Cerebral Small Vessel Diseases Clinical Trial
— BPV-COGOfficial title:
Multicenter Retrospective Study of Visit-to-Visit Variability in Blood Pressure as a Predictor of Poor Cognitive Function
Hypertension in midlife is an independent risk factor of late life cognitive dysfunction or
dementia. Chronic hypertension cause vascular damage and cerebral ischemia, which ultimately
gives rise to the cognitive dysfunction or dementia.
A recent study showed that high visit-to-visit variability in clinic systolic blood pressure
(BP) was a strong independent predictor of stroke. This finding suggests that high clinic
systolic BP variability itself as well as chronic hypertension may cause vascular damage and
cerebral ischemia. Therefore, high clinic SBP variability may be also an independent risk
factor of cognitive dysfunction or dementia.
Vascular damage leads to the diminished autoregulatory capacities of cerebral arteries. The
brain with the reduced autoregulatory capacity may be more vulnerable to BP fluctuation.
Therefore, high BP variability may be more harmful in patients with damaged vessels (for
example, in patients with cerebral small vessel disease).
Previous data about BP variability and cognition revealed very controversial. Some studies
showed poor cognition in patients with high BP variability, but others did not.
The previous studies were mostly based on cross-sectional designs, and performed in
small-sized heterogeneous population for primary prevention. The harmful effect of high BP
variability may be clearer in the population with damaged vascular bed, such as cerebral
small vessel disease. The previous studies usually used ambulatory BP monitoring (ABPM).
However, recent data suggested that variability in BP on ABPM may be a weaker predictor of
vascular events than be visit-to-visit variability in clinic BP.
The investigators sought to find whether high visit-to-visit variability in clinic BP is
related with poor cognitive function in patients with cerebral small vessel disease.
Status | Recruiting |
Enrollment | 140 |
Est. completion date | February 2013 |
Est. primary completion date | February 2013 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 60 Years to 80 Years |
Eligibility |
Inclusion Criteria: - Patients with cerebral small vessel disease previously documented on MRI (definition of small vessel disease - symptomatic lacunar infarction or white matter ischemic lesion with one or more asymptomatic lacunes) Exclusion Criteria: - Incomplete clinic BP data (less than 6 BP readings during recent one year) - History of cardiovascular or cerebrovascular events during recent one year - Documented cerebral infarction from large artery atherosclerosis - Atrial fibrillation or cardiac disease with high risk of embolism - Significant medical, neurological, or psychiatric disease affecting cognition - Known dementia treated with acetylcholine esterase inhibitor or memantine - Patients without informed consent |
Observational Model: Cohort, Time Perspective: Retrospective
Country | Name | City | State |
---|---|---|---|
Korea, Republic of | Hallym University Sacred Heart Hospital, Hallym University, College of Medicine | Anyang-si | Gyeonggi-do |
Korea, Republic of | Chuncheon Sacred Heart Hospital, Hallym University, College of Medicine | Chuncheon-si | Gangwon-do |
Korea, Republic of | Gangdong Sacred Heart Hospital, Hallym University, College of Medicine | Seoul | |
Korea, Republic of | Gangnam Sacred Heart Hospital, Hallym University, College of Medicine | Seoul | |
Korea, Republic of | Hangang Sacred Heart Hospital, Hallym University, College of Medicine | Seoul |
Lead Sponsor | Collaborator |
---|---|
Hallym University Medical Center |
Korea, Republic of,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Association between raw score of K-MMSE and visit-to-visit systolic BP variability | Difference of mean K-MMSE raw scores between the highest and the lowest tertile group stratified by visit-to-visit systolic BP variability: Wilcoxon_Mann_Whitney test Binary logistic regression analysis for independent association between visit-to-visit systolic BP variability and low cognition, including confounding variables with p<0.2 in univariate analysis (Low cognition, defined as the lowest tertile of K-MMSE raw score) |
Time from previous MRI documentation as small vessel disease to cognitive function evaluation; 1.5 to 7 years | No |
Secondary | Association between raw score of K-MMSE and visit-to-visit diastolic BP variability | Difference of mean K-MMSE raw scores between the highest and the lowest tertile group stratified by visit-to-visit diastolic BP variability: Wilcoxon_Mann_Whitney test Binary logistic regression analysis for independent association between visit-to-visit diastolic BP variability and low cognition, including confounding variables with p<0.2 in univariate analysis (Low cognition, defined as the lowest tertile of K-MMSE raw score) |
Time from previous MRI documentation as small vessel disease to cognitive function evaluation; 1.5 to 7 years | No |
Secondary | Association between raw scores of "K-VCI NP 30-minute protocol" sub-tests and visit-to-visit systolic BP variability | Difference of mean "K-VCI NP 30-minute protocol" sub-tests' raw scores between the highest and the lowest tertile group stratified by visit-to-visit systolic BP variability: Wilcoxon_Mann_Whitney test Binary logistic regression analysis for independent association between visit-to-visit systolic BP variability and low cognition, including confounding variables with p<0.2 in univariate analysis (Low cognition, defined as the lowest tertile of each "K-VCI NP 30-minute protocol" sub-test) "K-VCIHS NP 30-minute protocol" include Seoul Verbal Learning Test (SVLT), Semantic Fluency Test, Animal Phonemic Fluency Test, Digit Symbol-Coding (DSC), Geriatric Depression Scale (GDS), and Trail Making Test A & B. |
Time from previous MRI documentation as small vessel disease to cognitive function evaluation; 1.5 to 7 years | No |
Secondary | Association between raw scores of "K-VCI NP 30-minute protocol" sub-tests and visit-to-visit diastolic BP variability | Difference of mean "K-VCI NP 30-minute protocol" sub-tests' raw scores between the highest and the lowest tertile group stratified by visit-to-visit diastolic BP variability: Wilcoxon_Mann_Whitney test Binary logistic regression analysis for independent association between visit-to-visit diastolic BP variability and low cognition, including confounding variables with p<0.2 in univariate analysis (Low cognition, defined as the lowest tertile of each "K-VCI NP 30-minute protocol" sub-test) |
Time from previous MRI documentation as small vessel disease to cognitive function evaluation; 1.5 to 7 years | No |
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