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Effect of Antihypertensive Medication on Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

Tessa van Middelaar1,2, Tanja E Argillander3, Floris H B M Schreuder4

  • 1From the Department of Neurology, Donders Institute for Brain, Cognition, and Behavior (T.v.M., F.H.B.M.S., E.R., C.J.M.K.) t.vanmiddelaar@amc.uva.nl.

Stroke
|May 10, 2018
PubMed

Insights

Antihypertensive medication (AHM) slows white matter hyperintensity progression in cerebral small vessel disease. However, AHM showed no effect on brain atrophy, and data on other markers are lacking.

Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Hypertension is a significant risk factor for cerebral small vessel disease (CSVD).
  • Understanding the impact of antihypertensive medication (AHM) on CSVD progression is crucial.

Purpose of the Study:

  • To systematically evaluate the effect of antihypertensive medication (AHM) on the progression of cerebral small vessel disease (CSVD) markers.
  • To synthesize evidence from randomized controlled trials (RCTs) investigating AHM's impact on key CSVD indicators.

Main Methods:

  • A systematic literature search was conducted across electronic databases up to January 30, 2017.
  • A random-effects meta-analysis was performed on data from 4 RCTs, focusing on MRI-assessed CSVD markers over at least one year.
  • Standardized mean difference was used to quantify treatment effects.

Main Results:

  • Antihypertensive medication (AHM) demonstrated a significant protective effect, reducing white matter hyperintensity progression over 28–47 months (SMD -0.19; 95% CI -0.32 to -0.06).
  • Two trials reported conflicting results regarding AHM's effect on brain atrophy progression.
  • No trials reported on the impact of AHM on lacunes, microbleeds, enlarged perivascular spaces, or acute small subcortical infarcts.

Conclusions:

  • Antihypertensive medication (AHM) offers a protective effect against the progression of white matter hyperintensities in patients with cerebral small vessel disease.
  • Current evidence does not support an effect of AHM on brain atrophy progression.
  • Further research is needed to investigate the effects of AHM on other CSVD markers, as trials are currently lacking.
Abstract

Keywords:
antihypertensive agentscerebral small vessel diseaseshumansmeta-analysiswhite matter

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