Key result
Antihypertensive use is linked to ~5.6-fold higher odds of less severe cerebral small vessel disease.
Why the study?
This study was conducted to assess the association of antihypertensive medication use with the severities of neuropathological cerebrovascular disease (excluding lobar infarction) in older individuals.
Does past antihypertensive medication use reduce neuropathological cerebrovascular disease severity in older individuals?
Observational (n=149)
Does past antihypertensive medication use reduce neuropathological cerebrovascular disease severity in older individuals?
Effect estimate: OR 5.6-14.4
p-value: p=<0.001
Past antihypertensive medication use in older adults is associated with significantly less severe white matter small vessel disease and reduced amyloid-beta propagation in the brain.
Hypothesis-generating for antihypertensive effects on white matter SVD; should not yet change practice in older adults.
AIMS: This study assesses the association of antihypertensive medication use on the severities of neuropathological cerebrovascular disease (CVD excluding lobar infarction) in older individuals. METHODS: Clinical and neuropathological data were retrieved for 149 autopsy cases >75 years old with or without CVD or Alzheimer's disease and no other neuropathological diagnoses. Clinical data included hypertension status, hypertension diagnosis, antihypertensive medication use, antihypertensive medication dose (where available) and clinical dementia rating (CDR). Neuropathological CVD severity was evaluated for differences with anti-hypertensive medication usage. RESULTS: Antihypertensive medication use was associated with less severe white matter small vessel disease (SVD, mainly perivascular dilatation and rarefaction), with a 5.6-14.4 times greater likelihood of less severe SVD if medicated. No significant relationship was detected between infarction (presence, type, number and size), lacunes or cerebral amyloid angiopathy and antihypertensive medication use. Only increased white matter rarefaction/oedema and not perivascular dilation was associated with Alzheimer's pathology, with a 4.3 times greater likelihood of reduced Aβ progression through the brain if white matter rarefaction severity was none or mild. Antihypertensive medication use was associated with reduced Aβ progression but only in those with moderate to severe white matter SVD. CONCLUSIONS: This histopathological study provides further evidence that antihypertensive medication use in older individuals is associated with white matter SVD and not with other CVD pathologies. This is mainly due to a reduction in white matter perivascular dilation and rarefaction/oedema. Even in those with moderate to severe white matter SVD, antihypertensive medication use reduced rarefaction and Aβ propagation through the brain.
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Affleck et al. (2023) conducted an observational in Cerebrovascular disease and Alzheimer's disease (n=149). Antihypertensive medication use vs. No antihypertensive medication use was evaluated on Severity of white matter small vessel disease (SVD) (OR 5.6-14.4, p=<0.001). Past antihypertensive medication use in older individuals was associated with a 5.6 to 14.4 times greater likelihood of having less severe white matter small vessel disease at autopsy (p<0.001).
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