TY - JOUR
T1 - Association between microinfarcts and blood pressure trajectories
AU - Graff-Radford, Jonathan
AU - Raman, Mekala R.
AU - Rabinstein, Alejandro A.
AU - Przybelski, Scott A.
AU - Lesnick, Timothy G.
AU - Boeve, Bradley F.
AU - Murray, Melissa E.
AU - Dickson, Dennis W.
AU - Ross Reichard, R.
AU - Parisi, Joseph E.
AU - Knopman, David S.
AU - Petersen, Ronald C.
AU - Jack, Clifford R.
AU - Kantarci, Kejal
N1 - Funding Information:
This study received funding through grants U01 AG006786 (Mayo Clinic Study on Aging) (Dr Peterson), R01-AG040042 (Dr Kantarci), R01-AG011378 (Dr Peterson), R01-AG041851 (Dr Jack), P50AG044170 (Specialized Centers of Research) (Dr Kantarci), R01AG034676 (Rochester Epidemiology Project), and Robert H and Clarice Smith and Abigail van Buren Alzheimer Disease Research Program.
Funding Information:
receives funds from the Myron and Jane Hanley Career Development Award and National Institute on Aging of the National Institutes of Health (NIH). Dr Boeve has served as an investigator for clinical trials sponsored by Cephalon Inc, Allon Pharmaceuticals, and GE Healthcare; receives royalties from the publication of a book entitled Behavioral Neurology of Dementia (Cambridge Medicine; 2009), has received honoraria from the American Academy of Neurology; serves as a paid member of the Scientific Advisory Board of the Tau Consortium; and receives research support from the National Institute on Aging and the Alzheimer's Association. Dr Knopman serves as a paid consultant for the data safety monitoring board for Lundbeck Pharmaceuticals and for the DIAN study; is an investigator in clinical trials sponsored by TauRX Pharmaceuticals, Lilly Pharmaceuticals, and the Alzheimer’s Disease Cooperative Study; and receives research support from the NIH. Dr Petersen receives a consultant fee overseen by Mayo Clinic for Roche Inc, Merck Inc, Genentech Inc, Biogen Inc, and Eli Lilly and Company; receives publishing royalties for Mild Cognitive Impairment (Oxford University Press, 2003); and receives research support from the NIH. Dr Jack receives research funding from the NIH and the Alexander Family Alzheimer's Disease Research Professorship of the Mayo Foundation. The Mayo Clinic receives compensation for Dr Kantarci’s participation as a member of the data safety monitoring board for Pfizer Inc and Takeda Global Research & Development Center Inc and is funded by the NIH and Minnesota Partnership for Biotechnology and Medical Genomics. No other disclosures are reported.
Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - IMPORTANCE Cerebral microinfarcts are associated with increased risk of cognitive impairment and may have different risk factors than macroinfarcts. Subcortical microinfarcts are associated with declining blood pressure (BP) in elderly individuals. OBJECTIVE To investigate BP slopes as a risk factor for microinfarcts. DESIGN, SETTING, AND PARTICIPANTS From the population-based Mayo Clinic Study of Aging, 303 of 1158 individuals (26.2%) in this cohort study agreed to have an autopsy between November 1, 2004, and March 31, 2016. Cerebral microinfarcts were identified and classified as cortical or subcortical. Baseline and BP trajectories were compared for groups with no microinfarcts, subcortical microinfarcts, and cortical microinfarcts. A secondary logistic regression analysis was performed to assess associations of subcortical microinfarcts with midlife hypertension, as well as systolic and diastolic BP slopes. MAIN OUTCOMES AND MEASURES The presence of cerebral microinfarcts using BP slopes. RESULTS Of the 303 participants who underwent autopsy, 297 had antemortem BP measurements. Of these, 177 (59.6%) were men; mean (SD) age at death was 87.2 (5.3) years. The autopsied individuals and the group who died but were not autopsied were similar for all demographics except educational level with autopsied participants having a mean of 1 more year of education (1.06; 95% CI, 0.66-1.47 years; P <.01). Among 297 autopsied individuals with antemortem BP measurements, 47 (15.8%) had chronic microinfarcts; 30 (63.8%) of these participants were men. Thirty (63.8%) had cortical microinfarcts, 19 (40.4%) had subcortical microinfarcts, and 4 (8.5%) had only infratentorial microinfarcts. Participants with microinfarcts did not differ significantly on baseline systolic (mean difference, −1.48; 95% CI, −7.30 to 4.34; P = .62) and diastolic (mean difference of slope, −0.90; 95% CI, −3.93 to 2.13; P = .56) BP compared with those with no microinfarcts. However, participants with subcortical microinfarcts had a greater annual decline (negative slope) of systolic (mean difference of slope, 4.66; 95% CI, 0.13 to 9.19; P = .04) and diastolic (mean difference, 3.33; 95% CI, 0.61 to 6.06; P = .02) BP. CONCLUSIONS AND RELEVANCE Subcortical microinfarcts were associated with declining BP. Future studies should investigate whether declining BP leads to subcortical microinfarcts or whether subcortical microinfarcts are a factor leading to declining BP.
