Longitudinal Systolic Blood Pressure Characteristics and Integrity of White Matter Tracts in a Cohort of Very Old Black and White Adults

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.

[1]  Subashan Perera,et al.  Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. , 2013, Research in social & administrative pharmacy : RSAP.

[2]  C. Bulpitt,et al.  Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial – HYVET , 2013, Journal of hypertension.

[3]  Vijay K. Venkatraman,et al.  Aortic Pulse Wave Velocity Predicts Focal White Matter Hyperintensities in a Biracial Cohort of Older Adults , 2013, Hypertension.

[4]  I. Skoog,et al.  Blood Pressure Trajectories From Midlife to Late Life in Relation to Dementia in Women Followed for 37 Years , 2012, Hypertension.

[5]  Christian Enzinger,et al.  Vascular Risk Factors, White Matter Hyperintensities and Hippocampal Volume in Normal Elderly Individuals , 2012, Dementia and Geriatric Cognitive Disorders.

[6]  Ulman Lindenberger,et al.  White matter deterioration in 15 months: latent growth curve models in healthy adults , 2012, Neurobiology of Aging.

[7]  G. Mancia.  Prognostic value of long-term blood pressure variability: the evidence is growing. , 2011, Hypertension.

[8]  K. Reynolds,et al.  The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population: Findings From NHANES III, 1988 to 1994 , 2011, Hypertension.

[9]  C. Bulpitt,et al.  Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial , 2011, BMJ : British Medical Journal.

[10]  I. Hajjar,et al.  The relationship between blood pressure and cognitive function , 2010, Nature Reviews Cardiology.

[11]  L. Pantoni.  Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges , 2010, The Lancet Neurology.

[12]  Jordan Muraskin,et al.  Long-term blood pressure fluctuation and cerebrovascular disease in an elderly cohort. , 2010, Archives of neurology.

[13]  Daniel S Nagin,et al.  Group-based trajectory modeling in clinical research. , 2010, Annual review of clinical psychology.

[14]  C. Jack,et al.  Blood Pressure and White-Matter Disease Progression in a Biethnic Cohort: Atherosclerosis Risk in Communities (ARIC) Study , 2010, Stroke.

[15]  P. Passmore,et al.  Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. , 2009, The Cochrane database of systematic reviews.

[16]  L. Pantoni,et al.  Blood Pressure Components and Changes in Relation to White Matter Lesions: A 32-Year Prospective Population Study , 2009, Hypertension.

[17]  Lewis H. Kuller,et al.  White matter grade and ventricular volume on brain MRI as markers of longevity in the cardiovascular health study , 2007, Neurobiology of Aging.

[18]  Daniel S. Nagin,et al.  Advances in Group-Based Trajectory Modeling and an SAS Procedure for Estimating Them , 2007 .

[19]  C. Reynolds,et al.  A fully automated method for quantifying and localizing white matter hyperintensities on MR images , 2006, Psychiatry Research: Neuroimaging.

[20]  A. Newman,et al.  Cardiovascular disease and risk of Alzheimer's disease , 2006, Neurological research.

[21]  B. Winblad,et al.  The age-dependent relation of blood pressure to cognitive function and dementia , 2005, The Lancet Neurology.

[22]  George Bartzokis,et al.  Ambulatory blood pressure and the brain , 2005, Neurology.

[23]  P. Matthews,et al.  Risk factors for progression of brain atrophy in aging , 2005, Neurology.

[24]  C. Rosano,et al.  Subclinical Brain Magnetic Resonance Imaging Abnormalities Predict Physical Functional Decline in High‐Functioning Older Adults , 2005, Journal of the American Geriatrics Society.

[25]  P. J. Koudstaal,et al.  Association between blood pressure, white matter lesions, and atrophy of the medial temporal lobe , 2005, Neurology.

[26]  J T O'Brien,et al.  Hippocampal atrophy, whole brain volume, and white matter lesions in older hypertensive subjects , 2004, Neurology.

[27]  L. Lipsitz,et al.  Cerebral white matter changes and geriatric syndromes: is there a link? , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[28]  J. Goodwin.  Embracing complexity: A consideration of hypertension in the very old. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[29]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[30]  Tom den Heijer,et al.  Association between blood pressure levels over time and brain atrophy in the elderly , 2003, Neurobiology of Aging.

[31]  A. Peters.  The effects of normal aging on myelin and nerve fibers: A review , 2002, Journal of neurocytology.

[32]  Lenore J Launer,et al.  Variability in Midlife Systolic Blood Pressure Is Related to Late-Life Brain White Matter Lesions: The Honolulu-Asia Aging Study , 2002, Stroke.

[33]  E Auffray,et al.  Longitudinal study of blood pressure and white matter hyperintensities , 2001, Neurology.

[34]  B. Conrad,et al.  Extent of cerebral white matter lesions is related to changes of circadian blood pressure rhythmicity. , 2000, Archives of neurology.

[35]  L. Beckett,et al.  Current and remote blood pressure and cognitive decline. , 1999, JAMA.

[36]  R. Havlik,et al.  The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. , 1995, JAMA.

[37]  W. Applegate,et al.  Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. , 1994, Archives of internal medicine.

[38]  A. V. Peterson,et al.  Relationship Between Longitudinal Changes in Blood Pressure and Stroke Incidence , 1984, Stroke.

[39]  J. Saczynski,et al.  The Honolulu-Asia Aging Study , 2007 .