Past antihypertensive medication use is associated with lower levels of small vessel disease and lower Aβ plaque stage in the brains of older individuals.

IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Neuropathology and Applied Neurobiology Pub Date : 2023-08-01 DOI:10.1111/nan.12922
Andrew J Affleck, Perminder S Sachdev, Glenda M Halliday
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Abstract

Aims: This study assesses the association of antihypertensive medication use on the severities of neuropathological cerebrovascular disease (CVD excluding lobar infarction) in older individuals.

Methods: Clinical and neuropathological data were retrieved for 149 autopsy cases >75 years old with or without CVD or Alzheimer's disease and no other neuropathological diagnoses. Clinical data included hypertension status, hypertension diagnosis, antihypertensive medication use, antihypertensive medication dose (where available) and clinical dementia rating (CDR). Neuropathological CVD severity was evaluated for differences with anti-hypertensive medication usage.

Results: Antihypertensive medication use was associated with less severe white matter small vessel disease (SVD, mainly perivascular dilatation and rarefaction), with a 5.6-14.4 times greater likelihood of less severe SVD if medicated. No significant relationship was detected between infarction (presence, type, number and size), lacunes or cerebral amyloid angiopathy and antihypertensive medication use. Only increased white matter rarefaction/oedema and not perivascular dilation was associated with Alzheimer's pathology, with a 4.3 times greater likelihood of reduced Aβ progression through the brain if white matter rarefaction severity was none or mild. Antihypertensive medication use was associated with reduced Aβ progression but only in those with moderate to severe white matter SVD.

Conclusions: This histopathological study provides further evidence that antihypertensive medication use in older individuals is associated with white matter SVD and not with other CVD pathologies. This is mainly due to a reduction in white matter perivascular dilation and rarefaction/oedema. Even in those with moderate to severe white matter SVD, antihypertensive medication use reduced rarefaction and Aβ propagation through the brain.

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既往服用降压药与老年人大脑中较低程度的小血管疾病和较低的 Aβ 斑块阶段有关。
目的:本研究评估了抗高血压药物的使用与老年人神经病理学脑血管疾病(CVD,不包括脑叶梗死)严重程度的关系:检索了 149 例 75 岁以上尸检病例的临床和神经病理学数据,这些病例无论是否患有心血管疾病或阿尔茨海默病,均无其他神经病理学诊断。临床数据包括高血压状态、高血压诊断、降压药使用情况、降压药剂量(如有)和临床痴呆评级(CDR)。评估神经病理学心血管疾病严重程度与抗高血压药物使用情况的差异:结果:使用降压药与较轻的白质小血管疾病(SVD,主要是血管周围扩张和稀疏)有关,如果使用降压药,较轻的 SVD 的可能性是使用降压药的 5.6-14.4 倍。在脑梗塞(存在、类型、数量和大小)、脑裂或脑淀粉样血管病与服用降压药之间没有发现明显的关系。只有白质稀疏/水肿的增加而非血管周围扩张与阿尔茨海默氏症的病理变化有关,如果白质稀疏的严重程度为无或轻度,Aβ在大脑中的进展减少的可能性要高出4.3倍。抗高血压药物的使用与Aβ进展的减少有关,但仅适用于中度至重度白质稀疏的患者:这项组织病理学研究进一步证明,老年人服用降压药与白质 SVD 相关,而与其他心血管病变无关。这主要是由于白质血管周围扩张和稀释/水肿的减少。即使是那些患有中度至重度白质损伤的患者,服用降压药也会减少稀释和 Aβ 在大脑中的传播。
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来源期刊
CiteScore
8.20
自引率
2.00%
发文量
87
审稿时长
6-12 weeks
期刊介绍: Neuropathology and Applied Neurobiology is an international journal for the publication of original papers, both clinical and experimental, on problems and pathological processes in neuropathology and muscle disease. Established in 1974, this reputable and well respected journal is an international journal sponsored by the British Neuropathological Society, one of the world leading societies for Neuropathology, pioneering research and scientific endeavour with a global membership base. Additionally members of the British Neuropathological Society get 50% off the cost of print colour on acceptance of their article.
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