Hypertension pathology visible in white matter lesion volume

White matter lesions (WMLs) seem to represent a marker of advanced hypertension pathology, calling for early markers of brain damage such as structural and functional connectivity. Longitudinal studies are required to establish the possible long-term benefits of blood pressure control for brain health.

WMLs of presumed vascular origin are a frequent finding in older people. These are attributed to small vessel disease, involved in the pathogenesis of cognitive decline. Vascular risk factors, especially arterial hypertension, predispose for small vessel disease, and offer a potential for prevention. The population-based 1000BRAINS study aims to unravel the variability of brain structure, function, and connectivity, as well as cognition in relation to influences such as genetic factors, lifestyle, urban environment, and health conditions.

In the study, the association of systolic (SBP) as well as diastolic blood pressure (DBP), antihypertensive medication, and treatment efficacy with WML volume were analysed. Treatment efficacy was evaluated using a classification based on antihypertensive medication and BP: 1) untreated BP <120/<80 mmHg (n=180), 2) untreated SBP 120–139 mmHg or DBP 80–89 mmHg (n=159), 3) untreated BP 140/90 mmHg (n=75), 4) treated BP <120/<80 mmHg (n=62), 5) treated SBP 120–139 mmHg or DBP 80–89 mmHg (n=81), 6) treated BP 140/90 mmHg (n=71).

In 560 participants (65.2 years, 51.4% men), the following variables were significantly associated with WML volume in multivariable regression models adjusting for age, sex, education, depression, alcohol consumption, and smoking:

• continuous SBP (B=0.63 per 10 mmHg, 95% CI 0.32–0.94);
• DBP (B=0.64, 95% CI 0.37–0.91);
• antihypertensive treatment (B=1.23, 95% CI 0.14–2.23).

Participants with hypertension despite treatment (treated BP 140/90 mmHg) had significantly increased WML volume compared with normotension without treatment (untreated BP <120/<80mmHg).

1. Gronewold J, et al. Association of blood pressure, its treatment and treatment efficacy with white matter lesions in the 1000BRAINS study. OPR-126, EAN 2021 Virtual Congress, 19–22 June.

 

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Posted on 18 August 202113 June 2024