1) Smith EE, Saposnik G, Biessels GJ, Doubal FN, Fornage
M, Gorelick PB, Greenberg SM, Higashida RT, Kasner
SE, Seshadri S: American Heart Association Stroke
Council; Council on Cardiovascular Radiology and
Intervention; Council on Functional Genomics and
Translational Biology; and Council on Hypertension.
Prevention of Stroke in Patients With Silent
Cerebrovascular Disease: A Scientific Statement for
Healthcare Professionals From the American Heart
Association/American Stroke Association. Stroke, 2017;
48: e44-e71
2) Klarenbeek P, van Oostenbrugge RJ, Rouhl RP,
Knottnerus IL, Staals J: Ambulatory blood pressure in
patients with lacunar stroke: association with total MRI
burden of cerebral small vessel disease. Stroke, 2013; 44:
2995-2999
3) Darne B, Girerd X, Safar M, Cambien F, Guize L:
Pulsatile versus steady component of blood pressure: a
cross-sectional analysis and a prospective analysis on
cardiovascular mortality. Hypertension, 1989; 13: 392400
4) Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K,
Advance Publication Journal of Atherosclerosis and Thrombosis
Accepted for publication: November 9, 2020 Published online: January 22, 2021
Salman et al .
Obara T, Hoshi H, Hashimoto J, Totsune K, Satoh H,
Kondo Y, Imai Y: Predicting stroke using 4 ambulatory
blood pressure monitoring-derived blood pressure indices:
the Ohasama Study. Hypertension, 2006; 48: 877-882
5) Miura K, Nakagawa H, Ohashi Y, Harada A, Taguri M,
Kushiro T, Takahashi A, Nishinaga M, Soejima H,
Ueshima H; Japan Arteriosclerosis Longitudinal Study
(JALS) Group: Four blood pressure indexes and the risk
of stroke and myocardial infarction in Japanese men and
women: a meta-analysis of 16 cohort studies. Circulation,
2009; 119: 1892-1898
6) Lawes CM, Bennett DA, Parag V, Woodward M,
Whitlock G, Lam TH, Suh I, Rodgers A: Asia Pacific
Cohort Studies Collaboration. Blood pressure indices and
cardiovascular disease in the Asia Pacific region: a pooled
analysis. Hypertension, 2003; 42: 69-75
7) Miura K, Dyer AR, Greenland P, Daviglus ML, Hill M,
Liu K, Garside DB, Stamler J; Chicago Heart Association:
Pulse pressure compared with other blood pressure
indexes in the prediction of 25-year cardiovascular and
all-cause mortality rates: The Chicago Heart Association
Detection Project in Industry Study. Hypertension, 2001;
38: 232-237
8) Verhaaren BF, Vernooij MW, de Boer R, Hofman A,
Niessen WJ, van der Lugt A, Ikram MA: High blood
pressure and cerebral white matter lesion progression in
the general population. Hypertension, 2013; 61: 13541359
9) Guo X, Pantoni L, Simoni M, Bengtsson C, Björkelund
C, Lissner L, Gustafson D, Skoog I: Blood pressure
components and changes in relation to white matter
lesions: a 32-year prospective population study.
