Cerebral microbleeds are associated with white matter hyperintensities in patients with primary hypertension: A case–control study

Abstract: OBJECTIVE: The objective of the study was to describe and characterize the cross-sectional association between cerebral microbleeds (CMBs) and white matter hyperintensities (WMH) in patients with primary hypertension. MATERIALS AND METHODS: Hospitalized patients with primary hypertension were enrolled. Brain magnetic resonance imaging was scanned for the qualitative and semi-quantitative evaluations of CMBs and WMH. Univariate and multivariate analyses were conducted to investigate the correlation between CMBs and WMH. Subgroup analyses were performed in patients with CMBs, based on the severities and distributions of CMBs. RESULTS: This prospective study recruited 400 patients, and CMBs and WMH were detected in 86 (21.5%) and 250 (62.5%) patients, respectively. Moderate (a Fazekas score of 3–4) (odds ratio OR = 2.650 1.367–5.139, P = 0.004) and severe (a Fazekas score of 5–6) WMH (OR = 6.793 3.253–14.185, P 5) exhibited a higher Fazekas score, compared with those with mild CMBs (a CMBs number of 1–5) (5 vs. 2, P = 0.006). The number of CMBs was positively correlated with the Fazekas score of WMH ( r = 0.465, P < 0.001) in the 65 (16.3%) patients exhibiting both CMBs and WMH. In addition, those with CMBs in both lobar and deep/infratentorial regions exhibited a higher Fazekas score than those with CMBs only in lobes or only in deep/infratentorial regions (5 vs. 2, P = 0.003). CONCLUSIONS: Both moderate and severe WMH are independent risk factors for CMBs in patients with primary hypertension. More severe CMBs are associated with more severe WMH.