Diastolic Blood Pressure Is Associated With Regional White Matter Lesion Load

Abstract

Background and Purpose— Few studies have examined the separate contributions of systolic blood pressure and diastolic blood pressures (DBP) on subclinical cerebrovascular disease, especially using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines. Furthermore, associations with region-specific white matter hyperintensity volume (WMHV) are underexplored. Methods— Using data from the NOMAS (Northern Manhattan Study), a prospective cohort study of stroke risk and cognitive aging, we examined associations between systolic blood pressure and DBP, defined by the 2017 American College of Cardiology/American Heart Association guidelines, with regional WMHV. We used a linear mixed model approach to account for the correlated nature of regional brain measures. Results— The analytic sample (N=1205; mean age 64±8 years) consisted of 61% women and 66% Hispanics/Latinos. DBP levels were significantly related to WMHV differentially across regions ( P for interaction<0.05). Relative to those with DBP 90+ mm Hg, participants with DBP <80 mm Hg had 13% lower WMHV in the frontal lobe (95% CI, −21% to −3%), 11% lower WMHV in the parietal lobe (95% CI, −19% to −1%), 22% lower WMHV in the anterior periventricular region (95% CI, −30% to −14%), and 16% lower WMHV in the posterior periventricular region (95% CI, −24% to −6%). Participants with DBP 80 to 89 mm Hg also exhibited about 12% (95% CI, −20% to −3%) lower WMHV in the anterior periventricular region and 9% (95% CI, −18% to −0.4%) lower WMHV in the posterior periventricular region, relative to participants with DBP 90≥ mm Hg. Post hoc pairwise t tests showed that estimates for periventricular WMHV were significantly different from estimates for temporal WMHV (Holms stepdown–adjusted P <0.05). Systolic blood pressure was not strongly related to regional WMHV. Conclusions— Lower DBP levels, defined by the 2017 American College of Cardiology/American Heart Association guidelines, were related to lower white matter lesion load, especially in the periventricular regions relative to the temporal region.