Hypertension, 2009; 54: 57-62
10) Chen CT, Li Y, Zhang J, Wang Y, Ling HW, Chen KM,
Gao PJ, Zhu DL: Association between ambulatory
systolic blood pressure during the day and asymptomatic
intracranial arterial stenosis. Hypertension, 2014; 63:
61-67
11) Gutierrez J, Elkind MS, Cheung K, Rundek T, Sacco RL,
Wright CB: Pulsatile and steady components of blood
pressure and subclinical cerebrovascular disease: the
Northern Manhattan Study. J Hypertens, 2015; 33:
2115-2122
12) Satoh A, Arima H, Hozawa A, Ohkubo T, Hisamatsu T,
Kadowaki S, Kadota A, Fujiyoshi A, Miyagawa N, Zaid
M, Torii S, Okamura T, Sekikawa A, Miura K, Ueshima
H; SESSA Research Group: The association of home and
accurately measured office blood pressure with coronary
artery calcification among general Japanese men. J
Hypertens, 2019; 37: 1676-1681
13) Shitara S, Fujiyoshi A, Hisamatsu T, Torii S, Suzuki S, Ito
T, Arima H, Shiino A, Nozaki K, Miura K, Ueshima H;
SESSA Research group: Intracranial Artery Stenosis and
Its Association with Conventional Risk Factors in a
General Population of Japanese Men. Stroke, 2019; 50:
2967-2969
14) Pantoni L: Cerebral small vessel disease: from
pathogenesis and clinical characteristics to therapeutic
challenges. Lancet Neurol, 2010; 9: 689-701
15) Blanco PJ, Müller LO, Spence JD: Blood pressure
gradients in cerebral arteries: a clue to pathogenesis of
10
cerebral small vessel disease. Stroke Vasc Neurol, 2017; 2:
108-117
16) Seto-Yukimura R, Ogawa E, Hisamatsu T, Torii S, Shiino
A, Nozaki K, Fujiyoshi A, Miura K, Nakano Y, Ueshima
H; SESSA Research Group: Reduced Lung Function and
Cerebral Small Vessel Disease in Japanese Men: the Shiga
Epidemiological Study of Subclinical Atherosclerosis
(SESSA). J Atheroscler Thromb, 2018; 25: 1009-1021
17) Kashiwagi A, Kasuga M, Araki E, Oka Y, Hanafusa T, Ito
H: International clinical Harmonization of glycated
hemoglobin in Japan; From Japan Diabetes Society to
National Glycohemoglobin Standardization Program
values. J Diabetes Investig, 2012; 3: 39-40
18) Hisamatsu T, Miura K, Ohkubo T, Arima H, Fujiyoshi A,
Satoh A, Kadota A, Zaid M, Takashima N, Ohno S,
Horie M, Ueshima H; SESSA Research Group: Home
blood pressure variability and subclinical atherosclerosis
in multiple vascular beds: a population-based study. J
Hypertens, 2018; 36: 2193-2203
19) Khan MMH, Fujiyoshi A, Shiino A, Hisamatsu T, Torii S,
Suzuki S, Kunimura A, Segawa H, Kadota A, Ohkubo T,
Nozaki K, Miura K, Ueshima H; SESSA Research Group:
The Association Between Coronary Artery Calcification
and Subclinical Cerebrovascular Diseases in Men: An
Observational Study. J Atheroscler Thromb, 2020; 27:
995-1009
20) Shinohara Y, Tohgi H, Hirai S, Terashi A, Fukuuchi Y,
Yamaguchi T, Okudera T: Effect of the Ca antagonist
nilvadipine on stroke occurrence or recurrence and
extension of asymptomatic cerebral infarction in
hypertensive patients with or without history of stroke
(PICA Study). 1. Design and results at enrollment.
