Cerebral small vessel disease and cognitive dysfunction in relation to central systolic blood pressure

Abstract

Background: Higher blood pressure (BP) is closely associated with cerebral small vessel disease (CSVD) and poor cognition. However, little is known about the association of CSVD and cognitive dysfunction with central BP.

Methods: In 1447 participants (59.3 % women; mean age, 76.0 years) enrolled in the Atherosclerosis Risk in Communities (ARIC) study, we investigated the associations of MRI-defined CSVD, characterized by log-transformed white matter hyperintensity volumes (log-WMHv), and the presence of lacunar infarct, lobar and subcortical microhemorrhages, and cognitive function determined by the Mini Mental State Examination score with per 1-SD increment in central systolic BP (cSBP) derived by applanation tonometry. The model performance was assessed by the area under the receiver operating characteristic curve (AUC).

Results: After adjusted for potential confounders, cSBP was associated with log-WMHv (β, 0.031; p = 0.003) and lobar (OR, 1.58; p < 0.001) and subcortical microhemorrhages (OR, 1.20; p = 0.011). Adding cSBP to the base model enhanced the model performance for the risk of lobar microhemorrhages (p = 0.042), while AUC did not statistically increase with the addition of peripheral SBP (p = 0.49). Irrespective of adjustments, the associations of cSBP with CSVD markers and cognitive dysfunction were much stronger for Blacks compared with Whites. Incorporating cSBP into the base model significantly improved AUC from 0.63 to 0.68 (p = 0.042) for subcortical microhemorrhages in Blacks.

Conclusion: cSBP was associated with CSVD and cognition impairment. Our observations highlight that cSBP may help further investigation for the prevention strategies of CSVD.

Keywords: Central systolic blood pressure; Cerebral small vessel disease; Cognitive impairment; Hypertension.