Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions

Abstract

In older adults at risk of vascular disease, the effect of intensive systolic blood pressure (SBP) control on brain heath is uncertain, despite its proven efficacy for reducing cardiovascular disease morbidity and mortality.¹ Epidemiologic data have identified hypertension as a primary risk factor for cerebral small vessel ischemic disease (SVID), particularly development of white matter lesions (WMLs).^2,3 Observational studies have increasingly suggested that SVID is associated with cognitive decline and the pathogenesis of Alzheimer disease and related dementias.^4,5 WMLs seen on brain magnetic resonance imaging (MRI) are an independent risk factor for cognitive decline and dementia.^6,7 It has been estimated that 30% to 60% of patients with Alzheimer disease and related dementias have vascular findings contributing to their cognitive impairment, while Alzheimer disease pathology may be present in 40% to 80% of patients with dementia for which the primary etiology is classified as vascular.^8-10