Blood Pressure and Progression of Cerebral Atrophy in Patients With Vascular Disease

Background Cerebral atrophy on brain magnetic resonance imaging (MRI) has been associated with vascular risk factors including hypertension. Progression of cerebral atrophy and its risk factors have not been studied in vascular disease patients. This study aimed to assess the progression of cerebral atrophy and to evaluate possible associations with blood pressure (BP) in patients with pre-existing vascular disease. Methods A total of 331 patients with manifest vascular disease from the Second Manifestations of ARTerial Disease (SMART) Study underwent baseline and follow-up MRI scanning (mean follow-up 4.1 ± 0.3 years). The annual change in brain and ventricular volume was calculated with an automated quantitative volumetric method. Associations between BP and change in brain and ventricular volumes and between BP and the occurrence of lacunar infarcts were analyzed. Results At baseline mean age was 58 ± 9 years and mean BP was 138/80 mm Hg. Mean annual decrease in brain tissue volume was 6.5 ± 3.8 ml and mean annual increase in ventricular volume was 1.0 ± 1.0 ml. There was no association observed between BP and annual change in brain or ventricular volume, but a clear association was found between BP and incident lacunar infarcts (odds ratio 1.57; 1.11–2.22 per s.d. increase in systolic BP (SBP)). Conclusions The magnitude of changes in brain tissue and ventricular volume in patients with vascular disease was comparable to the physiological changes described in normal people at a much higher age. Progression of cerebral atrophy in this population may be associated with advanced physiological aging, but is probably not caused by elevated BP. American Journal of Hypertension 2009; 22:1183–1189 © 2009 American Journal of Hypertension, Ltd.