(Stroke. 2002;33:297.)
© 2002 American Heart Association, Inc.
Case Report |
Twenty-four–Hour Blood Pressure and MRI as Predictive Factors for Different Outcomes in Patients With Lacunar Infarct
From the Department of Neurology, Kyoto Second Red Cross Hospital (Y.Y., K. Oiwa, T.K., M.H.); Department of Neurology, Kyoto University Hospital (I.A.); and Department of Social Medicine and Cultural Sciences, Kyoto Prefectural University of Medicine (K. Ozasa) (Japan).
Correspondence to Y. Yamamoto, PhD, Department of Neurology, Kyoto Second Red Cross Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602, Japan. E-mail yamamotoyasumasa{at}hotmail.com
Background and Purpose— A long-term follow-up study was conducted in patients with lacunar infarct to assess how 24-hour blood pressure monitoring values and MRI findings, in particular lacunar infarcts and diffuse white matter lesions, can predict subsequent development of dementia and vascular events, which include cerebrovascular and cardiovascular events.
Methods— One hundred seventy-seven patients were tracked for a mean of 8.9 years of follow-up. Documented events comprise the development of dementia and the occurrence of vascular events. The predictors for developing dementia and vascular events were separately evaluated by Cox proportional hazards analysis.
Results— Twenty-six patients developed dementia (0.17/100 patient-years). Male sex (relative risk [RR], 4.2; 95% CI, 1.2 to 14.7), cognitive impairment (RR, 3.0; 95% CI, 1.0 to 8.5), confluent DWML (moderate: RR, 7.1; 95% CI, 1.6 to 31.5; severe: RR, 35.8; 95% CI, 7.2 to 177.3), and nondipping status (RR, 7.1; 95% CI, 2.2 to 22.0) were independent predictors for dementia. Forty-six patients suffered from vascular events (3.11/100 patient-years). Diabetes mellitus (RR, 5.7; 95% CI, 2.7 to 11.9), multiple lacunae (moderate: RR, 6.4; 95% CI, 2.5 to 15.8; severe: RR, 8.5; 95% CI, 3.1 to 23.3), and high 24-hour systolic blood pressure (>145 mm Hg versus <130 mm Hg) (RR, 10.3; 95% CI, 1.3 to 81.3) were independent predictors for vascular events.
Conclusions— Predictors for developing dementia and vascular events appear to differ. Male sex, confluent diffuse white matter lesions, and nondipping status were independent predictors for subsequent development of dementia, while diabetes mellitus, multiple lacunae, and high 24-hour systolic blood pressure were independent predictors for vascular events.
Key Words: blood pressure monitoring, ambulatory • dementia, vascular • lacunar infarction • white matter
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