Greater Impact of Coexistence of Hypertension and Diabetes on Silent Cerebral Infarcts

Abstract

Background and Purpose— Silent cerebral infarcts (SCIs), often found in the elderly and hypertensives, have been proposed as an indicator of poorer cerebrovascular prognosis. The aim of this study was to evaluate the prevalence and determinants of SCI in hypertensives with or without diabetes mellitus (DM). Methods— We studied 360 asymptomatic hypertensive subjects with or without DM (mean age, 67.4 years; range, 41 to 88 years). We performed 24-hour ambulatory blood pressure (BP) monitoring and brain MRI. The subjects were classified into a diabetic hypertension group with DM (DHT, n=159) or a non-DM hypertension group (non-DHT, n=201). Results— SCIs (presence of ≥1) were found in 82% of the DHT and 58% of the non-DHT ( P <0.001) group; multiple SCIs (the presence of ≥3) were found in 62% of the DHT and 35% of the non-DHT group ( P <0.001); and 24-hour ambulatory BP levels were comparable between groups. DM was a powerful determinant of both SCIs (odds ratio [OR], 2.95; P <0.01) and multiple SCIs (OR, 3.05; P <0.001) independently of age and 24-hour systolic BP, whereas only multiple SCIs were associated with 24-hour systolic BP. When patients were subclassified by ambulatory BP and the presence of DM (sustained hypertension [SHT]+DM, white-coat hypertension [WCHT]+DM, SHT, and WCHT groups), the prevalence of SCI and multiple SCIs was higher in the SHT+DM than in the SHT group, and only multiple SCIs were higher in the WCHT+DM than the WCHT group. Conclusions— Diabetes was the major determinant of SCIs in both SHT and WCHT.