AB - IMPORTANCE Cerebral microinfarcts are associated with increased risk of cognitive impairment and may have different risk factors than macroinfarcts. Subcortical microinfarcts are associated with declining blood pressure (BP) in elderly individuals. OBJECTIVE To investigate BP slopes as a risk factor for microinfarcts. DESIGN, SETTING, AND PARTICIPANTS From the population-based Mayo Clinic Study of Aging, 303 of 1158 individuals (26.2%) in this cohort study agreed to have an autopsy between November 1, 2004, and March 31, 2016. Cerebral microinfarcts were identified and classified as cortical or subcortical. Baseline and BP trajectories were compared for groups with no microinfarcts, subcortical microinfarcts, and cortical microinfarcts. A secondary logistic regression analysis was performed to assess associations of subcortical microinfarcts with midlife hypertension, as well as systolic and diastolic BP slopes. MAIN OUTCOMES AND MEASURES The presence of cerebral microinfarcts using BP slopes. RESULTS Of the 303 participants who underwent autopsy, 297 had antemortem BP measurements. Of these, 177 (59.6%) were men; mean (SD) age at death was 87.2 (5.3) years. The autopsied individuals and the group who died but were not autopsied were similar for all demographics except educational level with autopsied participants having a mean of 1 more year of education (1.06; 95% CI, 0.66-1.47 years; P <.01). Among 297 autopsied individuals with antemortem BP measurements, 47 (15.8%) had chronic microinfarcts; 30 (63.8%) of these participants were men. Thirty (63.8%) had cortical microinfarcts, 19 (40.4%) had subcortical microinfarcts, and 4 (8.5%) had only infratentorial microinfarcts. Participants with microinfarcts did not differ significantly on baseline systolic (mean difference, −1.48; 95% CI, −7.30 to 4.34; P = .62) and diastolic (mean difference of slope, −0.90; 95% CI, −3.93 to 2.13; P = .56) BP compared with those with no microinfarcts. However, participants with subcortical microinfarcts had a greater annual decline (negative slope) of systolic (mean difference of slope, 4.66; 95% CI, 0.13 to 9.19; P = .04) and diastolic (mean difference, 3.33; 95% CI, 0.61 to 6.06; P = .02) BP. CONCLUSIONS AND RELEVANCE Subcortical microinfarcts were associated with declining BP. Future studies should investigate whether declining BP leads to subcortical microinfarcts or whether subcortical microinfarcts are a factor leading to declining BP.
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U2 - 10.1001/jamaneurol.2017.3392
DO - 10.1001/jamaneurol.2017.3392
M3 - Article
C2 - 29204605
AN - SCOPUS:85041959538
VL - 75
SP - 212
EP - 218
JO - JAMA Neurology
JF - JAMA Neurology
SN - 2168-6149
IS - 2
ER -