Abstract 141: Systolic Blood Pressure and White Matter Hyperintensity Progression in ACCORD-MIND

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Jennifer J Majersik ◽  
David Tirschwell ◽  
J Scott McNally ◽  
Natalia Rost
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Hyperintensity

Abstract P622: Racial Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alison L Herman ◽  
Adam H De Havenon ◽  
Guido J Falcone ◽  
Shadi Yaghi ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Hyperintensity ◽  
Diabetic Patients ◽  
Patient Race ◽  
Black Patients ◽  
The Mean ◽  
White Patients

Introduction: White matter hyperintensities (WMH) are linked to cognitive decline and stroke. We hypothesized that Black race would be associated with greater WMH progression in the ACCORDION MIND trial. Methods: The primary outcome is WMH progression in mL, evaluated by fitting linear regression to WMH volume on the month 80 MRI and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as “other” race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels. Results: We included 276 patients who completed the baseline and month 80 MRI, of which 207 were white, 48 Black, and 21 Hispanic. During follow-up, the mean number of SBP, LDL, and A1c measurements per patient was 21, 8, and 15. The mean (SD) WMH progression was 3.3 (5.4) mL for blacks, 2.5 (3.2) mL for Hispanics, and 2.4 (3.3) mL for whites. In the multivariate regression model (Table 1), Black, compared to white, patients had significantly more WMH progression (β Coefficient 1.26, 95% CI 0.45-2.06, p=0.002). Hispanic, compared to white, patients did not have significantly different WMH progression (p=0.392), nor was there a difference when comparing Hispanic to Black patients (p=0.162). The predicted WMH progression was significantly higher for Black compared to white patients across a mean SBP of 117 to 139 mm Hg (Figure 1). Conclusions: Black diabetic patients in ACCORDION MIND have a higher risk of WMH progression than white patients across a normal range of systolic blood pressure.

scholarly journals Association of Low Blood Pressure with White Matter Hyperintensities in Elderly Individuals with Controlled Hypertension

2020 ◽  
Vol 22 (1) ◽  
pp. 99-107
Author(s):  
Jun Sung Kim ◽  
Subin Lee ◽  
Seung Wan Suh ◽  
Jong Bin Bae ◽  
Ji Hyun Han ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
White Matter Hyperintensities ◽  
Community Dwelling ◽  
White Matter Hyperintensity ◽  
Periventricular White Matter ◽  
Elderly Individuals ◽  
Low Blood Pressure

Background and Purpose Both hypertension and hypotension increase cerebral white matter hyperintensities. However, the effects of hypotension in individuals with treated hypertension are unknown. We analyzed the association of low blood pressure with the location and amount of white matter hyperintensities between elderly individuals with controlled hypertension and those without hypertension.Methods We enrolled 505 community-dwelling, cognitively normal elderly individuals from the participants of the Korean Longitudinal Study on Cognitive Aging and Dementia. We measured blood pressure three times in a sitting position using a mercury sphygmomanometer and defined low systolic and diastolic blood pressure as ≤110 and ≤60 mm Hg, respectively. We segmented and quantified the periventricular and deep white matter hyperintensities from 3.0 Tesla fluid-attenuated inversion recovery magnetic resonance images.Results Low systolic blood pressure was independently associated with larger volume of periventricular white matter hyperintensity (<i>P</i>=0.049). The interaction between low systolic blood pressure and hypertension was observed on the volume of periventricular white matter hyperintensity (<i>P</i>=0.005). Low systolic blood pressure was associated with the volume of periventricular white matter hyperintensity in individuals with controlled hypertension (F<sub>1,248</sub>=6.750, <i>P</i>=0.010), but not in those without hypertension (<i>P</i>=0.380). Low diastolic blood pressure was not associated with the volumes of white matter hyperintensities regardless of presence of controlled hypertension.Conclusions Low systolic blood pressure seems to be associated with larger volume of periventricular white matter hyperintensity in the individuals with a historyof hypertension but not in those without hypertension.

scholarly journals Variability in Midlife Systolic Blood Pressure Is Related to Late-Life Brain White Matter Lesions

Stroke ◽  
2002 ◽  
Vol 33 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Richard J. Havlik ◽  
Daniel J. Foley ◽  
Bryan Sayer ◽  
Kamal Masaki ◽  
Lon White ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Lesions ◽  
Late Life ◽  
Brain White Matter

Blood Pressure and White Matter Hyperintensity Volume - A Review of the Relationship and Implications for Stroke Prediction and Prevention

