Baseline and Longitudinal Increases in Diastolic Blood Pressure Are Associated With Greater White Matter Hyperintensity Volume: The Northern Manhattan Study
Open accessAbstract
Background and Purpose—: Elevated blood pressure (BP) is a risk factor for stroke and dementia, but the effect of BP, and change in BP over time, on white matter hyperintensity volume (WMHV) is not fully understood. Few studies have included Hispanics, who are at greater risk of stroke and dementia than non-Hispanic whites. We examined BP in relation to WMHV in a stroke-free cohort. Methods—: The Northern Manhattan Study includes 1290 stroke-free participants who had brain MRI. We examined baseline systolic and diastolic (DBP) BP, and changes in BP from baseline to MRI, and WMHV. Results—: There were 1281 participants with brain MRI and 2 BP measurements (mean age, 64 years; SD=8; range, 40 to 94 years). Baseline DBP was associated with greater WMHV ( P <0.0001) independent of sociodemographic and vascular risk factors. Each 10 mm Hg above the mean baseline DBP (83±11 mm Hg) was associated with a 1.17% greater WMHV. Over 7 years average follow-up, participants with an increase >5 mm Hg DBP from baseline to MRI had 1.21% greater WMHV relative to those whose BP did not increase ( P =0.02). The association between baseline DBP and WMHV was strongest for blacks compared with Hispanics and whites (interaction P =0.04). Conclusions—: Baseline DBP and longitudinal increases in DBP were independently associated with a greater WMHV, and the association between DBP and WMHV was greatest among blacks.
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WMH are directly related to vascular risk factors such as hypertension, diabetes, and obesity, which impair cerebral blood flow and lead to ischemic injury to small vessels.
“WMH are directly related to vascular risk factors such as hypertension, diabetes, and obesity, which impair cerebral blood flow and lead to ischemic injury to small vessels. 7 , 8”
From White matter hyperintensity modulates the amyloid‐tau‐cognition association and anti‐amyloid treatment efficacy in asymptomatic older adults (2025) · cites this paper as [8]
The Results and Discussion (page not provided) associate higher diastolic blood pressure and longer hypertension duration with greater WMH volume, supporting the hypertension portion. The paper does not establish the claimed links with diabetes or obesity, nor show that impaired cerebral blood flow causes ischemic small-vessel injury; its Discussion only suggests that peripheral vascular resistance may reflect small-vessel damage. (LLM, conf=0.88)
Experimental — accuracy not yet measuredElevated blood pressure some years previously appears more strongly associated with WMH than concurrent blood pressure in some studies, although it is unclear whether diastolic or systolic blood pressure is more important.
“Elevated BP some years previously appears to be more strongly associated with WMH in some studies than concurrent BP, although it is unclear whether diastolic84,85 or systolic82 BP are more important.”
From Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging (2013) · cites this paper as [85]
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- Authors
- Marcus, J., Gardener, H., Rundek, T., Elkind, M. S. V., Sacco, R. L., DeCarli, C., & Wright, C. B.
- Affiliations
- University of Miami (US)
- Corresponding author
- Wright, Clinton B.
- ORCID
- Venue
- Stroke
- Published
- 2011-09
- Volume
- 42
- Issue
- 9
- Pages
- 2639-2641
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC3189513
- OpenAlex
- W2083711255
- Cited by
- 79
- References
- 11
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 4 · 2023: 5 · 2022: 7 · 2021: 3 · 2020: 8 · 2019: 8 · 2018: 5 · 2017: 5 · 2016: 7 · 2015: 7 · 2014: 3 · 2013: 3 · 2012: 3
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R37NS029993, R01NS029993, R37 NS 29993., K02NS059729)
- Topics
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- diastolic blood pressure, white matter hyperintensity volume, hypertension, dementia, racial differences, Hispanic Americans, Northern Manhattan Study, brain MRI, vascular risk factors
- MeSH terms
- Adult, Aged, Aged, 80 and over, Black or African American, Blood Pressure, Cerebellum, Female, Follow-Up Studies, Hispanic or Latino, Humans, Magnetic Resonance Imaging, Male, Radiography, Dementia, Vascular, Stroke, White People
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