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Interactive relations of blood pressure and age to subclinical cerebrovascular disease

Waldstein, Shari R.a,b,c; Wendell, Carrington R.a; Lefkowitz, David M.d; Siegel, Eliot L.d,e; Rosenberger, William F.f; Spencer, Robert J.a; Manukyan, Zorayrf; Katzel, Leslie I.b,c

doi: 10.1097/HJH.0b013e3283595651
ORIGINAL PAPERS: Cerebrovascular disease

Objective: To examine interactive relations of blood pressure (BP) and age to MRI indices of subclinical cerebrovascular disease in middle-aged to older adults.

Methods: One hundred and thirteen stroke-free and dementia-free, community-dwelling adults (ages 54–81 years; 65% men; 91% white) engaged in (1) clinical assessment of resting SBP and DBP; (2) MRI rated for periventricular white matter hyperintensities (WMH) and deep WMH silent brain infarction (SBI) and brain atrophy (i.e. ventricular enlargement and sulcal widening ). Principal components analysis of the MRI ratings yielded a two-component solution – (1) periventricular and deep WMH SBI; and (2) ventricular enlargement, sulcal widening.

Results: Relations of SBP, DBP and pulse pressure (PP) (and their interactions with age) to each MRI component were examined in multiple regression analyses adjusted for age, sex, fasting plasma glucose and cholesterol, and antihypertensives. For component 1, results indicated significant interactions of SBP and PP with age (P < 0.05); higher levels of SBP and PP were associated with greater white matter disease and brain infarction at younger ages (≤68 years). Significant interactions of SBP and DBP with age were also noted for component 2 (P < 0.05); higher levels of BP were associated with greater brain atrophy at younger ages (≤63 years).

Conclusion: Higher BP and PP are associated with greater subclinical cerebrovascular disease most prominently in the ‘young old’. Appropriate management of hypertension and arterial stiffening may be critical to the preservation of brain structure with ageing.

aDepartment of Psychology, University of Maryland, Baltimore County, Baltimore

bDivision of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore

cGeriatric Research Education and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore

dDepartment of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore

eDepartment of Diagnostic Radiology, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland

fDepartment of Statistics, George Mason University, Fairfax, Virginia, USA

Correspondence to Shari R. Waldstein, PhD, Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA. Tel: +1 410 455 2374; fax: +1 410 455 1055; e-mail:

Abbreviations: BP, blood pressure; B-VAMC, Baltimore Veterans Affairs Medical Center; CHS, Cardiovascular Health Study; FLAIR, fluid attenuated inversion recovery; PP, pulse pressure; SBI, silent brain infarction; WMH, white matter hyperintensities

Received 7 March, 2012

Revised 10 August, 2012

Accepted 14 August, 2012

© 2012 Lippincott Williams & Wilkins, Inc.