What is the clinical evidence from this study?

Study design: Observational. Population: Cerebrovascular changes (white matter lesions and silent infarctions) (n=300). Intervention: Long-term diastolic hypertension vs. Normotension (mean SBP < 140 mmHg and mean DBP < 90 mmHg). Primary outcome: White matter lesions (WML) on CT (OR 7.1, 95% CI 2.4-21.6).

January 1, 2001Open Access

Long-term Blood Pressure Variability and Cerebrovascular Changes on CT in a Community-based Elderly Population.

Q: What are the key findings of this study?

Long-term diastolic hypertension significantly increased the risk of white matter lesions (OR 7.1) and silent infarctions (OR 7.2) on cranial CT in community-dwelling elderly adults.

ETEri TsukishimaNational Institute of Technology, Oshima College HSHiroya SaitoJapan Cancer Society KSKoichi ShidoTokyo Health Care University

Key Result

Long-term diastolic hypertension significantly increased the risk of white matter lesions (OR 7.1) and silent infarctions (OR 7.2) on cranial CT in community-dwelling elderly adults.

Study Design

Type

Observational (n=300)

Blinding

Single-blind

Multicenter

Structured PICO

Does long-term blood pressure variability increase the risk of cerebrovascular changes on CT in a community-based elderly population?

Population

300 healthy community-dwelling elderly adults aged 69 years and older with over 10 years of longitudinal blood pressure data, evaluated for cerebrovascular changes on CT.

Exposure

Long-term diastolic hypertension (DHT) and isolated systolic hypertension (ISHT) assessed over the 10 years prior to CT.

Comparator

Other patterns of long-term blood pressure variability.

Outcome

Cerebrovascular changes on cranial computed tomography (CT), specifically white matter lesions (WML) and/or silent infarctions (SI).surrogate

Long-term diastolic and isolated systolic hypertension are significantly associated with distinct structural cerebrovascular changes, highlighting the importance of blood pressure management in the elderly to prevent silent brain injury.

Main Result

Odds Ratio: 7.1 (95% CI 2.4–21.6)

Limitations

Lack of baseline information on cerebrovascular changes, meaning odds ratios represent prevalence rather than incidence.
Inability to analyze the effect of hypertension treatment due to unclear self-reported information and missing values.
Low response rate (44%) because many disabled persons did not participate in the cranial CT examination.

Abstract

The effects of long-term blood pressure (BP) levels on cerebrovascular changes were analyzed in a community-based healthy elderly population. Cranial computed tomography (CT) was performed for 300 residents aged 69 years and older. Long-term BP during the ten years prior to CT was assessed, and the cerebrovascular changes were compared among different patterns of long-term blood pressure variability. White matter lesions (WML) and/or silent infarctions (SI) were found in 73 subjects (23.6%). Multiple logistic regression analysis showed that subjects with long-term diastolic hypertension (DHT) had the highest risk of cerebrovascular changes (adjusted odds ratio (OR), 95% confidence interval (CI); 7.1, 2.4-21.6, for WML; 7.2, 2.7-19.4, for SI), and that long-term isolated systolic hypertension (ISHT) was significantly associated with SI (adjusted OR, 95%CI, 2.3, 1.1-4.9), but not with WML (adjusted OR, 95%CI, 1.3, 0.5-3.3). Efforts to prevent both DHT and ISHT would be beneficial, though different underlying mechanisms for WML and SI were suggested.

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