Aortic hemodynamics and white matter hyperintensities in normotensive postmenopausal women

Hypertension is associated with development of white matter hyperintensities (WMH) in the brain, which are risk factors for mild cognitive impairment. Hormonal shifts at menopause alter vascular function putting women at risk for both hypertension and WMH. Elevations in aortic hemodynamics precede the appearance of clinically defined hypertension but the relationship of aortic hemodynamics to development of WMH in women is not known. Therefore, this study aimed to characterize aortic hemodynamics in relationship to WMH in postmenopausal women. Aortic systolic and diastolic blood pressure (BP), aortic augmentation index (Alx) and aortic round trip travel time (Aortic TR) by tonometry were examined in 53 postmenopausal women (age 60 ± 2 years). WMH was calculated from fluid-attenuated inversion recovery MRI using a semi-automated segmentation algorithm. WMH as a fraction of total white matter volume positively associated with aortic systolic BP (regression coefficient = 0.018; p = 0.04) after adjusting for age. In addition, WMH fraction was positively associated with AIx (0.025; p = 0.04), and inversely associated with Aortic TR (−0.015; p = 0.04) after adjusting for age. Our results suggest that assessing aortic hemodynamics may identify individuals at risk for accelerated development of WMH and guide early treatment to reduce WMH burden and cognitive impairment in the future.

[1]  C. Jack,et al.  Thrombogenic microvesicles and white matter hyperintensities in postmenopausal women , 2013, Neurology.

[2]  H. Struijker‐Boudier,et al.  Expert consensus document on arterial stiffness: methodological issues and clinical applications. , 2006, European heart journal.

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

[4]  M. Joyner,et al.  Cyclooxygenase inhibition augments central blood pressure and aortic wave reflection in aging humans. , 2012, American journal of physiology. Heart and circulatory physiology.

[5]  R. Netea,et al.  Both body and arm position significantly influence blood pressure measurement , 2003, Journal of Human Hypertension.

[6]  Michael F O'Rourke,et al.  Validation of the transfer function technique for generating central from peripheral upper limb pressure waveform. , 2004, American journal of hypertension.

[7]  A. Dart,et al.  Large‐Artery Stiffness Contributes to the Greater Prevalence of Systolic Hypertension in Elderly Women , 2004, Journal of the American Geriatrics Society.

[8]  J. Cockcroft,et al.  Central blood pressure: current evidence and clinical importance. , 2014, European heart journal.

[9]  Thomas Weber,et al.  Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease , 2004, Circulation.

[10]  J. Kaye,et al.  Impact of white matter hyperintensity volume progression on rate of cognitive and motor decline , 2008, Neurology.

[11]  G. Martin,et al.  Roles of Arterial Stiffness and Blood Pressure in Hypertension-Associated Cognitive Decline in Healthy Adults , 2016, Hypertension.

[12]  D. Levy,et al.  Relations of arterial stiffness and endothelial function to brain aging in the community , 2013, Neurology.

[13]  Michael F O'Rourke,et al.  Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. , 2005, Hypertension.

[14]  Rowena J Dolor,et al.  Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. , 2011, Journal of the American College of Cardiology.

[15]  C. H. Chen,et al.  Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. , 1997, Circulation.

[16]  Robert D. Brown,et al.  Premature menopause or early menopause and risk of ischemic stroke , 2012, Menopause.

[17]  C. Jack,et al.  Early Postmenopausal Transdermal 17β-Estradiol Therapy and Amyloid-β Deposition , 2016, Journal of Alzheimer's disease : JAD.

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

[19]  Jeroen van der Grond,et al.  Association of aortic arch pulse wave velocity with left ventricular mass and lacunar brain infarcts in hypertensive patients: assessment with MR imaging. , 2009, Radiology.

[20]  Wilhelm Kuker,et al.  Increased Cerebral Arterial Pulsatility in Patients With Leukoaraiosis: Arterial Stiffness Enhances Transmission of Aortic Pulsatility , 2012, Stroke.

[21]  W. Nichols,et al.  McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles , 1998 .

[22]  C. DeCarli,et al.  Association of midlife blood pressure to late-life cognitive decline and brain morphology , 1998, Neurology.

[23]  L. Chambless,et al.  Arterial stiffness and the development of hypertension. The ARIC study. , 1999, Hypertension.

[24]  H. Black,et al.  Clinical Use of Pulse Wave Analysis: Proceedings From a Symposium Sponsored by North American Artery , 2015, Journal of clinical hypertension.

[25]  G. Stergiou,et al.  Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis , 2016, Hypertension.

[26]  James D. Cameron,et al.  Women exhibit a greater age-related increase in proximal aortic stiffness than men , 2001, Journal of hypertension.

[27]  Jennifer L. Whitwell,et al.  Hippocampal volumes, proton magnetic resonance spectroscopy metabolites, and cerebrovascular disease in mild cognitive impairment subtypes. , 2008, Archives of neurology.

[28]  G. Mitchell.  Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. , 2008, Journal of applied physiology.

[29]  A. Hofman,et al.  Cerebral white matter lesions, vascular risk factors, and cognitive function in a population‐based study , 1994, Neurology.

[30]  B L Miller,et al.  Cerebrovascular and brain morphologic correlates of mild cognitive impairment in the National Heart, Lung, and Blood Institute Twin Study. , 2001, Archives of neurology.

[31]  R. Vasan,et al.  Association of Aortic Stiffness With Cognition and Brain Aging in Young and Middle-Aged Adults: The Framingham Third Generation Cohort Study , 2016, Hypertension.

[32]  T. Waddell,et al.  Hormonal therapy increases arterial compliance in postmenopausal women. , 1997, Journal of the American College of Cardiology.

[33]  D. Liao,et al.  Arterial stiffness and the development of hypertension , 2000, Annals of medicine.