Progressive WMD in hypertension tied to cognitive impairment

  • Jiménez-Balado J & al.
  • Hypertension
  • 4 Jan 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In patients with hypertension, progressive periventricular white matter disease (WMD) on MRI is linked to a 6-fold increase in risk for cognitive decline, even if they’re taking antihypertensives.

Why this matters

  • Hypertension has been tied to increased dementia risk, but any subtle brain changes that underlie the link have been unclear. 

Key results

  • 9.1% had WMDs.
  • Compared with patients with no progression, participants with more periventricular white matter hyperintensities (WMHs) had greater risk for:
    • Mild cognitive decline: OR, 6.184 (95% CI, 1.506-25.370; P=.011), and
    • Global cognitive function: adjusted mean (standard error), −0.519 (0.176) vs 0.057 (0.044), respectively (P=.004).

Study design

  • Data from ISSYS (Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study), n=345 (median age, 65 years), average BP 144.5/76.5 mmHg.
  • WMHs on brain MRI graded as none, minor, or marked at baseline and follow-up.
  • Cognitive testing and diagnosis performed.
  • Funding: Instituto de Salud Carlos III, European Regional Development Fund.

Limitations

  • Generalizability is not clear.
  • Some potential sources of bias.

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