Major risk factors for the appearance of white-matter lesions on MRI in hypertensive patients with controlled blood pressure

Takeshi Takami1, Shigeru Yamano2, Sadanori Okada3, Mio Sakuma4, Takeshi Morimoto4, Hiroshi Hashimoto5, Satoshi Somekawa3, Yoshihiko Saito31Department of Internal Medicine, Clinic Jingumae, Kashihara, Japan; 2Department of Internal Medicine, Nara Rehabilitation Center, Nara, Japan; 3First Department of Internal Medicine, Nara Medical University, Kashihara, Japan; 4Center for General Internal Medicine and Emergency Care, Kinki University School of Medicine, Osaka, Japan; 5Department of Neurosurgery, Hashimoto Clinic, Kashihara, JapanPurpose: Blood pressure (BP), age, and reduced renal function are major risk factors for white-matter lesions (WMLs) in the general population. However, it remains unclear whether or not the BP itself or other parameters related to the BP are associated with WMLs in hypertensive patients with well-controlled BP. We investigated the relationships of the presence of WMLs with the central systolic BP (cSBP) and estimated glomerular filtration rate (eGFR) in treated hypertensive patients.Method: We studied 185 hypertensive patients with median duration of hypertension, 10.0 years, whose BP is controlled to SBP and diastolic BP (DBP) of 139 ± 17 and 79 ± 10 mmHg, respectively. We measured cSBP and brain magnetic resonance imaging (MRI) was examined within 2 weeks after last BP and biological measurements.Results: Patients with higher-grade WMLs, as assessed by the presence of Scheltens deep white-matter hyperintensity (SDWMH) in the frontal (grade 0–2 vs 3–6) and parietal areas (grade 0–2 vs 3–6) where small arteries are affected at earlier stage of hypertension, as well as that of Fazekas deep white-matter hyperintensity (FDWMH) (grade 2–3 vs 0–1) and Fazekas periventricular hyperintensity (FPVH) (grade 1–3 vs 0) were older, had higher serum creatinine levels, a longer duration of hypertension, and lower eGFR values. The grade of the WMLs was not associated with either the cSBP or the brachial SBP. In logistic regression analyses after adjustment for age, sex, cSBP, and hypertension duration, showed significant association between eGFR and WMLs. The patients with lower eGFR (<60 mL/minute/1.73 m2) tended to have higher grade WMLs. The odds ratio was 2.87 for FDWMH (P = 0.017), 1.99 for FPVH (P = 0.131), and 2.33 for SDWMH in the parietal area (P = 0.045).Conclusion: Presence of WMLs was associated with eGFR, but not with either the brachial SBP or cSBP in hypertensive patients with well-controlled BP.Keywords: white-matter lesions, central systolic blood pressure, estimated glomerular filtration rate