The Role of Brachial Pulse Pressure as an Indicator of Intracranial Atherosclerosis: The Atahualpa Project
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ORIGINAL ARTICLE
The Role of Brachial Pulse Pressure as an Indicator of Intracranial Atherosclerosis: The Atahualpa Project Oscar H. Del Brutto1 • Robertino M. Mera2 • For the Atahualpa Project Investigators
Received: 24 May 2017 / Accepted: 14 August 2017 / Published online: 23 August 2017 Ó Springer International Publishing AG 2017
Abstract Introduction Carotid siphon calcifications (CSC) are an important imaging marker of systemic atherosclerosis. Routine assessment of asymptomatic CSC may allow the implementation of intervention strategies before catastrophic cerebrovascular events occur. Aim To assess whether brachial PP determinations might independently predicts the presence and severity of CSC in community-dwelling adults. Methods All Atahualpa residents aged C40 years were invited for the practice of a non-enhanced CT scan of the head, and those who signed the informed consent and had no contraindications for this exam were enrolled. The brachial PP was calculated by subtracting the mean diastolic pressure from the mean systolic pressure obtained from three different readings with individuals in the sitting position. Results Of 830 eligible candidates, 663 (80%) were included. The mean brachial PP was 56.4 ± 19.9 mmHg; 182 persons (27.4%) had PP levels [65 mmHg. CT revealed Grade 1 CSC in 356 (54%), Grade 2 in 141 (21%), Grade 3 in 128 (19%), and Grade 4 in 38 (6%) subjects. Predictive margins of PP (delta method) were significantly lower in individuals with Grade 1 CSC than in the other groups. In the best adjusted linear model, PP levels increased up to 11.7 mmHg as the severity of CSC increased (b 11.71; 95% C.I. 5.36–18.08: p \ 0.001). & Oscar H. Del Brutto [email protected] 1
School of Medicine, Universidad Espı´ritu Santo – Ecuador, Guayaquil, Ecuador, Air Center 3542, PO Box 522970, Miami, FL 33152-2970, USA
2
Vanderbilt University Medical Center, Nashville, TN, USA
Conclusion This study provides evidence on the relationship between brachial PP levels and intracranial atherosclerosis. Calculation of the PP may be used for detecting candidates for CT screening, reducing costs during population-based surveys, particularly in remote areas. Keywords: Pulse pressure Carotid siphon calcifications Intracranial atherosclerosis Population-based study Atahualpa Project
1 Introduction Carotid siphon calcifications (CSC) have received little attention in the literature and their clinical relevance have been underestimated. While not all studies have found a correlation between the presence of high calcium content in the carotid siphon and intracranial artery stenosis, there is increasing evidence linking CSC with severe neurological complications, including stroke and cognitive decline [1–3]. In addition, CSC might be an important imaging marker of systemic atherosclerosis [4]. Other studies have found a significant association between CSC and neuroimaging signatures of cerebral small vessel disease, a major pathogenetic mechanism underlying lacunar infarcts, deep cerebral microbleeds, an
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