2012 ◽  
Vol 7 (3) ◽  
pp. 174 ◽  
Author(s):  
Royya Modir ◽  
Hannah Gardener ◽  
Clinton B Wright ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
White Matter ◽  
Large Population ◽  
Brain Perfusion ◽  
The Elderly ◽  
Vascular Cognitive Impairment ◽  
Population Based ◽  
White Matter Hyperintensity ◽  
Prediction And Prevention

A heavy burden of white matter hyperintensities (WMH) is a risk factor for stroke and vascular cognitive impairment making it important to understand their pathophysiology, aetiology and clinical implications. Ageing studies suggest a linear relationship between blood pressure (BP) and both WMH and microstructural integrity in normal-appearing white matter and, after age, hypertension is the strongest risk factor for WMH. Numerous large population-based observational studies have reported significant associations between elevated BP and WMH burden, however, the relative importance of systolic versus diastolic BP remains controversial. Limitations of prior studies include the use of only a single measurement of BP and oversimplifying hypertension as a dichotomous variable. Race/ethnic differences in the association between BP and WMH have been suggested, but most studies only included older Caucasians. Antihypertensive treatment has been demonstrated to slow WMH progression, but lowering BP in the elderly may also reduce brain perfusion in those with poor autoregulation. Ongoing trials aim to clarify the effects of BP treatment on WMH progression in multi-ethnic populations and the implications of these findings for stroke prevention require further study.

Remote brain hemorrhage after IV thrombolysis

Neurology ◽  
2019 ◽  
Vol 94 (9) ◽  
pp. e961-e967 ◽  
Author(s):  
Agathe Drelon ◽  
Gregory Kuchcinski ◽  
François Caparros ◽  
Nelly Dequatre-Ponchelle ◽  
Solène Moulin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Brain Lesions ◽  
White Matter Hyperintensity ◽  
Modified Rankin Scale ◽  
Baseline Systolic Blood Pressure ◽  
Vascular Origin ◽  
Mri Scans ◽  
Intracerebral Hemorrhages ◽  
Normal Area

ObjectiveTo test the hypothesis that remote intracerebral hemorrhages (r-ICHs) after IV thrombolysis occur in preexisting brain lesions.MethodWe prospectively collected baseline data from consecutive patients treated with IV thrombolysis for cerebral ischemia and reviewed their baseline MRI scans to identify preexisting lesions in those who developed r-ICH. We evaluated outcomes with the modified Rankin Scale (mRS) and defined good outcomes as scores of 0 to 2 or similar to the preexisting mRS score.ResultsOf 944 patients, 24 (2.5%) had r-ICH: lobar in 14, deep in 7, and both in 3. Sixteen of them (1.7% of all patients, 66.7% of those with r-ICH) were asymptomatic. Of the 41 r-ICHs found in these patients, 17 (41%) occurred within a lesion present before thrombolysis: 6 cerebral microbleeds (CMBs), 6 old and 1 recent infarct, and 4 areas of white matter hyperintensity. Patients with r-ICH were more likely to have strictly lobar CMBs (p = 0.049). They were 10 years older (p = 0.007), had a 16–mm Hg higher systolic blood pressure (p = 0.035) at baseline, and had more CMBs (p = 0.007). r-ICHs were better predicted by clinical (age, baseline systolic blood pressure) than imaging (purely lobar CMBs and having >5 CMBs) variables. r-ICHs tended to be associated with worse outcomes.ConclusionWe identified preexisting brain lesions in nearly half of the patients with r-ICH. All were of vascular origin, supporting the hypothesis that r-ICHs occur in preexisting brain lesions. Higher-field machines could help identifying preexisting lesions in those who developed r-ICH in an apparently normal area.

Prevention of White-Matter Lesions Through Control of Cerebrovascular Risk Factors

2003 ◽  
Vol 15 (S1) ◽  
pp. 147-151 ◽  
Author(s):  
Charles DeCarli
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
Strong Association ◽  
Treatment Strategies ◽  
White Matter Lesions ◽  
Elevated Blood Pressure ◽  
Cerebral White Matter ◽  
Elevated Blood ◽  
Atherosclerotic Vascular Disease

Multiple epidemiological and brain imaging studies show a strong association between elevations in systolic blood pressure and lesions of cerebral white matter. The association between white-matter lesions and systolic blood pressure persists even if individuals are receiving treatment, suggesting that these individuals may be undertreated. In addition, these studies suggest that lesions of cerebral white matter may serve as markers for atherosclerotic vascular disease. Treatment strategies, therefore, should focus on early and aggressive management of elevated blood pressure, but definitions of elevated blood pressure may need to be revised downward to achieve best results.

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