Abstract Details

Title Long-term premorbid blood pressure and cerebral small vessel disease burden on imaging in TIA and ischaemic stroke: population-based study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S40 - Stroke Risk Factors and Epidemiology (4:14 PM-4:25 PM)

Poster/Presentation
Number 005

Background Studies of causes of cerebral SVD should fully adjust for blood pressure (BP), but most aetiological studies use a single blood pressure (BP) measurement or “history of hypertension”, which might underestimate the role of hypertension. In patients with TIA and ischaemic stroke, we therefore compared the associations of baseline and long-term premorbid BP with measures of SVD on MRI brain.

Objective To compare the associations of baseline and long-term premorbid BP with measures of small vessel disease (SVD) on MRI brain in patients with TIA and ischaemic stroke.

Design/Methods We studied 1009 TIA/ischaemic stroke patients who had a brain MRI, in the population-based Oxford Vascular Study, and related baseline and 20-year premorbid BP (median:15 readings/patient) to the Total SVD Score on imaging.

Results SVD Score was associated with increasing mean baseline SBP [OR of top vs. bottom BP quartile: 2.28, 95% CI 1.62-3.21, p<0.0001) and with prior hypertension (2.53, 2.01-3.20, p<0.0001), but the association was much stronger with mean premorbid SBP (6.09, 4.34-8.55, p<0.0001). Mean DBP at baseline was negatively associated with SVD score (0.71, 0.51-1.00, p=0.050), and a positive association was only evident for DBP 10-20 years previously (3.35, 2.33-4.84; both p<0.0001). Relationships between overall mean premorbid BP and SVD-burden were strongest in patients age<70 (SBP: 6.99, 4.11-11.86; DBP: 3.13, 1.95-5.07; both p<0.0001) versus ≥70 years (2.37, 1.42-3.94, p=0.001; and 1.16, 0.74-1.84, p=0.52).

Conclusions Mean premorbid SBP is more strongly associated with SVD-burden than baseline SBP or history of hypertension, and baseline DBP yields a misleading estimate of the likely aetiological importance of mid-life hypertension for the subsequent development of SVD. Studies of novel potential aetiological factors for SVD should aim to adjust for long-term prior BP, and trials of BP-lowering with only a few years of follow-up may under-estimate the overall impact on SVD.

Authors/Disclosures
Gary K. Lau, MBBS (University of Hong Kong) PRESENTER	Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Amgen. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Boehringer Ingelheim. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Daiichi Sankyo. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Pfizer. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Eisai. Dr. Lau has stock in ReMobility. The institution of Dr. Lau has received research support from Croucher Foundation. The institution of Dr. Lau has received research support from Research Fund Secretariat of the Food and Health Bureau, Hong Kong. The institution of Dr. Lau has received research support from Innovation and Technology Bureau, Hong Kong. The institution of Dr. Lau has received research support from Research Grants Council, Hong Kong. Dr. Lau has received publishing royalties from a publication relating to health care.
Linxin Li, MD	The institution of Dr. Li has received research support from Medical Research Foundation.
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