Intensive Antihypertensive Treatment and Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis of Randomised Clinical Trials.

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

European Neurology Pub Date : 2025-07-26 DOI:10.1159/000547434

Ziwei Liao, Liping Cheng, Yining Wang, Yanjuan Yang, Xiaoxian Lv, Ping Gu

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引用次数: 0

Abstract

Introduction: Hypertension is a significant risk factor for the development of cerebral small vessel disease (SVD). This study was performed to evaluate the impact of intensive antihypertensive treatment on the progression of imaging markers and cognitive function of SVD.

Methods: Two independent reviewers searched for randomised controlled trials (RCTs) that investigated the associations between intensive antihypertensive treatment and the progression of imaging markers of SVD, including white matter hyperintensities (WMHs), brain atrophy, lacunes, or microbleeds and cognitive function scores. Fixed-effects models were used to pool the data for WMHs, brain atrophy, and severe adverse events, whereas cognitive function scores were synthesised with a random-effects model and were measured as standardised mean differences (SMDs) and odds ratios (ORs).

Results: A total of 8 RCTs were included in this meta-analysis, involving 2,891 participants with a follow-up period of 24 to 49 months. Compared with standard blood pressure treatment, intensive antihypertensive treatment was observed to be more effective at delaying WMH progression (SMD = -0.33, 95% CI: -0.44, -0.21) but was associated with greater brain volume loss (SMD = 4.06, 95% CI: 1.97, 6.15). No increased risk of incident lacunes (OR = 1.11, 95% CI: 0.57, 2.19) or significant association with cognitive function changes (SMD = -0.08, 95% CI: -0.23, 0.06) was observed. However, the pooled analysis of cerebral microbleeds was limited by the small number of eligible studies included in this meta-analysis.

Conclusion: Antihypertensive treatment (particularly intensive therapy) is associated with reductions in the progression of WMH volume and total brain volume. However, no significant association was observed between antihypertensive therapy and either the incidence of new lacunes or changes in cognitive function.

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强化降压治疗与脑血管疾病：随机临床试验的系统回顾和荟萃分析

背景与目的高血压是脑血管病（SVD）发生的重要危险因素。本研究旨在评估强化降压治疗对SVD影像学指标进展和认知功能的影响。方法两名独立评论者检索了随机对照试验（RCTs），这些试验调查了强化降压治疗与SVD成像标志物进展之间的关系，包括白质高信号（WMHs）、脑萎缩、腔隙或微出血和认知功能评分。固定效应模型用于汇总WMHs、脑萎缩和严重不良事件的数据，而认知功能评分则使用随机效应模型合成，并以标准化平均差异（SMDs）和优势比（ORs）进行测量。结果本荟萃分析共纳入8项随机对照试验，涉及2,891名参与者，随访时间为24 ~ 49个月。与标准降压治疗相比，强化降压治疗在延缓WMH进展方面更有效（SMD = -0.33, 95% CI: -0.44, -0.21），但与更大的脑容量损失相关（SMD = 4.06, 95% CI: 1.97 6.15）。没有观察到发生腔隙的风险增加（优势比[OR] = 1.11, 95% CI: 0.57 2.19）或与认知功能改变的显著关联（SMD = -0.08, 95% CI: -0.23 0.06）。然而，本荟萃分析中纳入的符合条件的研究数量较少，限制了脑微出血的汇总分析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Neurology 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

审稿时长

4-8 weeks

期刊介绍： ''European Neurology'' publishes original papers, reviews and letters to the editor. Papers presented in this journal cover clinical aspects of diseases of the nervous system and muscles, as well as their neuropathological, biochemical, and electrophysiological basis. New diagnostic probes, pharmacological and surgical treatments are evaluated from clinical evidence and basic investigative studies. The journal also features original works and reviews on the history of neurology.