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Blood Pressure and WM Hyperintensity Progression

Neurology; ePub 2019 Feb 8; de Havenon, et al

Higher systolic blood pressure (BP) was associated with white matter hyperintensity (WMH) progression, according to a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD MIND) research materials. However, an intensive BP control intervention reduced this progression. These recent results provide further support for an aggressive approach to BP control in type 2 diabetics. The primary outcome of this analysis was change in WMH volume (ΔWMH) between a baseline and month-40 MRI, and the primary predictor was BP mean (BPM) and A1c between the MRIs. Additional analyses compared ΔWMH in the intensive vs standard glycemic control randomization arms (n=502) and intensive vs standard BP control randomization arms (n=314). Key highlights included:

  • Higher systolic BPM, but not diastolic BPM or A1c, was associated with WMH progression.
  • The ΔWMH in tertiles of increasing systolic BPM was 0.7, 0.9, and 1.2 cm3.
  • ΔWMH was lower in the intensive vs standard BP control randomization arm, but there was no difference in the glycemic control arms.


de Havenon A, Majersik JJ, Tirschwell DL, McNally JS, Stoddard G, Rost NS. Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics. [Published online ahead of print February 8, 2019]. Neurology. doi:10.1212/WNL.0000000000007093.