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Effect of intensive blood pressure control on the prevention of white matter hyperintensity: Systematic review and meta-analysis of randomized trials.

ABSTRACT: Hypertension is an important cause of cerebral small vessel disease, especially of white matter hyperintensity (WMH). The ability of intensive blood pressure (BP) control in preventing this pathological progression remains unclear. The authors systematically searched PubMed, EMBASE, SCOPUS, and Cochrane library for publications until July 20, 2020. Studies included were clinical trials with random allocation to an antihypertensive medication against placebo, or different treatment targets. The primary outcome was intergroup differences in the change of WMH volume. A random-effect model was applied for pooling effect measures. Subgroup analysis and meta-regression were conducted to explore heterogeneity. Seven studies with 2693 patients were identified. Compared with the control group, patients in the intensive BP control group had a slower progression of WMH, with a pooled intergroup standard mean difference (SMD) for WMH change of -0.22 (95% CI: -0.35 ~ -0.09, I² = 63%). For studies comparing intensive and standard BP target, the pooled SMD is -0.37 (95% CI:-0.50~-0.24, I² = 0%), while the pooled SMD of studies comparing active antihypertensive medication and placebo was only -0.08 (95% CI: -0.17 ~ 0.01, I² = 0%). Meta-regression analysis showed that the reduction in WMH progression is proportional to the magnitude of intensive BP control (β = -0.028, P < .001). In conclusion, intensive BP control prevents WMH progression, and its effect is associated with the magnitude of intensive BP control.

SUBMITTER: Lai Y

PROVIDER: S-EPMC8029786 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Effect of intensive blood pressure control on the prevention of white matter hyperintensity: Systematic review and meta-analysis of randomized trials.

Lai Yiwei Y Jiang Chao C Du Xin X Sang Caihua C Guo Xueyuan X Bai Rong R Tang Ribo R Dong Jianzeng J Ma Changsheng C

Journal of clinical hypertension (Greenwich, Conn.) 20200910 11

Hypertension is an important cause of cerebral small vessel disease, especially of white matter hyperintensity (WMH). The ability of intensive blood pressure (BP) control in preventing this pathological progression remains unclear. The authors systematically searched PubMed, EMBASE, SCOPUS, and Cochrane library for publications until July 20, 2020. Studies included were clinical trials with random allocation to an antihypertensive medication against placebo, or different treatment targets. The p ...[more]

PMID: 33459521

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Project description:ImportanceThe effect of intensive blood pressure lowering on brain health remains uncertain.ObjectiveTo evaluate the association of intensive blood pressure treatment with cerebral white matter lesion and brain volumes.Design, setting, and participantsA substudy of a multicenter randomized clinical trial of hypertensive adults 50 years or older without a history of diabetes or stroke at 27 sites in the United States. Randomization began on November 8, 2010. The overall trial was stopped early because of benefit for its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Brain magnetic resonance imaging (MRI) was performed on a subset of participants at baseline (n = 670) and at 4 years of follow-up (n = 449); final follow-up date was July 1, 2016.InterventionsParticipants were randomized to a systolic blood pressure (SBP) goal of either less than 120 mm Hg (intensive treatment, n = 355) or less than 140 mm Hg (standard treatment, n = 315).Main outcomes and measuresThe primary outcome was change in total white matter lesion volume from baseline. Change in total brain volume was a secondary outcome.ResultsAmong 670 recruited patients who had baseline MRI (mean age, 67.3 [SD, 8.2] years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years. In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3 [95% CI, 0.69 to 1.14]) vs an increase from 4.40 to 5.85 cm3 (difference, 1.45 cm3 [95% CI, 1.21 to 1.70]) in the standard treatment group (between-group difference in change, -0.54 cm3 [95% CI, -0.87 to -0.20]). Mean total brain volume decreased from 1134.5 to 1104.0 cm3 (difference, -30.6 cm3 [95% CI, -32.3 to -28.8]) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm3 (difference, -26.9 cm3 [95% CI, 24.8 to 28.8]) in the standard treatment group (between-group difference in change, -3.7 cm3 [95% CI, -6.3 to -1.1]).Conclusions and relevanceAmong hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small.Trial registrationClinicalTrials.gov Identifier: NCT01206062.

Dataset Information

Effect of intensive blood pressure control on the prevention of white matter hyperintensity: Systematic review and meta-analysis of randomized trials.

Publications

Effect of intensive blood pressure control on the prevention of white matter hyperintensity: Systematic review and meta-analysis of randomized trials.

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