Relationship of Hypertension, Blood Pressure, and Blood Pressure Control With White Matter Abnormalities in the Women’s Health Initiative Memory Study (WHIMS)—MRI Trial

• Published in: The journal of clinical hypertension (Greenwich, Conn.) Conn.), 2010-03, Vol.12 (3), p.203-212
• Main Authors: Kuller, Lewis H., Margolis, Karen L., Gaussoin, Sarah A., Bryan, Nick R., Kerwin, Diana, Limacher, Marian, Wassertheil‐Smoller, Sylvia, Williamson, Jeff, Robinson, Jennifer G.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Brain - pathology; Drug Therapy, Combination; Estrogen Replacement Therapy; Estrogens, Conjugated (USP) - therapeutic use; Female; Follow-Up Studies; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Hypertensive Encephalopathy - diagnosis; Image Processing, Computer-Assisted; Journal of the CardioMetabolic Syndrome; Magnetic Resonance Imaging; Medroxyprogesterone Acetate - therapeutic use; Memory - drug effects; Mental Status Schedule; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; United States
• ISSN: 1524-6175; 1751-7176; 1751-7176
• DOI: 10.1111/j.1751-7176.2009.00234.x

J Clin Hypertens (Greenwich). 2010;12:203–212. ©2010 Wiley Periodicals, Inc. This paper evaluates the relationship of blood pressure (BP) levels at Women’s Health Initiative (WHI) baseline, treatment of hypertension, and white matter abnormalities among women in conjugated equine estrogen (CEE) and medroxyprogesterone acetate and CEE‐alone arms. The WHI Memory Study—Magnetic Resonance Imaging (WHIMS‐MRI) trial scanned 1424 participants. BP levels at baseline were significantly positively related to abnormal white matter lesion (WML) volumes. Participants treated for hypertension but who had BP ≥140/90 mm Hg had the greatest amount of WML volumes. Women with untreated BP ≥140/90 mm Hg had intermediate WML volumes. Abnormal WML volumes were related to hypertension in most areas of the brain and were greater in the frontal lobe than in the occipital, parietal, or temporal lobes. Level of BP at baseline was strongly related to amount of WML volumes. The results of the study reinforce the relationship of hypertension and BP control and white matter abnormalities in the brain. The evidence to date supports tight control of BP levels, especially beginning at younger and middle age as a possible and perhaps only way to prevent dementia.