Recent developments in brain magnetic resonance imaging using advanced Susceptibility Weighted Imaging (SWI) have significantly increased the detection and prevalence of Cerebral Microbleeds (CMBs). Here, we aimed to explore the association between Pulse Pressure (PP) and CMBs. Having been implicated in various arteriopathies, we hypothesized that elevated PP could also be a risk for CMBs. A retrospective case-control study was conducted from August 2021 to September 2022 at Zhongnan Hospital of Wuhan University China. Extracted data were analyzed in SPSS. Chi-square test, binary logistic regression, and Spearman’s correlation analysis were conducted.104 patients were analyzed. Univariate analysis showed no significant association between PP and CMBs, OR 1.65 (95% CI: 0.737 - 3.694; p > 0.05), while DBP and alcohol consumption were significant, ORs 2.956 (95% CI: 1.249 - 6.997, p < 0.05) and 2.525 (95% CI: 1.062 - 6.002, p < 0.05) respectively. Multivariate analysis, showed that PP was significantly associated with CMBs, OR 3.194 (95% CI: 1.024 - 9.964, p < 0.05) in combination with SBP, DBP, gender, age, smoking and alcohol consumption. Taken together, the study showed that elevated PP is associated with CMB, but is not an independent risk factor for CMBs.
Nighoghossian, N., Hermier, M., Adeleine, P., Blanc-Lasserre, K., Derex, L., Honnorat, J., et al. (2002) Old Microbleeds Are a Potential Risk Factor for Cerebral Bleeding After Ischemic Stroke: A Gradient-Echo T2*-Weighted Brain MRI Study. Stroke, 33, 735-742. https://doi.org/10.1161/hs0302.104615
Vernooij, M.W., van der Lugt, A., Ikram, M.A., Wielopolski, P.A., Niessen, W.J., Hofman, A., et al. (2008) Prevalence and Risk Factors of Cerebral Microbleeds: The Rotterdam Scan Study. Neurology, 70, 1208-1214. https://doi.org/10.1212/01.wnl.0000307750.41970.d9
Haller, S., Vernooij, M.W., Kuijer, J.P.A., Larsson, E.M., Jäger, H.R. and Barkhof, F. (2018) Cerebral Microbleeds: Imaging and Clinical Significance. Radiology, 287, 11-28. https://doi.org/10.1148/radiol.2018170803
Sepehry, A.A., Lang, D., Hsiung, G.Y. and Rauscher, A. (2016) Prevalence of Brain Microbleeds in Alzheimer Disease: A Systematic Review and Meta-Analysis on the Influence of Neuroimaging Techniques. American Journal of Neuroradiology, 37, 215-222. https://doi.org/10.3174/ajnr.A4525
Ibrahim, A.A., Ibrahim, Y.A., Darwish, E.A. and Khater, N.H. (2019) Prevalence of Cerebral Microbleeds and Other Cardiovascular Risk Factors in Elderly Patients with Acute Ischemic Stroke. Egyptian Journal of Radiology and Nuclear Medicine, 50, Article No. 38. https://doi.org/10.1186/s43055-019-0034-7
Graff-Radford, J., Lesnick, T.G., Mielke, M.M., Constantopoulos, E., Rabinstein, A.A., Przybelski, S.A., et al. (2021) Cerebral Amyloid Angiopathy Burden and Cerebral Microbleeds: Pathological Evidence for Distinct Phenotypes. Journal of Alzheimer’s Disease, 81, 113-122. https://doi.org/10.3233/JAD-201536
Renard, D., Tatu, L. and Thouvenot, E. (2018) Infratentorial Cerebral Microbleeds in Patients with Cerebral Amyloid Angiopathy. Journal of Stroke and Cerebrovascular Diseases, 27, 2534-2537. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.015
Werring, D.J. (2011) Cerebral Microbleeds: Pathophysiology to Clinical Practice. Cambridge University Press, Cambridge. http://libgen.rs/book/bibtex.php?md5=6e6009954c7515822490f845c3c7b582
