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From the Institut National de la Santé et de la Recherche Médicale U360 (Drs. Dufouil, Besançon, Alpérovitch, and Tzourio), Hôpital la Salpêtrière, Paris; the Department of Radiology (Drs. de Kersaint–Gilly and Auffray), Laënnec Hospital, Nantes; the Department of Radiology (Dr. Levy), Institut Hospitalier Jacques Cartier, Massy; and the Department of Radiology (Dr. Brunnereau), Hôpital Saint-Antoine, Paris, France.
Address correspondence and reprint requests to Dr. Carole Dufouil, INSERM U360, Hôpital La Salpêtrière, 75651 Paris Cédex 13, France; e-mail: carole.dufouil{at}chups.jussieu.fr
OBJECTIVE: To investigate the relationship between baseline hypertension and severity of white matter hyperintensities (WMH) at 4-year follow-up in a sample of subjects aged 59 to 71 years old at entry.
METHODS: Subjects were participants in the Epidemiology of Vascular Ageing study, a longitudinal study on vascular aging and cognitive decline. At 4-year follow-up, 845 subjects had a cerebral MRI. MRI examinations were read by a single rater to determine the severity of WMH, ranging from absent to severe. Hypertension at each wave of the study was defined as systolic blood pressure 
160 mm Hg, diastolic blood pressure 95 mm Hg, or use of antihypertensive medication.
RESULTS: Hypertension at baseline was significantly associated with an increased risk of having severe WMH at 4-year follow-up. When taking into account both blood pressure levels and antihypertensive drug intake, analysis showed that the risk of having severe WMH was significantly reduced in subjects with normal blood pressure taking antihypertensive medication compared with those with high blood pressure taking antihypertensive agents. Cross-sectional relationships between hypertension and WMH at 4-year follow-up showed that the frequency of severe WMH was significantly higher in people who were hypertensive at both baseline and 4-year follow-up than those who were hypertensive only at 4-year follow-up.
CONCLUSIONS: Hypertension is a major risk factor for severe WMH. Subjects taking antihypertensive drugs and who have controlled blood pressure had a reduced risk of severe WMH. Longitudinal studies are needed to investigate whether reduction of the development of WMH, by treatment and prevention of hypertension, might reduce the subsequent risk of cognitive deterioration or stroke.
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