Hypertension and cerebral diffusion tensor imaging in small vessel disease

Rob A R Gons, Karlijn F de Laat, Anouk G W van Norden, Lucas J B van Oudheusden, Inge W M van Uden, David G Norris, Marcel P Zwiers, Frank-Erik de Leeuw

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND AND PURPOSE: Hypertension is a risk factor for cerebral small vessel disease, which includes white matter lesions (WML) and lacunar infarcts. These lesions are frequently observed on MRI scans of elderly people and play a role in cognitive decline. Preferably, one would like to evaluate the effect of hypertension before fluid-attenuated inversion recovery visible macrostructural lesions occur, possibly by investigating its effect on the microstructural integrity of the white matter. Diffusion tensor imaging provides measures of structural integrity.

METHODS: In 503 patients with small vessel disease, aged between 50 and 85 years, we cross-sectionally studied the relation between blood pressure, hypertension, and hypertension treatment status and diffusion tensor imaging parameters in both normal-appearing white matter (NAWM) and WMLs. All of the subjects underwent 1.5-T MRI and diffusion tensor imaging scanning. Fractional anisotropy and mean diffusivity were calculated in both NAWM and WMLs.

RESULTS: Increased blood pressure and hypertension were significantly related to lower fractional anisotropy in both NAWM and WMLs and to higher mean diffusivity in WMLs. For hypertensives, odds ratios for the risk of impaired microstructural integrity (fractional anisotropy) were 3.1 (95% CI: 1.8 to 5.7) and 2.1 (95% CI: 1.2 to 3.5) in NAWM and WMLs, respectively, compared with normotensives. Fractional anisotropy odds ratios for treated uncontrolled subjects were 6.5 (95% CI: 3.3 to 12.7) and 2.7 (95% CI: 1.5 to 5.1) in NAWM and WMLs, respectively, compared with normotensives.

CONCLUSIONS: Our data show that diffusion tensor imaging may be an appropriate tool to monitor the effect of blood pressure and the response to treatment on white matter integrity, probably even before the development of WMLs on fluid-attenuated inversion recovery.

Original languageEnglish
Pages (from-to)2801-6
Number of pages6
JournalStroke
Volume41
Issue number12
DOIs
Publication statusPublished - Dec 2010

