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Hippocampal atrophy, whole brain volume, and white matter lesions in older hypertensive subjects

From the Institute for Aging and Health, University of Newcastle upon Tyne, UK.

Address correspondence and reprint requests to Professor Gary A. Ford, Wolfson Unit of Clinical Pharmacology, Claremont Place, University of Newcastle upon Tyne, NE2 4HH UK; e-mail: g.a.ford{at}ncl.ac.uk

Objective: To determine the potential role of whole brain atrophy, hippocampal atrophy, or both, and small vessel disease/white matter lesions as mechanisms underlying the cognitive impairment associated with hypertension.

Methods: Using MRI scanning the authors determined hippocampal volumes, whole brain volumes, and location and severity of white matter lesions, using Scheltens scale, in 103 hypertensive (166 ± 8/88 ± 7 mm Hg, 54 female) and 51 normotensive (132 ± 12/74 ± 7 mm Hg, 21 female) subjects age 70 years.

Results: Compared to normotensive subjects, older hypertensive subjects had significantly smaller whole brain volumes (887 ± 109 vs 930 ± 97 cm³, p = 0.02) and nonsignificantly reduced hippocampal volumes (5.39 ± 1.60 vs 5.67 ± 1.80 cm³, p = 0.33). Hypertensive subjects had an increased burden of periventricular lesions: bands (p = 0.03), frontal caps (p = 0.08), occipital caps (p = 0.07), and total periventricular hyperintensities (p = 0.02). They also had higher scores in subcortical areas: frontal (p = 0.04), temporal (p = 0.03), and deep white matter areas (p = 0.05). A correlation was found between whole brain volumes and systolic blood pressure (r = –0.19, p = 0.02). No correlation was seen between whole brain volumes and white matter lesion burden.

Conclusions: Moderate hypertension in non-impaired older subjects is associated with smaller whole brain volume and an increased burden of subcortical and periventricular white matter lesions.

Received August 8, 2003. Accepted in final form July 19, 2004.

G.A.F. and J.T.O. have received honoraria from Astra.

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