Alistair, D.G. (2006) Hypertensive Cerebral Small Vessel Disease and Stroke. Brain Pathology, 12, 358-370. https://doi.org/10.1111/j.1750-3639.2002.tb00450.x
Munoz, D.G. (2003) Small Vessel Disease: Neuropathology. International Psychogeriatrics, 15, 67-69. https://doi.org/10.1017/S1041610203008986
Lesnik Oberstein, S.A.J., van den Boom, R., van Buchem, M.A., van Houwelingen, H.C., Bakker, E., Vollebregt, E., et al. (2001) Cerebral Microbleeds in CADASIL. Neurology, 57, 1066-1070. https://doi.org/10.1212/WNL.57.6.1066
Ishikawa, T., Kuroda, S., Nakayama, N., Terae, S., Kudou, K. and Iwasaki, Y. (2005) Prevalence of Asymptomatic Microbleeds in Patients with Moyamoya Disease. Neurologia Medico-Chirurgica, 45, 495-500. https://doi.org/10.2176/nmc.45.495
Kikuta, K.-I., Takagi, Y., Nozaki, K., Hanakawa, T., Okada, T., et al. (2005) Asymptomatic Microbleeds in Moyamoya Disease: T2*-Weighted Gradient-Echo Magnetic Resonance Imaging Study. Journal of Neurosurgery, 102, 470-475. https://doi.org/10.3171/jns.2005.102.3.0470
Tsushima, Y., Tanizaki, Y., Aoki, J. and Endo, K. (2002) MR Detection of Microhemorrhages in Neurologically Healthy Adults. Neuroradiology, 44, 31-36. https://doi.org/10.1007/s002340100649
Liu, P.-F., Cui, Y.-Z., Na, J. and Gao, P.-Y. (2010) Cerebral Microbleeds-Prevalence, Distribution and Risk Factors in Northeast Population without Preceding Large-Area Stroke. Chinese Medical Journal, 123, 286-290.
Staals, J., van Oostenbrugge, R.J., Knottnerus, I.L.H., Rouhl, R.P.W., Henskens, L.H.G. and Lodder, J. (2009) Brain Microbleeds Relate to Higher Ambulatory Blood Pressure Levels in First-Ever Lacunar Stroke Patients. Stroke, 40, 3264-3268. https://doi.org/10.1161/STROKEAHA.109.558049
van Es, A.C.G.M., van der Grond, J., de Craen, A.J.M., Admiraal-Behloul, F., Blauw, G.J. and van Buchem, M.A. (2008) Risk Factors for Cerebral Microbleeds in the Elderly. Cerebrovascular Diseases, 26, 397-403. https://doi.org/10.1159/000151680
Roob, G., Schmidt, R., Kapeller, P., Lechner, A., Hartung, H.P. and Fazekas, F. (1999) MRI Evidence of Past Cerebral Microbleeds in a Healthy Elderly Population. Neurology, 52, 991-991. https://doi.org/10.1212/WNL.52.5.991
Sveinbjornsdottir, S., Sigurdsson, S., Aspelund, T., Kjartansson, O., Eiriksdottir, G., Valtysdottir, B., et al. (2008) Cerebral Microbleeds in the Population Based AGES-Reykjavik Study: Prevalence and Location. Journal of Neurology, Neurosurgery & Psychiatry, 79, 1002-1006. https://doi.org/10.1136/jnnp.2007.121913
Poels, M.M.F., Vernooij, M.W., Ikram, M.A., Hofman, A., Krestin, G.P., van der Lugt, A., et al. (2010) Prevalence and Risk Factors of Cerebral Microbleeds. Stroke, 41, S103-S106. https://doi.org/10.1161/STROKEAHA.110.595181
Lee, S.-H., Bae, H.-J., Yoon, B.-W., Kim, H., Kim, D.-E. and Roh, J.-K. (2002) Low Concentration of Serum Total Cholesterol Is Associated with Multifocal Signal Loss Lesions on Gradient-Echo Magnetic Resonance Imaging. Stroke, 33, 2845-2849. https://doi.org/10.1161/01.STR.0000036092.23649.2E
Darweesh, S.K.L., Leening, M.J.G., Akoudad, S., Loth, D.W., Hofman, A., Arfan Ikram, M., et al. (2013) Clopidogrel Use Is Associated With an Increased Prevalence of Cerebral Microbleeds in a Stroke-Free Population: The Rotterdam Study. Journal of the American Heart Association, 2, e000359. https://doi.org/10.1161/JAHA.113.000359