Cerebrovasc Dis, 2007; 24: 202-209
21) A new guideline making committee of a brain dock. Brain
MRI examination. In: Japanese Society for Detection of
Asymptomatic Brain Disease, ed. Braindock Guideline
2014 [in Japanese]. 4th ed. Tokyo, Japan: Kyobunsha;
2014. pp38-47
22) Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman
RA: MR signal abnormalities at 1.5 T in Alzheimer’s
dementia and normal aging. AJR Am J Roentgenol, 1987;
149: 351-356
23) Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz
MI: A standardized method for measuring intracranial
arterial stenosis. AJNR Am J Neuroradiol, 2000; 21: 643646
24) Staals J, Makin SD, Doubal FN, Dennis MS, Wardlaw
JM: Stroke subtype, vascular risk factors, and total MRI
brain small-vessel disease burden. Neurology, 2014; 83:
1228-1234
25) Henskens LH, van Oostenbrugge RJ, Kroon AA, de
Leeuw PW, Lodder J: Brain microbleeds are associated
with ambulatory blood pressure levels in a hypertensive
population. Hypertension, 2008; 51: 62-68
26) Yubi T, Hata J, Ohara T, Mukai N, Hirakawa Y, Yoshida
D, Gotoh S, Hirabayashi N, Furuta Y, Ago T, Kitazono T,
Kiyohara Y, Ninomiya T: Prevalence of and risk factors
for cerebral microbleeds in a general Japanese elderly
community. Neurol Clin Pract, 2018; 8: 223-231
27) Park JH, Ovbiagele B, Hong KS, Kwon SU: Association
of Systolic Blood Pressure with Progression of
Advance Publication Journal of Atherosclerosis and Thrombosis
Accepted for publication: November 9, 2020 Published online: January 22, 2021
BP Indexes and Cerebrovascular Disease
Symptomatic Intracranial Atherosclerotic Stenosis. J
Stroke, 2017; 19: 304-311
28) Wang D, Wang C, Zhou Y, Wang A, Gao X, Wu S, Zhao
X: Different blood pressure indexes on intracranial arterial
stenosis in Asymptomatic Polyvascular Abnormalities in
Community study in China. J Hypertens, 2015; 33:
1452-1457
29) Hara A, Tanaka K, Ohkubo T, Kondo T, Kikuya M,
Metoki H, Hashimoto T, Satoh M, Inoue R, Asayama K,
Obara T, Hirose T, Izumi S, Satoh H, Imai Y: Ambulatory
versus home versus clinic blood pressure: the association
with subclinical cerebrovascular diseases: The Ohasama
Study. Hypertension, 2012; 59: 22-28
30) Abraham HM, Wolfson L, Moscufo N, Guttmann CR,
Kaplan RF, White WB: Cardiovascular risk factors and
small vessel disease of the brain: Blood pressure, white
matter lesions, and functional decline in older persons. J
Cereb Blood Flow Metab, 2016; 36: 132-142
31) Regenhardt RW, Das AS, Lo EH, Caplan LR: Advances
in Understanding the Pathophysiology of Lacunar Stroke:
A Review. JAMA Neurol, 2018; 75: 1273-1281
32) Ungvari Z, Tarantini S, Kirkpatrick AC, Csiszar A,
Prodan CI: Cerebral microhemorrhages: mechnaisms,
consequences, and prevention. Am J Physiol Heart Circ
Physiol, 2017; 312: H1128-H1143
33) Yang S, Yuan J, Qin W, Yang L, Fan H, Li Y, Hu W:
Twenty-four-hour ambulatory blood pressure variability is
associated with total magnetic resonance imaging burden
of cerebral small-vessel disease. Clin Interv Aging, 2018;
13: 1419-1427
Advance Publication Journal of Atherosclerosis and Thrombosis
Accepted for publication: November 9, 2020 Published online: January 22, 2021
11
Salman et al .
$ /DFXQDULQIDUFWLRQ
' 0LFUREOHHGV
25 &,
P YDOXH
25 &,
P YDOXH
6%39
6%39
6%39
6%39
'%39
'%39
'%39
'%39
339
339
339
339
0$39
0$39
0$39
0$39
% 3HULYHQWULFXODUK\SHULQWHQVLW\
25 &,
P YDOXH
6%39
6%39
'%39
'%39
339
339
0$39
0$39
( ,QWUDFUDQLDODUWHU\VWHQRVLV
25 &,
P YDOXH
6%39
6%39
'%39
'%39
339
339
0$39
0$39
& 'HHSVXEFRUWLFDOZKLWHPDWWHUK\SHULQWHQVLW\
25 &,
P YDOXH
