.24hmSBP,24hSBP-SD,SBPwSD,dmSBP,dSBP-SD,nmSBP,nSBP-SD,nmDBP and DBPwSD were positively correlated with the total MRI load of CSVD;2.Age,serum Hcy level and higher 24hSBP-SD are independent risk factors for total MRI load of CSVD,and it may be beneficial to monitoring serum Hcy level and 24hSBP-SD for the intervention of risk factors for total load of CSVD.