4.7 Article

Association Between Ambulatory 24-Hour Blood Pressure Levels and Brain Volume Reduction A Cross-Sectional Elderly Population-Based Study

Journal

HYPERTENSION
Volume 60, Issue 5, Pages 1324-+

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.112.193409

Keywords

blood pressure; lobar atrophy; aged; cross-sectional study; magnetic resonance imaging

Funding

  1. French Minister of Health (Cellule Projet Hospitalier de Recherche Clinique National)
  2. French Minister of Health (Direction Interregionale de la Recherche Clinique)
  3. French Minister of Health (CHU Saint-Etienne)
  4. French Minister of Health (Appel d'Offre)
  5. Association de Recherche SYNAPSE
  6. Societe Francaise d'Hypertension Arterielle (Bourse)

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Previous literature has shown mixed results regarding the association between blood pressure levels and brain volume reduction. The objectives of this study were to determine whether high blood pressure levels were associated with focal brain volume reduction and whether high blood pressure-related focal brain volume reduction was associated with a decline in executive function performance. On the basis of a cross-sectional design, 24-hour ambulatory blood pressure measurements, as well as brain morphology from 3-dimensional magnetic resonance images, were assessed among 183 participants (mean, 65 +/- 0.6 years; 62.4% women). Average levels of systolic and diastolic blood pressures, as well as dip, pulse pressure, and mean arterial blood pressure, were used as outcomes. Cortical gray and white matter volumes were determined by automatic calculation using Statistical Parametric Mapping segmentation. Folstein's Mini-Mental State Examination, digit span, part B of Trail Making, and Stroop tests were used to assess executive function performance. Sex, use of antihypertensive drugs, duration of hypertension, leukoaraiosis, body mass index, education level, and total brain matter volume were used as potential confounders. A significant blood pressure-related decrease in gray matter volume of the left supplementary motor areas (Brodmann area 6) and of the left superior and middle frontal gyrus (Brodmann area 8) was shown. No significant decrease was found with white matter volume. Blood pressure-related decreases in gray matter volume were significantly associated with a decline in executive function performance. The association of high blood pressure with brain volume reduction may in part explain blood pressure-related cognitive decline leading to dementia. (Hypertension. 2012;60:1324-1331.) circle Online Data Supplement

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