Related Experiment Video
Updated: Dec 24, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
Anthony G Chesebro1, Jesus D Melgarejo1, Reinier Leendertz1
1From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
Objective:
To test the hypotheses that hypertension and nocturnal blood pressure are related to white matter hyperintensity (WMH) volume, an MRI marker of small vessel cerebrovascular disease, and that WMH burden statistically mediates the association of hypertension and dipping status with memory functioning, we examined the relationship of hypertension and dipping status on WMH volume and neuropsychological test scores in middle-aged and older adults.
Methods:
Participants from the community-based Maracaibo Aging Study received ambulatory 24-hour blood pressure monitoring, structural MRI, and neuropsychological assessment. Four hundred thirty-five participants (mean ± SD age 59 ± 13 years, 71% women) with available ambulatory blood pressure, MRI, and neuropsychological data were included in the analyses. Ambulatory blood pressure was used to define hypertension and dipping status (i.e., dipper, nondipper, and reverse dipper based on night/day blood pressure ratio <0.9, 0.9-1, and >1, respectively). Outcome measures included regional WMH and memory functioning derived from a neuropsychological test battery.
Results:
The majority of the participants (59%) were hypertensive. Ten percent were reverse dippers, and 40% were nondippers. Reverse dipping in the presence of hypertension was associated with particularly elevated periventricular WMH volume (F 2,423 = 3.78, p = 0.024) and with lowered memory scores (F 2,423 = 3.911, p = 0.021). Periventricular WMH volume mediated the effect of dipping status and hypertension on memory (β = -4.1, 95% confidence interval -8.7 to -0.2, p < 0.05).
Conclusion:
Reverse dipping in the presence of hypertension is associated with small vessel cerebrovascular disease, which, in turn, mediates memory functioning. These results point toward reverse dipping as a marker of poor nocturnal blood pressure control, particularly among hypertensive individuals, with potentially pernicious effects on cerebrovascular health and associated cognitive function.
Insights
Hypertension combined with reverse dipping, a lack of nocturnal blood pressure decrease, is linked to increased white matter hyperintensity (WMH) volume and impaired memory functioning in middle-aged and older adults.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- Hypertension is a risk factor for cerebrovascular disease.
- Nocturnal blood pressure dipping patterns may influence cardiovascular and cognitive health.
- White matter hyperintensities (WMH) on MRI indicate small vessel cerebrovascular disease.
Purpose of the Study:
- To investigate the relationship between hypertension, nocturnal blood pressure dipping status, and white matter hyperintensity (WMH) volume.
- To determine if WMH burden mediates the association between hypertension/dipping status and memory functioning.
- To examine these associations in middle-aged and older adults.
Main Methods:
- Utilized data from the Maracaibo Aging Study, including 435 participants (mean age 59).
- Assessed ambulatory 24-hour blood pressure, structural MRI for WMH volume, and neuropsychological tests for memory functioning.
- Defined hypertension and dipping status (dipper, nondipper, reverse dipper) based on blood pressure patterns.
Main Results:
- Hypertension was prevalent in 59% of participants; 10% were reverse dippers.
- Reverse dipping with hypertension correlated with higher periventricular WMH volume and lower memory scores.
- Periventricular WMH volume significantly mediated the impact of dipping status and hypertension on memory.
Conclusions:
- Reverse dipping in hypertensive individuals is associated with small vessel cerebrovascular disease.
- This cerebrovascular disease, indicated by WMH, mediates the effect on memory functioning.
- Reverse dipping serves as a marker for poor nocturnal blood pressure control, negatively impacting brain health and cognition.
More Related Videos
04:33Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression
Published on: April 26, 2024
06:23A Chronic Sleep Fragmentation Model using Vibrating Orbital Rotor to Induce Cognitive Deficit and Anxiety-Like Behavior in Young Wild-Type Mice
Published on: September 22, 2020
Related Concept Videos
01:18Neural Regulation of Blood Pressure
Baroreceptor Reflex
Baroreceptors, located in the carotid sinuses and aortic arch, detect changes in blood pressure. When blood pressure rises, these stretch-sensitive receptors...
01:29Hypertension II: Pathophysiology
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
01:28Factors affecting Blood pressure
Physiological Factors:
01:18Hypertension and Regulation of Blood Pressure