Abstract
Hypertension is associated with development of white matter hyperintensities (WMH) in the brain, which are risk factors for mild cognitive impairment. Hormonal shifts at menopause alter vascular function putting women at risk for both hypertension and WMH. Elevations in aortic hemodynamics precede the appearance of clinically defined hypertension but the relationship of aortic hemodynamics to development of WMH in women is not known. Therefore, this study aimed to characterize aortic hemodynamics in relationship to WMH in postmenopausal women. Aortic systolic and diastolic blood pressure (BP), aortic augmentation index (Alx) and aortic round trip travel time (Aortic TR) by tonometry were examined in 53 postmenopausal women (age 60 ± 2 years). WMH was calculated from fluid-attenuated inversion recovery MRI using a semi-automated segmentation algorithm. WMH as a fraction of total white matter volume positively associated with aortic systolic BP (regression coefficient = 0.018; p = 0.04) after adjusting for age. In addition, WMH fraction was positively associated with AIx (0.025; p = 0.04), and inversely associated with Aortic TR (−0.015; p = 0.04) after adjusting for age. Our results suggest that assessing aortic hemodynamics may identify individuals at risk for accelerated development of WMH and guide early treatment to reduce WMH burden and cognitive impairment in the future.
Highlights
White matter hyperintensities (WMH) in the brain are risk factors for mild cognitive impairment [1, 2] and are associated the rate of cognitive decline in older adults [3]
white matter hyperintensities (WMH) fraction was positively associated with aortic systolic BP and AIx, and inversely associated with Aortic TR (Table 3; Fig. 2)
There was no association between WMH fraction and aortic diastolic BP, augmented pressure, or LV wasted energy (p [ 0.05 for all; Table 3)
Summary
White matter hyperintensities (WMH) in the brain are risk factors for mild cognitive impairment [1, 2] and are associated the rate of cognitive decline in older adults [3]. Arterial stiffness at midlife, which often develops prior to hypertension [5], predicts future WMH volume [6]. Unlike diastolic BP, which is similar when measured centrally (aortic) or peripherally (brachial), systolic BP is dependent on the location in the arterial tree where it is measured [7]. These differences in systolic BP are due to pulse pressure amplification and may have an impact on risk stratification [8]. It is possible that, even though brachial systolic BP may be within the ‘‘normative’’ range, central or aortic hemodynamics may be associated with vascular brain injury as early as midlife
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