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Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics

Adam de Havenon1, Jennifer J Majersik2, David L Tirschwell2

  • 1From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA. adam.dehavenon@hsc.utah.edu.

Neurology
|February 10, 2019
PubMed
Abstract

Insights

Higher systolic blood pressure, not A1c, drives white matter hyperintensity progression in type 2 diabetes. Intensive blood pressure control significantly slowed this progression, highlighting its importance for diabetic patients.

Area of Science:

  • Neurology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Type 2 diabetes is linked to increased risk of cerebrovascular complications, including white matter hyperintensity (WMH) progression.
  • Understanding the interplay between glycemic control, blood pressure, and WMH is crucial for managing diabetic patients.

Purpose of the Study:

  • To investigate the association between blood pressure mean (BPM) and hemoglobin A1c (HbA1c) with WMH progression in type 2 diabetes.
  • To evaluate the efficacy of intensive blood pressure and glycemic control in mitigating WMH progression.

Main Methods:

  • Secondary analysis of the ACCORD MIND trial data.
  • Assessed change in WMH volume (ΔWMH) via MRI from baseline to 40 months.
  • Correlated ΔWMH with systolic and diastolic BPM and HbA1c levels.
  • Compared ΔWMH between intensive and standard glycemic and blood pressure control arms.

Main Results:

  • Higher systolic BPM, but not diastolic BPM or HbA1c, was significantly associated with increased WMH progression (p < 0.001).
  • Intensive blood pressure control demonstrated a significant reduction in WMH progression compared to standard control (p < 0.001).
  • No significant difference in WMH progression was observed between intensive and standard glycemic control arms (p = 0.917).

Conclusions:

  • Elevated systolic blood pressure is a key driver of WMH progression in patients with type 2 diabetes.
  • Intensive blood pressure management is an effective strategy to reduce WMH progression in this population.
  • Aggressive blood pressure control is recommended for type 2 diabetics to prevent micro- and macrovascular complications.

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