Blood pressure and white matter hyperintensity volume - A review of the relationship and implications for stroke prediction and prevention

Royya Modir, Hannah Gardener, Clinton B Wright

Research output: Contribution to journalArticle

Abstract

A heavy burden of white matter hyperintensities (WMH) is a risk factor for stroke and vascular cognitive impairment making it important to understand their pathophysiology, aetiology and clinical implications. Ageing studies suggest a linear relationship between blood pressure (BP) and both WMH and microstructural integrity in normal-appearing white matter and, after age, hypertension is the strongest risk factor for WMH. Numerous large population-based observational studies have reported significant associations between elevated BP and WMH burden, however, the relative importance of systolic versus diastolic BP remains controversial. Limitations of prior studies include the use of only a single measurement of BP and oversimplifying hypertension as a dichotomous variable. Race/ethnic differences in the association between BP and WMH have been suggested, but most studies only included older Caucasians. Antihypertensive treatment has been demonstrated to slow WMH progression, but lowering BP in the elderly may also reduce brain perfusion in those with poor autoregulation. Ongoing trials aim to clarify the effects of BP treatment on WMH progression in multi-ethnic populations and the implications of these findings for stroke prevention require further study.

Original languageEnglish
Pages (from-to)224-227
Number of pages4
JournalEuropean Neurological Review
Volume7
Issue number4
StatePublished - Dec 1 2012

Fingerprint

Stroke
Blood Pressure
Hypertension
White Matter
Antihypertensive Agents
Population
Observational Studies
Blood Vessels
Homeostasis
Perfusion
Brain
Therapeutics

Keywords

  • Blood pressure
  • Cerebral small vessel disease
  • Hypertension
  • Leukoaraiosis
  • Vascular cognitive impairment
  • White matter hyperintensities

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Blood pressure and white matter hyperintensity volume - A review of the relationship and implications for stroke prediction and prevention. / Modir, Royya; Gardener, Hannah; Wright, Clinton B.

In: European Neurological Review, Vol. 7, No. 4, 01.12.2012, p. 224-227.

Research output: Contribution to journalArticle

@article{ac192b0e76b549fb8ea2df5ba60a83c4,
title = "Blood pressure and white matter hyperintensity volume - A review of the relationship and implications for stroke prediction and prevention",
abstract = "A heavy burden of white matter hyperintensities (WMH) is a risk factor for stroke and vascular cognitive impairment making it important to understand their pathophysiology, aetiology and clinical implications. Ageing studies suggest a linear relationship between blood pressure (BP) and both WMH and microstructural integrity in normal-appearing white matter and, after age, hypertension is the strongest risk factor for WMH. Numerous large population-based observational studies have reported significant associations between elevated BP and WMH burden, however, the relative importance of systolic versus diastolic BP remains controversial. Limitations of prior studies include the use of only a single measurement of BP and oversimplifying hypertension as a dichotomous variable. Race/ethnic differences in the association between BP and WMH have been suggested, but most studies only included older Caucasians. Antihypertensive treatment has been demonstrated to slow WMH progression, but lowering BP in the elderly may also reduce brain perfusion in those with poor autoregulation. Ongoing trials aim to clarify the effects of BP treatment on WMH progression in multi-ethnic populations and the implications of these findings for stroke prevention require further study.",
keywords = "Blood pressure, Cerebral small vessel disease, Hypertension, Leukoaraiosis, Vascular cognitive impairment, White matter hyperintensities",
author = "Royya Modir and Hannah Gardener and Wright, {Clinton B}",
year = "2012",
month = "12",
day = "1",
language = "English",
volume = "7",
pages = "224--227",
journal = "European Neurological Review",
issn = "1758-3837",
publisher = "Touch Briefings",
number = "4",

}

TY - JOUR

T1 - Blood pressure and white matter hyperintensity volume - A review of the relationship and implications for stroke prediction and prevention

AU - Modir, Royya

AU - Gardener, Hannah

AU - Wright, Clinton B

PY - 2012/12/1

Y1 - 2012/12/1

N2 - A heavy burden of white matter hyperintensities (WMH) is a risk factor for stroke and vascular cognitive impairment making it important to understand their pathophysiology, aetiology and clinical implications. Ageing studies suggest a linear relationship between blood pressure (BP) and both WMH and microstructural integrity in normal-appearing white matter and, after age, hypertension is the strongest risk factor for WMH. Numerous large population-based observational studies have reported significant associations between elevated BP and WMH burden, however, the relative importance of systolic versus diastolic BP remains controversial. Limitations of prior studies include the use of only a single measurement of BP and oversimplifying hypertension as a dichotomous variable. Race/ethnic differences in the association between BP and WMH have been suggested, but most studies only included older Caucasians. Antihypertensive treatment has been demonstrated to slow WMH progression, but lowering BP in the elderly may also reduce brain perfusion in those with poor autoregulation. Ongoing trials aim to clarify the effects of BP treatment on WMH progression in multi-ethnic populations and the implications of these findings for stroke prevention require further study.

AB - A heavy burden of white matter hyperintensities (WMH) is a risk factor for stroke and vascular cognitive impairment making it important to understand their pathophysiology, aetiology and clinical implications. Ageing studies suggest a linear relationship between blood pressure (BP) and both WMH and microstructural integrity in normal-appearing white matter and, after age, hypertension is the strongest risk factor for WMH. Numerous large population-based observational studies have reported significant associations between elevated BP and WMH burden, however, the relative importance of systolic versus diastolic BP remains controversial. Limitations of prior studies include the use of only a single measurement of BP and oversimplifying hypertension as a dichotomous variable. Race/ethnic differences in the association between BP and WMH have been suggested, but most studies only included older Caucasians. Antihypertensive treatment has been demonstrated to slow WMH progression, but lowering BP in the elderly may also reduce brain perfusion in those with poor autoregulation. Ongoing trials aim to clarify the effects of BP treatment on WMH progression in multi-ethnic populations and the implications of these findings for stroke prevention require further study.

KW - Blood pressure

KW - Cerebral small vessel disease

KW - Hypertension

KW - Leukoaraiosis

KW - Vascular cognitive impairment

KW - White matter hyperintensities

UR - http://www.scopus.com/inward/record.url?scp=84873863065&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873863065&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:84873863065

VL - 7

SP - 224

EP - 227

JO - European Neurological Review

JF - European Neurological Review

SN - 1758-3837

IS - 4

ER -