Ge, L., Niu, G., Han, X., Gao, Y., Wu, Q., Wu, H., et al. (2011) Aspirin Treatment Increases the Risk of Cerebral Microbleeds. Canadian Journal of Neurological Sciences, 38, 863-868. https://doi.org/10.1017/S0317167100012440
Vernooij, M.W., Haag, M.D.M., van der Lugt, A., Hofman, A., Krestin, G.P., Stricker, B.H., et al. (2009) Use of Antithrombotic Drugs and the Presence of Cerebral Microbleeds: The Rotterdam Scan Study. Archives of Neurology, 66, 714-720. https://doi.org/10.1001/archneurol.2009.42
Kim, B.J. and Lee, S.-H. (2013) Cerebral Microbleeds: Their Associated Factors, Radiologic Findings, and Clinical Implications. Journal of Stroke, 15, 153-163. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859003/
Reddy, S.T. and Savitz, S.I. (2020) Hypertension-Related Cerebral Microbleeds. Case Reports in Neurology, 12, 266-269. https://doi.org/10.1159/000508760 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548923/
Yamashiro, K., Tanaka, R., Shimo, Y., Oyama, G., Ogawa, T., Umemura, A., et al. (2018) Cerebral Microbleeds and Blood Pressure Abnormalities in Parkinson’s Disease. eNeurologicalSci, 10, 5-11. https://www.sciencedirect.com/science/article/pii/S2405650217300370
Fisher, M., French, S., Ji, P. and Kim, R.C. (2010) Cerebral Microbleeds in the Elderly: A Pathological Analysis. Stroke, 41, 2782-2785. https://doi.org/10.1161/STROKEAHA.110.593657
Bots, M.L., Witteman, J.C.M., Hofman, A., de Jong, P.T. and Grobbe, D.E. (1996) Low Diastolic Blood Pressure and Atherosclerosis in Elderly Subjects: The Rotterdam Study. Archives of Internal Medicine, 156, 843-848. https://doi.org/10.1001/archinte.1996.00440080029004
Franklin, S.S., Sutton-Tyrrell, K., Belle, S.H., Weber, M.A. and Kuller, L.H. (1997) The Importance of Pulsatile Components of Hypertension in Predicting Carotid Stenosis in Older Adults. Journal of Hypertension, 15, 1143-1150. https://doi.org/10.1097/00004872-199715100-00012
James, M.A., Watt, P.A.C., Potter, J.F., Thurston, H. and Swales, J.D. (1995) Pulse Pressure and Resistance Artery Structure in the Elderly. Hypertension, 26, 301-306. https://doi.org/10.1161/01.HYP.26.2.301
Khattar, R.S., Acharya, D.U., Kinsey, C., Senior, R. and Lahiri, A. (1997) Longitudinal Association of Ambulatory Pulse Pressure with Left Ventricular Mass and Vascular Hypertrophy in Essential Hypertension. Journal of Hypertension, 15, 737-743. https://journals.lww.com/jhypertension/Fulltext/1997/15070/Longitudinal_association_of_ambulatory_pulse.5.aspx
Lassila, H.C., Tyrrell, K.S., Matthews, K.A., Wolfson, S.K. and Kuller, L.H. (1997) Prevalence and Determinants of Carotid Atherosclerosis in Healthy Postmenopausal Women. Stroke, 28, 513-517. https://doi.org/10.1161/01.STR.28.3.513
Nielsen, W.B., Lindenstrøm, E., Vestbo, J. and Jensen, G.B. (1997) Is Diastolic Hypertension an Independent Risk Factor for Stroke in the Presence of Normal Systolic Blood Pressure in the Middle-aged and Elderly? American Journal of Hypertension, 10, 634-639. https://doi.org/10.1016/S0895-7061(96)00505-5
Suurküla, M., Agewall, S., Fagerberg, B., Wendelhag, I., Widgren, B. and Wikstrand, J. (1994) Ultrasound Evaluation of Atherosclerotic Manifestations in the Carotid Artery in High-Risk Hypertensive Patients. Risk Intervention Study (RIS) Group. Arteriosclerosis and Thrombosis: A Journal of Vascular Biology, 14, 1297-1304. https://doi.org/10.1161/01.ATV.14.8.1297
