Determinants of visit-to-visit variability in blood pressure and the related risks of stroke and dementia.
Award Number
G1000372Award Type
FellowshipStatus / Stage
CompletedDates
21 January 2011 -7 August 2013
Duration (calculated)
02 years 06 monthsFunder(s)
MRC (UKRI)Funding Amount
£198,480.00Funder/Grant study page
MRC UKRIContracted Centre
University of OxfordPrincipal Investigator
Dr Webb, AlastairPI Contact
alastair.webb@ndcn.ox.ac.ukWHO Catergories
Tools and methodologies for interventionsUnderstanding risk factors
Disease Type
Vascular Dementia (VD)CPEC Review Info
| Reference ID | 275 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | G1000372 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20110121 |
| End Date | 20130807 |
| Duration (calculated) | 02 years 06 months |
| Funder/Grant study page | MRC UKRI |
| Contracted Centre | University of Oxford |
| Funding Amount | £198,480.00 |
Abstract
Prospective cohort study, nested in a population-based cohort of all patients post-TIA or stroke (Oxford Vascular Study – OXVASC). Methodology: 500 consecutive well-phenotyped patients with TIA/stroke who already undergo remote Bluetooth home monitoring of BP (3 measures, 3 times daily) for 1-6 months (depending on control), 24-hour ambulatory BP monitoring (baseline and one-year), brain imaging (baseline MRI), and face-to-face clinical follow-up, with detailed documentation of any recurrent vascular events or cognitive decline. This extremely well-phenotyped cohort, with detailed BP monitoring and follow-up already in place, will provide a unique opportunity for me to better understand the physiology underlying visit-to-visit variability in BP. Specifically, I will assess postural variability in BP, spontaneous baroreceptor sensitivity, aortic pressure, arterial stiffness, central neural sympathetic BP responsiveness, BP response to vasodilatation and middle cerebral artery stiffness. I will relate these to clinical characteristics, brain imaging (including infarct location and white matter disease), and subsequent outcome. Opportunities: Professor Rothwell‘s group has recently demonstrated that visit-to-visit BP variability is a powerful new risk factor for stroke and vascular dementia, independent of mean BP, and that different classes of BP-lowering drugs have different effects on variability. These results challenge the usual BP hypothesis and have major implications for the diagnosis, treatment and monitoring of hypertension. However, more work is required in order to better understand the physiology underlying vit-to-visit variability in clinic BP and to find simple physiological tests that might identify individuals prone to variable BP. The group is well placed to do this by combining expertise in epidemiology and stroke with the expertise in hypertension and cardiovascular physiology of colleagues (Casadei and Leeson) in the Department of Cardiovascular Medicine, where the vascular lab has a track record in large scale physiology studies. The availability of detailed premorbid BP records and intensive post-event home and ambulatory BP monitoring in the OXVASC Study patients with TIA and stroke also affords the unique opportunity to determine the clinical, brain imaging and physiological correlates of visit-to-visit, day-to-day, and ambulatory variability in BP, and to relate these parameters to the risk of stroke and vascular dementia during the detailed OXVASC follow-up.
Aims
Determine the clinical, brain imaging and physiological correlates of visit-to-visit variability in blood pressure (BP) in patients with recent TIA or minor stroke, and which individual physiological tests or combinations best account for its prognostic value in relation to the risks of recurrent stroke and vascular dementia.