Cite this

Gons, R. A. R., de Laat, K. F., van Norden, A. G. W., van Oudheusden, L. J. B., van Uden, I. W. M., Norris, D. G., ... de Leeuw, F-E. (2010). Hypertension and cerebral diffusion tensor imaging in small vessel disease. Stroke, 41(12), 2801-6. https://doi.org/10.1161/STROKEAHA.110.597237
Gons, Rob A R ; de Laat, Karlijn F ; van Norden, Anouk G W ; van Oudheusden, Lucas J B ; van Uden, Inge W M ; Norris, David G ; Zwiers, Marcel P ; de Leeuw, Frank-Erik. / Hypertension and cerebral diffusion tensor imaging in small vessel disease. In: Stroke. 2010 ; Vol. 41, No. 12. pp. 2801-6.
@article{698ac3ad21de47f79fb7a9c124a0eac0,
title = "Hypertension and cerebral diffusion tensor imaging in small vessel disease",
abstract = "BACKGROUND AND PURPOSE: Hypertension is a risk factor for cerebral small vessel disease, which includes white matter lesions (WML) and lacunar infarcts. These lesions are frequently observed on MRI scans of elderly people and play a role in cognitive decline. Preferably, one would like to evaluate the effect of hypertension before fluid-attenuated inversion recovery visible macrostructural lesions occur, possibly by investigating its effect on the microstructural integrity of the white matter. Diffusion tensor imaging provides measures of structural integrity.METHODS: In 503 patients with small vessel disease, aged between 50 and 85 years, we cross-sectionally studied the relation between blood pressure, hypertension, and hypertension treatment status and diffusion tensor imaging parameters in both normal-appearing white matter (NAWM) and WMLs. All of the subjects underwent 1.5-T MRI and diffusion tensor imaging scanning. Fractional anisotropy and mean diffusivity were calculated in both NAWM and WMLs.RESULTS: Increased blood pressure and hypertension were significantly related to lower fractional anisotropy in both NAWM and WMLs and to higher mean diffusivity in WMLs. For hypertensives, odds ratios for the risk of impaired microstructural integrity (fractional anisotropy) were 3.1 (95{\%} CI: 1.8 to 5.7) and 2.1 (95{\%} CI: 1.2 to 3.5) in NAWM and WMLs, respectively, compared with normotensives. Fractional anisotropy odds ratios for treated uncontrolled subjects were 6.5 (95{\%} CI: 3.3 to 12.7) and 2.7 (95{\%} CI: 1.5 to 5.1) in NAWM and WMLs, respectively, compared with normotensives.CONCLUSIONS: Our data show that diffusion tensor imaging may be an appropriate tool to monitor the effect of blood pressure and the response to treatment on white matter integrity, probably even before the development of WMLs on fluid-attenuated inversion recovery.",
keywords = "Aged, Aged, 80 and over, Anisotropy, Antihypertensive Agents/therapeutic use, Blood Pressure/physiology, Cerebrovascular Disorders/pathology, Cognition Disorders/pathology, Cross-Sectional Studies, Diffusion Magnetic Resonance Imaging, Drug Resistance, Female, Humans, Hypertension/drug therapy, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Odds Ratio, Risk Factors, Smoking/epidemiology",
author = "Gons, {Rob A R} and {de Laat}, {Karlijn F} and {van Norden}, {Anouk G W} and {van Oudheusden}, {Lucas J B} and {van Uden}, {Inge W M} and Norris, {David G} and Zwiers, {Marcel P} and {de Leeuw}, Frank-Erik",
year = "2010",
month = "12",
doi = "10.1161/STROKEAHA.110.597237",
language = "English",
volume = "41",
pages = "2801--6",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

Gons, RAR, de Laat, KF, van Norden, AGW, van Oudheusden, LJB, van Uden, IWM, Norris, DG, Zwiers, MP & de Leeuw, F-E 2010, 'Hypertension and cerebral diffusion tensor imaging in small vessel disease' Stroke, vol. 41, no. 12, pp. 2801-6. https://doi.org/10.1161/STROKEAHA.110.597237

Hypertension and cerebral diffusion tensor imaging in small vessel disease. / Gons, Rob A R; de Laat, Karlijn F; van Norden, Anouk G W; van Oudheusden, Lucas J B; van Uden, Inge W M; Norris, David G; Zwiers, Marcel P; de Leeuw, Frank-Erik.

In: Stroke, Vol. 41, No. 12, 12.2010, p. 2801-6.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Hypertension and cerebral diffusion tensor imaging in small vessel disease

