The Effects of Mean of Visit-to-Visit Blood Pressure on Incident Brain Vascular Lesions and Functional-Cognitive Decline

Abstract

Background: Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear. Objective: To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up. Methods: 373 patients from a memory-clinic underwent BP measurements at baseline, year 1, and year 2. The mean of visit-to-visit systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were calculated. Baseline and year 2 MRI scans were graded for WMH, infarcts, CMBs, intracranial stenosis, and hippocampal volume. Functional-cognitive decline was assessed using locally validated protocol. Logistic and linear regression models with odds ratios, mean difference, and 95%confidence interval were constructed to analyze associations of visit-to-visit BP on CeVD incidence and progression as well as functional-cognitive decline. Results: Higher mean of visit-to-visit diastolic BP was associated with WMH progression. Higher tertiles of diastolic BP was associated with WMH progression and incident CMBs. There was no association between mean of visit-to-visit BP measures with incident cerebral infarcts, intracranial stenosis, change in hippocampal volume, and functional-cognitive decline. Conclusion: These findings suggest the possibility of hypertension-related vascular brain damage. Careful monitoring and management of BP in elderly patients is essential to reduce the incidence and progression of CeVD.

Impact of cardiometabolic factors and blood beta-amyloid on the volume of white matter hyperintensities in dementia-free subjects with cognitive complaints

“…Thus, the early diagnosis of cardiometabolic risk factors is important in CC, not in demented subjects, to potentially alleviate and influence the progression to MCI, or even dementia. Careful monitoring and management of blood pressure in the elderly and in patients with CC are essential to reduce the incidence and progression of cerebrovascular disease and its consequent cognitive decline [52].…”

Statin Usage Increases White Matter Hyperintensities

“…Conventional cerebrovascular risk factors, namely chronic arterial hypertension and obstructive sleep apnea, are associated with WMH. [6][7][8][9] However, the association between WMH and dyslipidemia appears to be more complex, with a variety of studies suggesting both protective and harmful effects of hyperlipidemia on WMH development and conflicting reports on the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on WMH progression. [10][11][12][13][14][15][16] Significant limitations exist in available literature due to short follow-up imaging intervals and heterogeneity of statin exposure which constrains generalizability.…”

“…As a result, there is a need to further the understanding of factors contributing to the development of WMH. Conventional cerebrovascular risk factors, namely chronic arterial hypertension and obstructive sleep apnea, are associated with WMH 6–9. However, the association between WMH and dyslipidemia appears to be more complex, with a variety of studies suggesting both protective and harmful effects of hyperlipidemia on WMH development and conflicting reports on the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on WMH progression 10–16.…”