• Pim Klarenbeek, Robert J van Oostenbrugge, Rob P W Rouhl, Iris L H Knottnerus, and Julie Staals.
• From the Department of Neurology (P.K., R.J.v.O., R.P.W.R., I.L.H.K., J.S.), and Cardiovascular Research Institute Maastricht (CARIM) (R.J.v.O., J.S.), Maastricht University Medical Centre, Maastricht, The Netherlands.
• Stroke. 2013 Nov 1;44(11):2995-9.

Background And PurposeAsymptomatic lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces are MRI markers of cerebral small vessel disease (cSVD). Higher blood pressure (BP) levels are associated with the presence of these markers separately, but the association with the total burden of cSVD on brain MRI, expressed by the simultaneous presence of multiple markers of cSVD (a compound score), has not been investigated.MethodsWe performed 24-hour ambulatory BP monitoring in 122 patients with first-ever lacunar stroke. On brain MRI, we scored the presence of each marker of cSVD. One point was awarded for the presence of each marker, producing a score between 0 and 4. Associations with BP levels were tested with ordinal regression analyses.ResultsEighteen (15%) patients had no markers of cSVD, and 6 (5%) patients had 4 markers. Most patients (45; 37%) had 2 different markers. After correction for age and sex, higher 24-hour, day, and night systolic (24-hour odds ratio, 1.25; 95% confidence interval, 1.02-1.52 per 10 mm Hg) and diastolic (24-hour odds ratio, 1.32; 95% confidence interval, 1.12-1.56 per 5 mm Hg) BP were all significantly associated with an increasing total burden of cSVD.ConclusionsWe found a positive association of ambulatory BP levels with total burden of cSVD on brain MRI. With increasing BP levels, there is a piling up of damage in the brain. We suggest that further cSVD studies also consider viewing the total burden in addition to each of the MRI markers separately.

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