Brain atrophy and white matter hyperintensity change in older adults and relationship to blood pressure : Brain atrophy, WMH change and blood pressure

Hypertension is a major risk factor for stroke and dementia and is associated with white matter hyperintensities (WMH) and reduced brain volumes. We measured the increase in WMH volume, and rate of cerebral atrophy over two years, in hypertensive subjects participating in the Study on COgnition and...

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Bibliographic Details
Published in:	Journal of neurology Vol. 254; no. 6; pp. 713 - 721
Main Authors:	FIRBANK, Michael J, WISEMAN, Rebecca M, BURTON, Emma J, SAXBY, Brian K, O'BRIEN, John T, FORD, Gary A
Format:	Journal Article
Language:	English
Published:	Berlin Springer 01-06-2007 Springer Nature B.V
Subjects:	Aged Aged, 80 and over Aging - pathology Antihypertensive Agents - therapeutic use Atrophy Atrophy - etiology Atrophy - pathology Atrophy - physiopathology Biological and medical sciences Blood pressure Blood Pressure - drug effects Blood Pressure - physiology Brain - blood supply Brain - pathology Brain - physiopathology Brain research Cerebral circulation. Blood-brain barrier. Choroid plexus. Cerebrospinal fluid. Circumventricular organ. Meninges Cognition & reasoning Cohort Studies Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Dementia Dementia, Vascular - etiology Dementia, Vascular - pathology Dementia, Vascular - physiopathology Double-Blind Method Female Fundamental and applied biological sciences. Psychology Humans Hypertension Hypertension - complications Hypertension - drug therapy Magnetic Resonance Imaging Male Medical sciences Nerve Fibers, Myelinated - pathology Neurology Older people Pacemakers Placebo Effect Predictive Value of Tests Shrinkage Treatment Outcome Vertebrates: nervous system and sense organs United Kingdom > UK Hypertension Nervous system diseases Senescence Central nervous system Cardiovascular disease Nuclear magnetic resonance imaging White matter Encephalon Atrophy aging,magnetic resonance imaging Arterial pressure Blood pressure Hemodynamics Hyperintensity
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Summary:	Hypertension is a major risk factor for stroke and dementia and is associated with white matter hyperintensities (WMH) and reduced brain volumes. We measured the increase in WMH volume, and rate of cerebral atrophy over two years, in hypertensive subjects participating in the Study on COgnition and Prognosis in the Elderly (SCOPE), receiving candesartan or placebo, and normotensive controls. We recruited 163 subjects who had MRI (FLAIR and volumetric T1) at 2 and 4 years after baseline assessment. From these two scans, volumetric change in WMH (n = 133) and brain atrophy rates (n = 95) were determined. Total WMH fraction increased in both normotensive and treated hypertensive groups (p < 0.01) median change: 0.05% of brain volume [range: -0.45% to 1.51%]. Deep WMH increased in hypertensive (p = 0.001) but not the normotensive group. The number of subjects with an increase of total WMH in the 5(th) quintile differed between the treatment groups (chi square p = 0.006), being greatest in the placebo group (32%), then candesartan (20%) then normotensive (5%). Regression analysis found significant predictors of change in WMH to be blood pressure and initial deep WMH, but not treatment group. Increased atrophy rate was predicted by baseline systolic blood pressure (p = 0.02) but was not associated with measures of WMH. Similar to WMH, there was a trend with treatment, with atrophy in normotensive < Candesartan < Placebo (Spearman's rho = 0.23, p = 0.026). Hypertension in older people is associated with increased rates of progressive whole brain atrophy and an increase in WMH. These changes are independent. Successful hypertension treatment was associated with reduced risk of WMH progression and possibly brain atrophy.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-News-1 ObjectType-Feature-3
ISSN:	0340-5354 1432-1459
DOI:	10.1007/s00415-006-0238-4