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Hypothesis We hypothesized that P wave terminal Force in the V1 lead (PTFV1) would be associated with leukoaraiosis and subclinical infarcts, especially cortical infarcts, in a population-based, multi-ethnic cohort. Methods PTFV1 was collected manually from baseline electrocardiograms of clinically stroke-free Northern Manhattan Study participants. Investigators read brain MRIs for superficial infarcts, deep infarcts, and white matter hyperintensity volume (WMHV). WMHV was adjusted for head size and log transformed, achieving a normal distribution. Logistic regression models investigated the association of PTFV1 with cortical and with all subclinical infarcts. Linear regression models examined logWMHV. Models were adjusted for demographics and risk factors. Results Among 1174 participants with PTFV1 measurements, the mean age at MRI was 70 ± 9 years. Participants were 14.4% white, 17.6% black, and 65.8% Hispanic. Mean PTFV1 was 3587.35 ± 2315.62 μV-ms. Of the 170 subclinical infarcts, 40 were cortical. PTFV1 ≥ 5000 μV-ms was associated with WMHV in a fully adjusted model (mean difference in logWMHV 0.15, 95% confidence interval 0.01–0.28). PTFV1 exhibited a trend toward an association with cortical infarcts (unadjusted OR per SD change logPTFV1 1.30, 95% CI 0.94–1.81), but not with all subclinical infarcts. Conclusion Electrocardiographic evidence of left atrial abnormality was associated with leukoaraiosis.

Blood pressure (BP) control in hypertensive patients is crucial for reducing the risk of heart failure development and may be particularly important in elderly subjects, who have an especially high prevalence of hypertension and risk of heart failure (1). Left ventricular (LV) global longitudinal strain (GLS) is an echocardiographic measure of LV systolic function that can be an indicator of early subclinical cardiac dysfunction, even when LV ejection fraction is normal. The association of BP control with early subclinical LV dysfunction according to GLS has not been extensively studied, and it is also unknown whether assessing BP control with ambulatory blood pressure (ABP) monitoring is superior to using office BP measurements in this regard. Therefore, we investigated the association of BP control with GLS by using ABP and office BP criteria in a community-based, predominantly elderly cohort with normal LV ejection fraction.

Clinic blood pressure (BP) is not always representative of an individual’s BP during everyday life. Twenty-four-hour ambulatory BP (ABP) monitoring is used to assess individuals’ BP during normal daily activities. ABP normally shows diurnal fluctuation, with higher BP levels during the day and lower levels at night. Sustained adrenergic activity during sleep is associated with a blunting of the typical nocturnal BP reduction. Individuals whose BP remains high at night (nondippers) have more cardiovascular morbidity and mortality1 than those with a normal diurnal pattern. Evidence regarding ABP in Hispanics is limited. Only 2 small studies, which suggest that Hispanics are more likely to be nondippers than non-Hispanic whites, exist.2,3 However, determinants of ABP among Hispanics have been largely unexplored. Lower socioeconomic status (SES) is associated with increased cardiovascular morbidity and mortality.4,5 The reasons for this association are not completely understood. Sympathetic stimulation has been shown to vary with environmental exposures, such as low SES adversity.6 It is likely that lower SES individuals are exposed to more frequent and severe stressors and thereby experience more frequent sympathetic activation. An altered autonomic tone associated with lower SES may be reflected as ABP nondipping7–10 and be particularly important among Hispanics whom, according to the US Census, are more likely to be living in poverty than non-Hispanic whites.11 In addition, there is evidence that ABP nondipping may be related to adverse psychosocial factors, such as depressive symptoms and lack of social support.12–14 However, there is little information available as to the role of psychosocial factors and SES as they relate to ABP measures among Hispanics. Furthermore, there is clear importance to the role of race as it relates to ABP in non-Hispanic populations, with ABP nondipping being more prevalent among non-Hispanic blacks than among non-Hispanic whites.15,16 The role of race among Hispanics as it relates to ABP has not been explored. In this study, we further characterize ABP nondipping and its determinants in a sample of Hispanics. Our aim is to examine the association of SES and psychosocial factors with ABP nondipping. We hypothesize that lower SES, lower social support, and higher depressive symptoms are associated with greater ABP nondipping in this Hispanic cohort. As a secondary aim, we explore whether these associations vary by race.