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. 2023 Apr 1;44(5):2099-2108.
doi: 10.1002/hbm.26196. Epub 2022 Dec 30.

Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study

Liangqi Wang  1   2   3   4 , Huandong Lin  2   3   5 , Zehua Zhao  1 , Lingyan Chen  6 , Li Wu  2   5 , Ting Liu  2 , Jing Li  2 , Chu-Chung Huang  7 , Yifeng Peng  1 , Chun-Yi Zac Lo  8 , Xin Gao  2   3   5
Affiliations

Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study

Liangqi Wang et al. Hum Brain Mapp. .

Abstract

White matter hyperintensity (WMH) is associated with vascular hemodynamic alterations and reflects white matter injury. To date, the sex difference of tract-specific WMH and the relationship between high blood pressure (BP) and tract-specific WMH remain unclear. We recruited 515 subjects from the Shanghai Changfeng study (range 53-89 years, mean age 67.33 years). Systolic and diastolic blood pressure (SBP and DBP) were collected and used to calculate pulse pressure (PP). Magnetic resonance T1 and T2 FLAIR images were acquired to measure WMH and calculate WMH index. The ANCOVA test was performed to test the difference between sexes, and the linear regression model was used to examine the associations between BP and WMH index. Men showed higher WMH index than women in all white matter tracts (p < .001, respectively) except for the bilateral superior longitudinal fasciculus (SLF) and its left temporal part (tSLF). High SBP and PP was associated with a lower WMH index on the left corticospinal tract (CST), SLF, tSLF and right cingulum in hippocampus (p ≤ .001, respectively) in women, while high DBP was associated with a higher WMH index on the bilateral CST (left p < .001; right p = .001), left inferior longitudinal fasciculus (p < .001) and inferior fronto-occipital fasciculus (p = .002) in men. Men tend to have more WMH compared to women. A high SBP/PP relates to a lower WMH burden in women. This suggests that women could benefit from higher blood pressure in older age.

Keywords: MRI; high blood pressure; sex difference; tract-specific white matter hyperintensity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Difference of WMH index between male and female subjects. WMH index (mean ± SD) between male and female subjects. Men displayed significantly higher WMH index in most of the JHU white matter tracts than women. *p‐value < .05, **p‐value < .01, ***p‐value <.001. Black asterisk denotes significant difference without multiple comparison correction, violet asterisk denotes significant difference with Bonferroni correction
FIGURE 2
FIGURE 2
The interaction of age and blood pressure in prediction of total WMH index. Relationship between age and total WMH index in high SBP and low SBP female subjects (A). Relationship between age and total WMH index in high DBP and low DBP male subjects (B). Relationship between age and total WMH index in high PP and low PP female subjects (C). Blood pressure was dichotomized by the median value of SBP, DBP and PP. DBP, diastolic blood pressure; PP, pulse pressure; SBP, systolic blood pressure; WMH_index, white matter hyperintensity index
FIGURE 3
FIGURE 3
Relationship between age and tract‐specific WMH index in high‐blood pressure and low‐blood pressure subjects. Relationship between age and tract‐specific WMH index in high SBP and low SBP female subjects (A). Relationship between age and tract‐specific WMH index in high DBP and low DBP male subjects (B). Relationship between age and tract‐specific WMH index in high PP and low PP female subjects (C). Blood pressure was dichotomized by the median value of SBP, DBP and PP. DBP: diastolic blood pressure; PP: pulse pressure; SBP: systolic blood pressure; WMH_index: white matter hyperintensity index
See this image and copyright information in PMC

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