title: Major risk factors for the appearance of white-matter lesions on MRI in hypertensive patients with controlled blood pressure.
abstract: OBJECTIVE
  Blood pressure (BP), age, and reduced renal function are major risk factors for white-matter lesions (WMLs) in the general population. However, it remains unclear whether or not the BP itself or other parameters related to the BP are associated with WMLs in hypertensive patients with well-controlled BP. We investigated the relationships of the presence of WMLs with the central systolic BP (cSBP) and estimated glomerular filtration rate (eGFR) in treated hypertensive patients.
  
  
  METHODS
  We studied 185 hypertensive patients with median duration of hypertension, 10.0 years, whose BP is controlled to SBP and diastolic BP (DBP) of 139 ± 17 and 79 ± 10 mmHg, respectively. We measured cSBP and brain magnetic resonance imaging (MRI) was examined within 2 weeks after last BP and biological measurements.
  
  
  RESULTS
  Patients with higher-grade WMLs, as assessed by the presence of Scheltens deep white-matter hyperintensity (SDWMH) in the frontal (grade 0-2 vs 3-6) and parietal areas (grade 0-2 vs 3-6) where small arteries are affected at earlier stage of hypertension, as well as that of Fazekas deep white-matter hyperintensity (FDWMH) (grade 2-3 vs 0-1) and Fazekas periventricular hyperintensity (FPVH) (grade 1-3 vs 0) were older, had higher serum creatinine levels, a longer duration of hypertension, and lower eGFR values. The grade of the WMLs was not associated with either the cSBP or the brachial SBP. In logistic regression analyses after adjustment for age, sex, cSBP, and hypertension duration, showed significant association between eGFR and WMLs. The patients with lower eGFR (<60 mL/minute/1.73 m(2)) tended to have higher grade WMLs. The odds ratio was 2.87 for FDWMH (P = 0.017), 1.99 for FPVH (P = 0.131), and 2.33 for SDWMH in the parietal area (P = 0.045).
  
  
  CONCLUSIONS
  Presence of WMLs was associated with eGFR, but not with either the brachial SBP or cSBP in hypertensive patients with well-controlled BP.
authors.affiliation: Department of Internal Medicine, Clinic Jingumae, Kashihara, Japan. takami66@m5.kcn.ne.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takami
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yamano
authors.forename: Sadanori
authors.initials: S
authors.lastname: Okada
authors.forename: Mio
authors.initials: M
authors.lastname: Sakuma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Somekawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001921:Brain / Q000473:pathology*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D056784:Leukoencephalopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents