Average ambulatory daytime blood pressure, but not office blood pressure is associated with progression of cerebrovascular disease and cognitive decline in older people Objective: A prospective cohort study in subjects 75 to 89 years of age to determine relations among ambulatory and clinic BP, progression of white matter lession (white matter hyperintensity volume), and functional capabilities in older people ABPM, Clinic brachial BP, magnetic resonance imaging, gait studies and neuro-psychological testing were performed at baseline an 24 months White WB. Circulation. 2011;124:

Characteristics of the patient population at baseline and 24 months ParameterBaseline Mean (SD) 24-Month mean (SD) P Age, y82.1 (3.9)84.2 (3.9)NA Sex, M:F31:46 NA Body mass index, kg/m² 26.7 (4.7)26.3 (4.5)0,02 Total cholesterol, mg/dL 198 (39)180 (41)< * Low-density lipoprotein cholesterol, mg/dL 126 (36)102 (33)< * High-density lipoprotein cholesterol, mg/dL 56 (15)55 (16)0.06 Triglycerides, mg/dL100 (41)95 (41)0.25 Serum glucose, mg/dL 99 (14)101 (17)0.09 Insulin, µlU/mL7.64 (7.92)8.02 ( 10.63)0.47 High-sensitivity C- reactive protein, mg/L 3.32 (3.99)3.49 (5.48)0.79 Plasminogen activator inhibitor, mg/dL 21.9 (13.5)24.6 (19.3)0.08 ParameterBaseline Mean (SD) 24-Month mean (SD) P Magnetic resonance Imaging Total brain volume, mL (143.1) (144.1)0.43 White matter hyperintensity volume, mL 13.9 (12.8)20.5 (16.2)< * White matter hyperintensity/total brain volume (%) 1.00 (0.90)1.47 (1.20)< * Functional assessments: Mobility parameters Tinetti Gait11.24 (1.19)11.24 (1.31) ft walk time, s3.1 (0.7)3.2 (0.8)0.40 Maximum velocity, m/s 0.70 (0.15)0.70 (0.18)0.84 Time to descend 3 stairs, ms 5019 (1121)6400 (2521)< * Cognitive studies Trails B, s114 (68)130 (76.)0.05 Stroop color and word reaction time, ms 27 (9.0)26 (9)0.23 Sequential process time, ms 589 (149)545 (194)0.07 Simple reaction time, ms 414 (132)417 (164)0.72

Changes in ABPM, but not in Brachial BP, predict white matter lesions and functional parameter decline Change in 24-h Systolic BPChange in Clinic Systolic BP Estimate (95% CI)PEtstimate (95% CI)P Total WMH, %0.02 (0.01–0.029)0,000*0.003 ( to 0.009)0.42 Tinetti Gait ( to 0.028) ( to 0.029)0.776 Stair descent time, ms6.973 ( to 37.29) ( to 15.15)0.645 Maximal gait velocity, m/s ( to 0.005) ( to 0.001)0.219 Walk time, s0.01 ( to 0.022) ( to 0.007)0.945 Trails B, s1.081 (0.128–2.035)0.030*0.153 (-0.58 to 0.887)0.684 Stroop color and Word, ms ( to 0.016) ( to 0.061)0.678 Sequential process time, ms0.874 ( to 4.31) (-4.07 to 0.319)0.099 Simple reaction time, ms3.913 (1.13–6.696)0.008*0.508 ( to 2.38)0.596 * significant

Ambulatory blood pressure, but not office brachial BP predicts white matter lesions Ambulatory blood pressureClinic blood pressure « Increased ambulatory systolic BP, but not clinic BP, from baseline to 24 months of follow-up was associated with increased white matter hyperintensity volume ».

Only the HYpertension in the Very Elderly Trial (HYVET) has studied the benefits of antihypertensive therapy in an age group similar to that in the present study. The present study demonstrates for the first time the importance of 24-hour systolic BP in the progression of brain white matter lesion burden, associated with impairment of cognitive function in older people Of interest is that the mean values in the highest tertile of clinic and 24-hour systolic BP are 153 and 144 mm Hg, respectively. The 24-hour systolic BP might be a potential target for intervention in the elderly to reduce progression of microvascular disease of the brain, and thus favorably affect function. Only the HYpertension in the Very Elderly Trial (HYVET) has studied the benefits of antihypertensive therapy in an age group similar to that in the present study. The present study demonstrates for the first time the importance of 24-hour systolic BP in the progression of brain white matter lesion burden, associated with impairment of cognitive function in older people Of interest is that the mean values in the highest tertile of clinic and 24-hour systolic BP are 153 and 144 mm Hg, respectively. The 24-hour systolic BP might be a potential target for intervention in the elderly to reduce progression of microvascular disease of the brain, and thus favorably affect function. Implications of the findings