Response to Letters Regarding Article, “Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People”
Year: 2012
Type: article
Abstract: The issue of diastolic blood pressure (BP) effects is a valid one, as noted by Drs Castilla-Guerra and Fernandez-Moreno. Because systolic BP has typically been recognized as the BP parameter of interest (and cardiovascular risk) in older patients, we chose to focus on systolic measures in our study. Analyses of changes in diastolic BP relative to the white matter hyperintensity (WMH) lesions and 2 of the cognitive parameters at 24 months of follow-up did demonstrate significant relationships for 24-hour, awake, and sleep diastolic BP, but the clinic diastolic BP data did not. These findings are similar to our findings for systolic BP. 1 There was no relationship between changes in postural BP and WMH or functional outcomes in our study. The second point made by Castilla-Guerra and Fernandez-Moreno concerns the differential effects of ambulatory BP on periventricular WMH versus deep WMH, as suggested by an earlier study. 2 Although this could result in disparate compromise of motor and cognitive function, the differential impact on periventricular WMH and deep WMH is still unclear. Although differences between the 2 white matter lesion subtypes have been reported, 2,3 there is also evidence to suggest that the distinction may not be justified. The volumes of periventricular WMH and deep WMH are reported as highly correlated, and it has been suggested that the differentiation is entirely arbitrary. Additionally, fiber tracts may cross both periventricular and deep white matter and thus are potentially compromised by lesions in both locations. It is for these reasons we did not separate the effects of ambulatory blood pressure on periventricular WMH and deep WMH.
Source: Circulation
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2124456364