• Lester Y Leung, Traci M Bartz, Kenneth Rice, James Floyd, Bruce Psaty, Jose Gutierrez, W T Longstreth, and Kenneth J Mukamal.
• From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.). lester.y.leung.md@gmail.com.
• Arterioscler. Thromb. Vasc. Biol. 2017 Aug 1; 37 (8): 1579-1586.

ObjectiveIn people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings.Approach And ResultsIn the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses.ConclusionsElevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.© 2017 American Heart Association, Inc.

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