Optimal systolic and diastolic blood pressure threshold that associated with lower risk of white matter hyperintensity progression

Sibo Liu; Mengxing Wang; De'an Gu; Yanzhao Li; Xin Zhang; Hang Li; Chenhua Ji; Ximing Nie; Jinjie Liu

doi:10.3389/fnagi.2023.1254463

Optimal systolic and diastolic blood pressure threshold that associated with lower risk of white matter hyperintensity progression

Front Aging Neurosci. 2023 Oct 19:15:1254463. doi: 10.3389/fnagi.2023.1254463. eCollection 2023.

Authors

Sibo Liu¹, Mengxing Wang², De'an Gu³, Yanzhao Li⁴, Xin Zhang⁵, Hang Li⁶, Chenhua Ji⁵, Ximing Nie⁷, Jinjie Liu⁵

Affiliations

¹ Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China.
² China National Clinical Research Center for Neurological Diseases Beijing China, Beijing, China.
³ Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China.
⁴ Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
⁵ Department of General Medicine, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China.
⁶ Department of Geriatrics, Affiliated Dalian Friendship Hospital of Dalian Medical University, Dalian, China.
⁷ Neurocritical Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Abstract

Background: The optimal control thresholds for systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with white matter hyperintensity (WMH) are still unclear.

Method: A longitudinal retrospective study of patients with brain magnetic resonance imaging (MRI) scans with intervals of more than 3 years was conducted. Blood pressure records during hospitalization and from outpatient visits between baseline and the last MRI scan were collected. The outcome was the change in total WMH from baseline to the final visit.

Results: Among the 965 patients with MRI scans, 457 patients with detailed longitudinal blood pressure records were ultimately included and classified into the WMH absent group (n = 121), mild WMH group (n = 126), and moderate to severe WMH group (n = 210). Both baseline and longitudinal mean SBP, DBP, and SBP SD were significantly associated with WMH severity (p < 0.05). An average SBP of 130-140 mmHg [vs. <130 mmHg, aOR, 1.80, (95% CI, 1.05-3.07), p = 0.03] was associated with a higher risk of WMH progression. DBP ≥ 90 mmHg [vs. <80 mmHg, OR, 1.81, (95% CI, 0.88-3.74), p = 0.02, aOR, 1.54, (95% CI, 0.66-3.53), p = 0.32] was associated with a higher risk of WMH progression, but was not after adjusted for other covariates. Longitudinal BP variability was not significantly associated with WMH progression.

Conclusion: Both SBP and DBP had a stronger relationship with the severity of WMH. A target mean SBP of <130 mmHg and mean DBP of <80 mmHg was associated with a lower risk of WMH progression.

Keywords: blood pressure; blood pressure variability; diastolic blood pressure; systolic blood pressure; white matter hyperintensity.

Grants and funding

This work was supported by the Dalian High-Level and Talent Innovation Support Plan (Youth Science and Technology Star Project, 2021RQ029). National Natural Science Foundation of China (82001920). Beijing Municipal Administration of Hospitals’ Youth Programme (QML20210503). AI + Health Collaborative Innovation Cultivation Project of Beijing Municipal Commission of Science and Technology (Z221100003522012). Dalian Medical Key Specialty “Climbing the Peak Plan” [grant number 2023ZZ012].