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Association between cerebral microbleeds and hypertension in the Swedish general population "Good Aging in Skåne"
Sölve Elmståhl1, Katarina Ellström1, Arkadiusz Siennicki-Lantz1
1Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
Abstract:
Cerebral microbleeds (CMB) on MRI are frequent in healthy aging individuals but precede ischemic and hemorrhagic stroke and dementia. Different etiologies have been suggested for nonlobar CMB, which have a stronger connection to hypertension (HT) than do lobar CMB. This study aimed to investigate the prevalence of CMB and the association between nonlobar/lobar CMB and different blood pressure (BP) and HT treatment conditions in a longitudinal, population-based cohort of the Good Aging in Skåne (GÅS) study. White matter hyperintensities (WMH), CMB, atrophies, and infarctions were identified with brain 3T MRI, and BP parameters were examined in 344 randomly selected subjects between 70 and 87 years old. CMB were observed in 26% of the whole cohort, increasing from 19% of subjects in their 70s to 30% of those over 80 years of age. Of these subjects, 38% had multiple CMB, and 59% had a lobar localization. CMB were associated with severe confluent WMH (odds ratio = 7.02; 2.16-18.84). Increasing age, being male, and having HT, impaired cognition, or a history of angina pectoris were associated with CMB. Both lobar and nonlobar CMB were associated with HT. Nonlobar CMB were particularly associated with increased BP, pulse pressure, controlled HT, and uncontrolled HT. After controlling for sex and HT, age was no longer a risk factor for CMB In conclusion, sex and HT are the major risk factors for CMB, especially nonlobar CMB, which suggests stricter implementation of recommended guidelines for HT treatment in the elderly.
Insights
Cerebral microbleeds (CMB) are common in older adults and linked to hypertension (HT). Sex and HT are key risk factors, particularly for nonlobar CMB, highlighting the need for strict HT management in the elderly.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Cerebral microbleeds (CMB) are frequent in aging populations and associated with stroke and dementia risk.
- Nonlobar CMB show a stronger association with hypertension (HT) than lobar CMB.
- Understanding CMB prevalence and risk factors is crucial for managing neurological health in aging individuals.
Purpose of the Study:
- To investigate the prevalence of CMB in a population-based cohort.
- To examine the association between lobar/nonlobar CMB and blood pressure (BP) / HT treatment.
- To identify key risk factors for CMB in older adults.
Main Methods:
- Utilized brain 3T MRI to identify white matter hyperintensities (WMH), CMB, atrophies, and infarctions.
- Examined BP parameters in 344 randomly selected subjects aged 70-87 years from the Good Aging in Skåne (GÅS) study.
- Analyzed CMB prevalence and associations with demographic, clinical, and BP variables.
Main Results:
- CMB observed in 26% of the cohort, increasing with age (19% in 70s to 30% in 80s).
- CMB associated with severe confluent WMH, increasing age, male sex, HT, impaired cognition, and angina pectoris.
- Both lobar and nonlobar CMB linked to HT; nonlobar CMB particularly associated with elevated BP and pulse pressure, regardless of HT control status.
- Sex and HT identified as major risk factors for CMB, especially nonlobar CMB, after controlling for age and HT.
Conclusions:
- Sex and hypertension are the primary risk factors for cerebral microbleeds, particularly nonlobar CMB.
- Findings underscore the importance of stringent hypertension management in the elderly to mitigate CMB risk.
- Further research into targeted interventions for hypertension control may reduce the incidence of CMB and associated neurological conditions.