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Blood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening
Lester Y Leung1, Traci M Bartz2, Kenneth Rice2
1From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.). lester.y.leung.md@gmail.com.
Objective:
In people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings.
Approach And Results:
In the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses.
Conclusions:
Elevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.
Insights
Elevated blood pressure is linked to silent brain changes. High systolic blood pressure increases the risk of covert brain infarcts, while high diastolic blood pressure is associated with worsening leukoaraiosis.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Covert brain infarcts and leukoaraiosis on MRI are associated with increased stroke and dementia risk in individuals without prior stroke.
- Understanding the relationship between blood pressure (BP) and these subclinical cerebrovascular changes is crucial for prevention.
Purpose of the Study:
- To evaluate the association between various measures of blood pressure (BP) and heart rate with incident covert brain infarcts and worsening leukoaraiosis on serial MRI.
Main Methods:
- The Cardiovascular Health Study (CHS) cohort of older adults was analyzed.
- Relative risk regression was used to assess associations between BP/heart rate measures (mean, variability, trend) and MRI findings.
- Participants with no prior stroke and stable antihypertensive medication status between two brain MRIs were included.
Main Results:
- Among 878 participants, 15% had incident covert brain infarction and 27% had worsening white matter grade.
- Elevated mean systolic BP was associated with a higher risk of incident covert brain infarction (RR per 10 mm Hg, 1.28).
- Elevated mean diastolic BP was associated with a higher risk of worsening white matter grade (RR per 10 mm Hg, 1.45).
Conclusions:
- Elevated mean systolic BP is a risk factor for covert brain infarction.
- Elevated mean diastolic BP is a risk factor for worsening leukoaraiosis.
- These findings highlight the role of hypertension in silent cerebrovascular diseases, suggesting potentially different pathophysiological pathways for systolic and diastolic BP effects.
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