title: Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study.
abstract: OBJECTIVE
  This study was designed to explore the appropriate blood pressure (BP) target required to reduce cognitive decline and brain white matter lesions (WMLs) in elderly hypertensive patients.
  
  
  METHODS
  Elderly patients (n = 294, ≥80 years of age) being treated for hypertension were enrolled in a longitudinal study examining cognitive impairment after an initial assessment and a period of 4 years. All patients underwent neurological and cognitive assessment, laboratory examination, and magnetic resonance imaging of the brain.
  
  
  RESULTS
  The 4-year follow-up examination revealed that body mass index, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure, and Mini-Mental State Examination (MMSE) all showed a significant decline, whereas fasting plasma glucose, white matter hyperintensities (WMH) volume, and the WMH/total intracranial volume (TIV) ratio were significantly increased when compared with baseline observations. Interestingly, the decline in MMSE, as well as the increment of WMH and WMH/TIV ratio was smaller in patients with SBP ranging from 140 to 160 mm Hg than in those whose SBP was lower than 140 mm Hg or higher than 160 mm Hg (P < .05). Furthermore, we observed that a 15 to 35 mm Hg targeted lowering of SBP in the elderly patients was more beneficial to our cognitive analysis than treatments that achieved less than 15 mm Hg or greater than 35 mm Hg (P < .05).
  
  
  CONCLUSIONS
  In elderly hypertensive patients, there exists a beneficial target for SBP lowering beyond which treatment may not be beneficial for improving or delaying the progression of cognitive impairment and WMLs.
authors.affiliation: Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Peng
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China.
authors.forename: Fanghong
authors.initials: F
authors.lastname: Lu
authors.affiliation: Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Zhihao
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Na
authors.initials: N
authors.lastname: Hu
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China. Electronic address: zhendongliu876@126.com.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China. Electronic address: zhangwei7@medmail.com.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects*; D015992:Body Mass Index; D003072:Cognition Disorders / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000473:pathology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D012307:Risk Factors; D066127:White Matter / Q000473:pathology*
keywords: Systolic blood pressure; brain white matter lesions; cognitive impairment; excessive old age