AU - Gons, Rob A R

AU - de Laat, Karlijn F

AU - van Norden, Anouk G W

AU - van Oudheusden, Lucas J B

AU - van Uden, Inge W M

AU - Norris, David G

AU - Zwiers, Marcel P

AU - de Leeuw, Frank-Erik

PY - 2010/12

Y1 - 2010/12

N2 - BACKGROUND AND PURPOSE: Hypertension is a risk factor for cerebral small vessel disease, which includes white matter lesions (WML) and lacunar infarcts. These lesions are frequently observed on MRI scans of elderly people and play a role in cognitive decline. Preferably, one would like to evaluate the effect of hypertension before fluid-attenuated inversion recovery visible macrostructural lesions occur, possibly by investigating its effect on the microstructural integrity of the white matter. Diffusion tensor imaging provides measures of structural integrity.METHODS: In 503 patients with small vessel disease, aged between 50 and 85 years, we cross-sectionally studied the relation between blood pressure, hypertension, and hypertension treatment status and diffusion tensor imaging parameters in both normal-appearing white matter (NAWM) and WMLs. All of the subjects underwent 1.5-T MRI and diffusion tensor imaging scanning. Fractional anisotropy and mean diffusivity were calculated in both NAWM and WMLs.RESULTS: Increased blood pressure and hypertension were significantly related to lower fractional anisotropy in both NAWM and WMLs and to higher mean diffusivity in WMLs. For hypertensives, odds ratios for the risk of impaired microstructural integrity (fractional anisotropy) were 3.1 (95% CI: 1.8 to 5.7) and 2.1 (95% CI: 1.2 to 3.5) in NAWM and WMLs, respectively, compared with normotensives. Fractional anisotropy odds ratios for treated uncontrolled subjects were 6.5 (95% CI: 3.3 to 12.7) and 2.7 (95% CI: 1.5 to 5.1) in NAWM and WMLs, respectively, compared with normotensives.CONCLUSIONS: Our data show that diffusion tensor imaging may be an appropriate tool to monitor the effect of blood pressure and the response to treatment on white matter integrity, probably even before the development of WMLs on fluid-attenuated inversion recovery.

AB - BACKGROUND AND PURPOSE: Hypertension is a risk factor for cerebral small vessel disease, which includes white matter lesions (WML) and lacunar infarcts. These lesions are frequently observed on MRI scans of elderly people and play a role in cognitive decline. Preferably, one would like to evaluate the effect of hypertension before fluid-attenuated inversion recovery visible macrostructural lesions occur, possibly by investigating its effect on the microstructural integrity of the white matter. Diffusion tensor imaging provides measures of structural integrity.METHODS: In 503 patients with small vessel disease, aged between 50 and 85 years, we cross-sectionally studied the relation between blood pressure, hypertension, and hypertension treatment status and diffusion tensor imaging parameters in both normal-appearing white matter (NAWM) and WMLs. All of the subjects underwent 1.5-T MRI and diffusion tensor imaging scanning. Fractional anisotropy and mean diffusivity were calculated in both NAWM and WMLs.RESULTS: Increased blood pressure and hypertension were significantly related to lower fractional anisotropy in both NAWM and WMLs and to higher mean diffusivity in WMLs. For hypertensives, odds ratios for the risk of impaired microstructural integrity (fractional anisotropy) were 3.1 (95% CI: 1.8 to 5.7) and 2.1 (95% CI: 1.2 to 3.5) in NAWM and WMLs, respectively, compared with normotensives. Fractional anisotropy odds ratios for treated uncontrolled subjects were 6.5 (95% CI: 3.3 to 12.7) and 2.7 (95% CI: 1.5 to 5.1) in NAWM and WMLs, respectively, compared with normotensives.CONCLUSIONS: Our data show that diffusion tensor imaging may be an appropriate tool to monitor the effect of blood pressure and the response to treatment on white matter integrity, probably even before the development of WMLs on fluid-attenuated inversion recovery.

KW - Aged

KW - Aged, 80 and over

KW - Anisotropy

KW - Antihypertensive Agents/therapeutic use

KW - Blood Pressure/physiology

KW - Cerebrovascular Disorders/pathology

KW - Cognition Disorders/pathology

KW - Cross-Sectional Studies

KW - Diffusion Magnetic Resonance Imaging

KW - Drug Resistance

KW - Female

KW - Humans

KW - Hypertension/drug therapy

KW - Image Processing, Computer-Assisted

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Risk Factors

KW - Smoking/epidemiology

U2 - 10.1161/STROKEAHA.110.597237

DO - 10.1161/STROKEAHA.110.597237

M3 - Article

VL - 41

SP - 2801

EP - 2806

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 12

ER -

Gons RAR, de Laat KF, van Norden AGW, van Oudheusden LJB, van Uden IWM, Norris DG et al. Hypertension and cerebral diffusion tensor imaging in small vessel disease. Stroke. 2010 Dec;41(12):2801-6. https://doi.org/10.1161/STROKEAHA.110.597237