6%39
6%39
'%39
'%39
339
339
0$39
0$39
Supplemental Fig. 1. Sensitivity analysis of adjusted odds ratio for the presence of MRI outcomes per 1-SD higher office BP
indexes in Visits 1 [V1 = 443] (aged 40–80) and 2 [V2 = 390] (aged 46–83) after the exclusion of participants
receiving hypertension medication
The variables adjusted in the multivariable model in Visits 1 and 2 are age, BMI, HbA1c, LDL-C, HDL-C, smoking status, drinking status,
diabetes mellitus medication, and dyslipidemia medication. V1, Visit 1; V2, Visit 2; OR, odds ratio; SBP, systolic blood pressure; DBP,
diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure
12
Advance Publication Journal of Atherosclerosis and Thrombosis
Accepted for publication: November 9, 2020 Published online: January 22, 2021
BP Indexes and Cerebrovascular Disease
$ /DFXQDULQIDUFWLRQ
' 0LFUREOHHGV
25 &,
P YDOXH
25 &,
P YDOXH
6%39
6%39
6%39
6%39
'%39
'%39
'%39
'%39
339
339
339
339
0$39
0$39
0$39
0$39
% 3HULYHQWULFXODUK\SHULQWHQVLW\
25 &,
P YDOXH
( ,QWUDFUDQLDODUWHU\VWHQRVLV
25 &,
6%39
6%39
'%39
'%39
339
339
0$39
0$39
P YDOXH
6%39
6%39
'%39
'%39
339
339
0$39
0$39
& 'HHSVXEFRUWLFDOZKLWHPDWWHUK\SHULQWHQVLW\
25 &,
P YDOXH
6%39
6%39
'%39
'%39
339
339
0$39
0$39
Supplemental Fig. 2. Multivariable adjusted odds ratio for the presence of MRI outcomes per 1-SD higher home BP indexes of
616 men in Visits 1 (aged 40–80) and 2 (aged 46–83)
The variables adjusted in the multivariable model in Visits 1 and 2 are age, BMI, HbA1c, LDL-C, HDL-C, smoking status, drinking status,
hypertension medication, diabetes mellitus medication, and dyslipidemia medication. V1, Visit 1; V2, Visit 2; OR, odds ratio; SBP, systolic
blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure
Advance Publication Journal of Atherosclerosis and Thrombosis
Accepted for publication: November 9, 2020 Published online: January 22, 2021
13
Salman et al .
Supplemental Table 1. Frequency of participants in each score value of
the total small vessel disease score (N = 616)
SVD Score
n (%)
346 (56.2)
137 (22.3)
76 (12.3)
42 (6.8)
15 (2.4)
Values are presented as number (percentage)
SVD, small vessel disease
Supplemental Table 2. Univariable and multivariable ordinal logistic regression for the relationship of 1-SD
office BP indexes and total small vessel disease score (N = 616)
Total SVD score
SBP
V1
V2
DBP
V1
V2
PP
V1
V2
MAP
V1
V2
OR (95% CI)
P value
OR (95% CI)
P value
OR (95% CI)
P value
OR (95% CI)
P value
OR (95% CI)
P value
OR (95% CI)
P value
OR (95% CI)
P value
OR (95% CI)
P value
Univariable model
Multivariable model
1.52 (1.30 - 1.78)
< 0.001
1.44 (1.23 - 1.67)
< 0.001
1.32 (1.14 - 1.54)
0.001
1.11 (0.95 - 1.29)
0.177
1.42 (1.22 - 1.65)
< 0.001
1.48 (1.27 - 1.72)
< 0.001
1.45 (1.24 - 1.69)
< 0.001
1.27 (1.09 - 1.48)
0.002
1.34 (1.13 - 1.57)
0.001
1.33 (1.13 - 1.56)
0.001
1.41 (1.19 - 1.66)
< 0.001
1.34 (1.13 - 1.58)
0.001
1.14 (0.96 - 1.35)
0.142
1.20 (1.01 - 1.42)
0.038
1.40 (1.19 - 1.65)
< 0.001
1.36 (1.16 - 1.60)
0.001
The variables adjusted in the multivariable model in Visit 1 and Visit 2 are age, BMI, HbA1c, LDL-C, HDL-C, smoking status,
drinking status, hypertension medication, diabetes mellitus medication, and dyslipidemia medication.
SVD, small vessel disease; V1, Visit 1; V2, Visit 2; OR, odds ratio; SBP, systolic blood pressure; DBP, diastolic blood
pressure; PP, pulse pressure; MAP, mean arterial pressure
14
Advance Publication Journal of Atherosclerosis and Thrombosis
Accepted for publication: November 9, 2020 Published online: January 22, 2021
...