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Updated: Apr 24, 2026

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
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Systolic blood pressure and future stroke risk by asymptomatic brain lesions in a community MRI cohort: a

Kenichi Iwasa1, Naoki Omori2, Shun Aritake2

  • 1Department of Neurology, Faculty of Medicine, Shimane University, Izumo, Japan. ken1wasa@med.shimane-u.ac.jp.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|April 22, 2026
PubMed

Insights

Asymptomatic brain lesions (ABLs) are linked to increased stroke risk with higher systolic blood pressure (SBP). Current data suggests SBP management is crucial for primary stroke prevention in these individuals.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Radiology

Background:

  • Asymptomatic brain lesions (ABLs) like white matter hyperintensities (WMHs), silent brain infarcts (SBIs), and cerebral microbleeds (CMBs) are key MRI markers of cerebral small-vessel disease.
  • These ABLs are established predictors of future stroke events.
  • The ideal blood pressure (BP) target for primary stroke prevention in individuals with ABLs is not yet clearly defined.

Purpose of the Study:

  • To investigate the association between systolic blood pressure (SBP) and incident stroke risk in neurologically healthy adults with and without ABLs.
  • To explore whether ABL status modifies the relationship between SBP and stroke risk.

Main Methods:

  • Analysis of 2363 neurologically healthy adults from the "Brain Dock" cohort with brain MRI screening.
  • Follow-up for a mean of 8.9 years to ascertain incident stroke.
  • Cox proportional hazards models with restricted cubic splines were used to evaluate SBP and stroke risk, stratified by ABL status (SBI, WMH grade ≥ 2, or CMBs) and adjusted for relevant covariates.

Main Results:

  • Stroke risk showed a progressive increase with higher SBP levels in both individuals with and without ABLs.
  • No statistically significant interaction was found between SBP and ABL status regarding stroke risk.
  • Exploratory analysis suggested a potential increase in risk at lower SBP levels in the ABL-positive group, though this requires further investigation.

Conclusions:

  • Systolic blood pressure is a significant risk factor for stroke, irrespective of the presence of ABLs.
  • While exploratory findings suggest a possible heightened sensitivity to SBP in those with ABLs, definitive conclusions require larger prospective cohorts and interventional studies.
  • Current evidence does not support altering clinical BP strategies based solely on MRI-defined cerebrovascular markers like ABLs.
Keywords:
Asymptomatic brain lesionsDigital hypertensionImplemental hypertensionMRIStroke

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