Hypertension, Vol 23, 565-568, Copyright © 1994 by American Heart Association
K Matsushita, Y Kuriyama, K Nagatsuka, M Nakamura, T Sawada and T Omae
The goal of this study was to elucidate the association between the
development of periventricular white matter lucency and autoregulation of
cerebral blood flow in hypertensive patients through the arteriovenous
oxygen saturation difference method. We studied 51 hypertensive patients
who had previously suffered from minor strokes (lacunar infarction, 43;
deep basal minor hemorrhage, 8). Patients were divided into three groups
based on the findings of periventricular white matter lucency. We measured
the absolute value of resting cerebral blood flow using the argon
inhalation method, and stepwise reduction of blood pressure was obtained
with patients on a tilting table. Intracerebral venous blood sampling was
accomplished by direct cannulation into the jugular vein up to the jugular
bulb. We calculated several cerebral circulatory parameters, such as
cerebrovascular resistance and cerebral oxygen consumption, and also
delineated individual autoregulation curves. Cerebrovascular resistance was
significantly greater in patients with severe periventricular white matter
lucency than in patients without it (P < .05). Impaired autoregulation
was also significantly more prevalent in patients with more severe
periventricular lesions (P < .05). Multiple regression analysis revealed
that the impaired autoregulation was significant and an independent
determinant of the severity of such periventricular lesions (R = .34, P
< .05). In conclusion, our findings indicated that hypertensive patients
with severe periventricular white matter lucency were more likely to have
impaired autoregulation of cerebral blood flow and suggest that stricter
blood pressure control is required in such patients to prevent
deterioration of the cerebral microcirculation.
ARTICLES
Periventricular white matter lucency and cerebral blood flow autoregulation in hypertensive patients
First Department of Internal Medicine, Osaka University Medical School, Japan.
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