Key result
Higher mean SBP linked to ~10-fold worse white matter integrity per 10 mm Hg increase.
Why the study?
The associations between longitudinal systolic blood pressure characteristics and brain integrity in very old adults, and whether these differ between white and gray matter, were unclear.
Are higher and variable longitudinal systolic blood pressure characteristics associated with reduced brain structural integrity in very old adults?
Cohort (n=311)
Are higher and variable longitudinal systolic blood pressure characteristics associated with reduced brain structural integrity in very old adults?
A history of higher and variable systolic blood pressure in very old adults is associated with lower white matter integrity, suggesting longitudinal SBP may be a better marker of cerebrovascular risk than cross-sectional measurements.
Answers are grounded in this paper and cite their sources.
Prior higher/variable SBP was associated with lower white matter integrity; hypothesis-generating for SBP stabilization to preserve brain structure in the very old.
BACKGROUND: We sought to determine which systolic blood pressure (SBP) characteristics are associated with reduced brain integrity and whether these associations are stronger for white or gray matter. We hypothesized that exposure to higher and variable SBP will be associated with lower structural integrity of both gray and white matter. METHODS: Neuroimaging, SBP, and cognition were obtained in 311 community-dwelling adults in 2006-2008 (average age = 83 years; 58% women; 40% black). Antihypertensive medications, SBP, and health-related factors were collected from 1997 to 1998 to time of neuroimaging. SBP values obtained from 1997 to 1998 to time of neuroimaging were used to compute mean; pulse pressure; coefficient of variation; and peak, load, and group-based trajectories. RESULTS: Higher mean SBP was associated with lower white matter integrity in uncinate and superior lateral fasciculi bilaterally, independent of age, stroke history, antihypertensive medication use (odds ratio of having white matter hyperintensities greater than or equal to the median for 10mm Hg of SBP = 10.4, 95% confidence interval = 10.2-10.6, P = 0.0001; standardized beta for fractional anisotropy = -13.54, SE = 4.58, P = 0.003). These neuroimaging markers attenuated the association between higher SBP and lower digit symbol substitution test. Results were similar for trajectories of SBP and stronger for those with previously higher and variable SBP even if SBP was normal at neuroimaging. Results were similar for those without stroke. Associations with gray matter measures were not significant. CONCLUSIONS: If confirmed, these data suggest a history of higher and variable SBP for very old adults may be useful to alert clinicians to potential lower integrity in selected tracts, whereas cross-sectional SBP measurements may obscure the risk of underlying white matter hyperintensities. Whether lowering and/or stabilizing SBP levels in very old adults without a remarkable cardiovascular history would have neuroprotective effects and reduce dementia risk needs further study.
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Rosano et al. (2014) reported a cohort. Higher mean systolic blood pressure was evaluated on having white matter hyperintensities greater than or equal to the median (OR 10.4, 95% CI 10.2-10.6, p=0.0001). Higher mean systolic blood pressure was associated with lower white matter integrity (OR 10.4 per 10 mm Hg increase; 95% CI 10.2-10.6; P=0.0001) in very old adults.
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