Abstract-Previous literature has shown mixed results regarding the association between blood pressure levels and brain volume reduction. The objectives of this study were to determine whether high blood pressure levels were associated with focal brain volume reduction and whether high blood pressure-related focal brain volume reduction was associated with a decline in executive function performance. On the basis of a cross-sectional design, 24-hour ambulatory blood pressure measurements, as well as brain morphology from 3-dimensional magnetic resonance images, were assessed among 183 participants (mean, 65±0.6 years; 62.4% women). Average levels of systolic and diastolic blood pressures, as well as dip, pulse pressure, and mean arterial blood pressure, were used as outcomes. Cortical gray and white matter volumes were determined by automatic calculation using Statistical Parametric Mapping segmentation. Folstein's MiniMental State Examination, digit span, part B of Trail Making, and Stroop tests were used to assess executive function performance. Sex, use of antihypertensive drugs, duration of hypertension, leukoaraiosis, body mass index, education level, and total brain matter volume were used as potential confounders. A significant blood pressure-related decrease in gray matter volume of the left supplementary motor areas (Brodmann area 6) and of the left superior and middle frontal gyrus (Brodmann area 8) was shown. No significant decrease was found with white matter volume. Blood pressurerelated decreases in gray matter volume were significantly associated with a decline in executive function performance. The association of high blood pressure with brain volume reduction may in part explain blood pressure-related cognitive decline leading to dementia. We had the opportunity to examine the association between 24-hour BP measurements and gray and white matter volumes in a large representative community survey of older adults, the PROgnostic indicator OF cardiovascular and cerebrovascular events (PROOF) study. 17 We reported previously that high mean BP levels were associated with a decline in memory performance related to attention disorders, involving the frontal lobe among the participants of the PROOF study.13 Thus, we hypothesized that high mean BP levels could be associated with focal frontal lobe volume reduction and that high BP-related focal frontal volume reduction could be associated with a decline in EF performance. The purposes of this crosssectional study were to determine at the baseline assessment of the PROOF study whether high BP levels were associated with focal brain volume reduction and whether any significant high BP-related focal brain volume reduction was associated with a decline in ESDs performance.
Methods
Brain Imaging and Neuropsychological AssessmentA total of 183 participants from the PROOF study 17 were included in the current study (see online-only Data Supplement for description of participant's selection). All participants had 3D T 1 -weighted magnetic resonance imaging at 1....