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Comparative Study
. 2010 Jan;41(1):3-8.
doi: 10.1161/STROKEAHA.109.566992. Epub 2009 Nov 19.

Blood pressure and white-matter disease progression in a biethnic cohort: Atherosclerosis Risk in Communities (ARIC) study

Rebecca F Gottesman  1 , Josef Coresh, Diane J Catellier, A Richey Sharrett, Kathryn M Rose, Laura H Coker, Dean K Shibata, David S Knopman, Clifford R Jack, Thomas H Mosley Jr
Affiliations
Comparative Study

Blood pressure and white-matter disease progression in a biethnic cohort: Atherosclerosis Risk in Communities (ARIC) study

Rebecca F Gottesman et al. Stroke. 2010 Jan.

Abstract

Background and purpose: Blood pressure (BP) is a predictor of concurrent and subsequently measured white-matter hyperintensity (WMH), but longitudinal studies of WMH changes and data in black participants are lacking. We hypothesized that WMH progression would be (1) strongly related to BP in blacks and whites and (2) predicted more strongly by earlier (midlife) or cumulative BP measurements than by measures at older ages.

Methods: Participants were 983 individuals (49% black) from the Atherosclerosis Risk in Communities (ARIC) Study who underwent cerebral magnetic resonance imaging in 1993-1995 and 2004-2006. Associations between BP (measured at each of 5 visits, in addition to a time-averaged cumulative BP) and progression of WMHs were analyzed and compared.

Results: Cumulative systolic BP (SBP) was the strongest BP predictor of WMH progression in adjusted models. Higher cumulative SBP (by 20 mm Hg) was associated with greater progression of WMHs and was similar in blacks (2.5 cm(3), P<0.0001) and whites (2.6 cm(3), P<0.0001). Higher cumulative SBP (per 20 mm Hg) was also associated with being in the top quintile of WMH progression (adjusted odds ratio=2.0; 95% CI, 1.6 to 2.6). Earlier SBP measurements were stronger predictors of WMH progression than were later SBP measurements, but in blacks only.

Conclusions: In this population-based cohort, cumulative SBP was a stronger predictor of WMH progression than SBP from individual visits, in both blacks and whites. Earlier BPs were stronger predictors than BPs measured at later time points in blacks only.

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Conflict of interest statement

CONFLICT OF INTEREST: Dr. Knopman has served on a Data Safety Monitoring Board for Sanofi-Aventis Pharmaceuticals, will serve on a Data Safety Monitoring Board for Lilly, and is an investigator for clinical trials sponsored by Baxter Pharmaceuticals, Elan Pharmaceuticals and Forest Pharmaceuticals. He has served as a one-time consultant to GlaxoSmithKline regarding an anti-Alzheimer drug. He is an Associate Editor of Neurology for which he receives compensation from the American Academy of Neurology. Dr. Jack has received research support from and has been a consultant for Pfizer. The other authors have neither conflicts of interest nor other financial disclosures.

Figures

Figure 1
Figure 1
Scatterplot of semiautomated white matter volume for each qualitative white matter grade. Both measurements are made from the same follow-up Brain MRI (visit 5). The line shows a quadratic fit of the data.
Figure 2
Figure 2
Distribution of white matter grade categories at visits 3 and 5, by race. Diagonal line demonstrates no change in grade. Larger circles indicate more individuals.
Figure 3
Figure 3
Adjusted odds ratios (OR) of top quintile of change in white matter hyperintensity volume, per 20 mm Hg higher SBP at varying time points and shown by race. Cumulative time-averaged SBP and SBP measurements from each visit are displayed.
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