Thorin-Trescases, N., de Montgolfier, O., Pinçon, A., Raignault, A., Caland, L., Labbé, P., et al. (2018) Impact of Pulse Pressure on Cerebrovascular Events Leading to Age-Related Cognitive Decline. American Journal of Physiology-Heart and Circulatory Physiology, 314, H1214-H1224. https://doi.org/10.1152/ajpheart.00637.2017
Heistad, D.D. (2001) What’s New in the Cerebral Microcirculation? Microcirculation, 8, 66-75. https://doi.org/10.1111/j.1549-8719.2001.tb00184.x
Elmståhl, S., Ellström, K., Siennicki-Lantz, A. and Abul-Kasim, K. (2019) Association between Cerebral Microbleeds and Hypertension in the Swedish General Population “Good Aging in Skåne” Study. The Journal of Clinical Hypertension, 21, 1099-1107. https://onlinelibrary.wiley.com/doi/abs/10.1111/jch.13606
Lyu, L., Shen, J., Zeng, C., Ji, J., Hu, W., Wei, T., et al. (2020) Cerebral Microbleeds Are Associated with Blood Pressure Levels in Individuals with Hypertension. Clinical and Experimental Hypertension, 42, 328-334. https://doi.org/10.1080/10641963.2019.1665673
Van Bortel, L.M.A.B., Struijker-Boudier, H.A.J. and Safar, M.E. (2001) Pulse Pressure, Arterial Stiffness, and Drug Treatment of Hypertension. Hypertension, 38, 914-921. https://doi.org/10.1161/hy1001.095773
Unger, T., Borghi, C., Charchar, F., Khan, N.A., Poulter, N.R., Prabhakaran, D., et al. (2020) 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75, 1334-1357. https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.120.15026
Safar, M.E., St Laurent, S., Safavian, A.L., Pannier, B.M. and London, G.M. (1987) Pulse Pressure in Sustained Essential Hypertension: A Haemodynamic Study. Journal of Hypertension, 5, 213-218. https://doi.org/10.1097/00004872-198704000-00013
Asmar, R., Vol, S., Brisac, A.M., Tichet, J. and Topouchian, J. (2001) Reference Values for Clinic Pulse Pressure in a Nonselected Population. American Journal of Hypertension, 14, 415-418. https://doi.org/10.1016/S0895-7061(01)01284-5
Park, J.-H., Lee, J., Kwon, S.U., Kwon, H.S., Lee, M.H. and Kang, D.-W. (2022) Elevated Pulse Pressure and Recurrent Hemorrhagic Stroke Risk in Stroke with Cerebral Microbleeds or Intracerebral Hemorrhage. Journal of the American Heart Association, 11, e022317. https://doi.org/10.1161/JAHA.121.022317
Ding, J., Sigurdsson, S., Garcia, M., Phillips, C.L., Eiriksdottir, G., et al. (2015) Risk Factors Associated with Incident Cerebral Microbleeds According to Location in Older People: The Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study. JAMA Neurology, 72, 682-688. https://doi.org/10.1001/jamaneurol.2015.0174
Su, N., Zhai, F.-F., Zhou, L.-X., Ni, J., Yao, M., Li, M.-L., et al. (2017) Cerebral Small Vessel Disease Burden Is Associated with Motor Performance of Lower and Upper Extremities in Community-Dwelling Populations. Frontiers in Aging Neuroscience, 9, Article 313. https://doi.org/10.3389/fnagi.2017.00313
Hou, Y., Li, Y., Yang, S., Qin, W., Yang, L. and Hu, W. (2021) Gait Impairment and Upper Extremity Disturbance Are Associated with Total Magnetic Resonance Imaging Cerebral Small Vessel Disease Burden. Frontiers in Aging Neuroscience, 13, Article 640844. https://doi.org/10.3389/fnagi.2021.640844
Hou, Y., Yang, S., Li, Y., Qin, W., Yang, L. and Hu, W. (2022) Impact of Cerebral Microbleeds on Lower and Upper Extremities Function in Cerebral Small Vessel Disease. Preprint. https://www.researchsquare.com/article/rs-1868697/v1