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(Hypertension. 2009;54:57.)
© 2009 American Heart Association, Inc.

Original Articles

Blood Pressure Components and Changes in Relation to White Matter Lesions

A 32-Year Prospective Population Study

Xinxin Guo; Leonardo Pantoni; Michela Simoni; Calle Bengtsson; Cecilia Björkelund; Lauren Lissner; Deborah Gustafson; Ingmar Skoog

From the Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology (X.G., D.G., I.S.), and Sections for Primary Health Care (C. Bengtsson, C. Björkelund) and Public Health Epidemiology (L.L.), Sahlgrenska School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and the Department of Neurological and Psychiatric Sciences (L.P., M.S.), University of Florence, Florence, Italy.

Correspondence to Xinxin Guo, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Wallinsgatan 6, SE-431 41 Mölndal, Sweden. E-mail xinxin.guo{at}neuro.gu.se

This study aimed to examine the long-term effect of high blood pressure (systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure) on white matter lesions and to study changes in different blood pressure components in relation to white matter lesions. A representative population of women was examined in 1968 and re-examined in 1974, 1980, 1992, and 2000. The presence and severity of white matter lesions on computed tomography were rated by a visual rating scale in 1992 and 2000 in 539 women. Systolic and diastolic blood pressures were measured at all of the examinations. We found that presence and severity of white matter lesions in 1992/2000 were associated with higher diastolic blood pressure and mean arterial pressure at each examination but not with systolic blood pressure and pulse pressure. Odds ratios (95% CIs) for the presence of white matter lesions per 10-mm Hg increase in diastolic pressure were 1.4 (1.0 to 1.9) in 1968, 1.3 (1.0 to 1.8) in 1974, 1.4 (1.1 to 1.9) in 1980, and 1.3 (1.0 to 1.6) in 1992 after adjustment for confounders. The presence of white matter lesions was also associated with a 24-year increase in diastolic pressure (>10 mm Hg), systolic pressure (>40 mm Hg), pulse pressure (>24 mm Hg), and mean arterial pressure (>6 mm Hg; odds ratios [95% CIs]: 2.6 [1.3 to 5.1] for diastolic pressure; 2.0 [1.2 to 3.4] for systolic pressure; 1.8 [1.1 to 2.7] for pulse pressure; and 2.2 [1.4 to 3.4] for mean arterial pressure). Our findings suggest that lowering high diastolic blood pressure and preventing large increases in systolic and diastolic blood pressures may have a protective effect on white matter lesions.

Key Words: blood pressure • white matter lesions • longitudinal study