| Objectives 1 To explore the relationship between ambulatory blood pressure(ABP)and total cerebral small vessel disease(CSVD)burden in patients with CSVD.2 To investigate the correlation between ABP and cognitive function in patients with CSVD.Methods 1 A total of 326 inpatients with CSVD from the neurology department in Hebei General Hospital between October 2016 to October 2020 were selected in our study,all of whom completed cranial magnetic resonance imaging(MRI)and 24-hour ambulatory blood pressure monitoring(ABPM).The demographic and general clinical data of the patients were collected,and the total CSVD burden of the patients were evaluated(0-4 points)based on the cranial MRI.According to the total CSVD burden,183 patients were divided into mildmoderate burden group(0-2 points)and 143 patients into severe burden group(3-4 points).Meanwhile,the related indexes of ABP were recorded and calculated,according to the results of 24-hour ABPM.Then,statistical methods,such as t-test,Mann-Whitney U test,χ~2 test,Logistic regression and Spearman correlation analysis were used to explore the influencing factors for the total CSVD burden and the relationship between ABP and the total CSVD burden in patients with CSVD.2 A total of 55 inpatients with CSVD from the neurology department in Hebei General Hospital between October 2016 to October 2020 were selected in our study,all of whom completed cranial MRI,24-hour ABPM and the assessment of cognitive function.The demographic and general clinical data,cranial MRI and ABPM data were arranged.The mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were used to assess cognitive function.According to the MMSE score,26 patients were divided into cognitive normal group and 29 patients were divided into cognitive impairment group.Then,statistical methods,such as t-test,MannWhitney U test,χ~2 test,Logistic regression and Spearman correlation analysis were adopted to analyze the risk factors of cognitive impairment and the correlation between ABP and the overall cognition and each cognitive domain assessed by MoCA in patients with CSVD.Results 1 Compared with the mild-moderate burden group,the patients in the severe burden group appeared older,higher composition ratios of male,previous history of cerebral infarction and non-dipping pattern,higher levels of homocysteine,24-hour mean systolic blood pressure(24h SBP),nighttime mean systolic blood pressure(NSBP),weighted standard deviation of 24-hour systolic blood pressure(24h SBP-w SD),weighted standard deviation of 24-hour diastolic blood pressure(24h DBP-w SD),standard deviation of nighttime systolic blood pressure(NSBP-SD)and lower level of apolipoprotein A(P<0.05).2 Logistic regression analysis showed that previous history of cerebral infarction(OR: 2.700,95%CI: 1.512-4.822,P=0.001),NSBP-SD(OR: 1.085,95%CI: 1.041-1.131,P<0.001),age(OR: 1.034,95%CI: 1.013-1.055,P=0.001),male(OR: 1.856,95%CI: 1.132-3.041,P=0.014)and non-dipping pattern(OR: 1.974,95%CI: 1.106-3.522,P=0.021)were the independent risk factors for the severe total CSVD burden in patients with CSVD.3 Spearman correlation analysis showed that the NSBP-SD was positively correlated with the total CSVD burden(r=0.203,P<0.001),and the nocturnal dip of SBP was negatively correlated with the severe total CSVD burden(r=-0.204,P<0.001).4 Patients who were divided into cognitive impairment group displayed older,higher levels of 24 h SBP,NSBP,24 h SBP-w SD,24 h DBP-w SD,standard deviation of daytime systolic blood pressure,standard deviation of daytime diastolic blood pressure,NSBP-SD and total CSVD burden,lower proportion of patients with education≥12 years(P<0.05).5 Logistic regression analysis showed that age(OR: 1.122,95%CI: 1.032-1.219,P=0.007),24 h SBP-w SD(OR: 1.325,95%CI: 1.101-1.594,P=0.003)and total CSVD burden(OR: 1.796,95%CI: 1.010-3.195,P=0.046)were independent risk factors for cognitive impairment in patients with CSVD.6 Spearman correlation analysis showed that the 24 h SBP-w SD was negatively related to Mo CA total score(r=-0.322,P=0.016)and its sub-items including visuospatial and execution(r=-0.376,P=0.005),attention(r=-0.282,P=0.037),abstraction(r=-0.267,P=0.049).Conclusions 1 The previous history of cerebral infarction,NSBP variability,age,male and non-dipping pattern are possibly independent risk factors for the severe total CSVD burden in patients with CSVD.2 The higher the NSBP variability is,the more severe the total CSVD burden is.3 The smaller the nocturnal dip of blood pressure is,the more severe the total CSVD burden is.4 Age,whole-day SBP variability and total CSVD burden may be independent risk factors for cognitive impairment in patients with CSVD.5 The higher the whole-day SBP variability is,the more obvious the decline of cognitive function is,mainly reflected in the overall cognitive function,visuospatial and execution,attention,abstraction thinking ability.Table 12;Reference 150... |
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