Editors' Note: White Matter Hyperintensities Mediate the Association of Nocturnal Blood Pressure With Cognition

Abstract

In “White Matter Hyperintensities Mediate the Association of Nocturnal Blood Pressure With Cognition,” Chesebro et al. reported that patients with hypertension who have reverse dipping of blood pressure (night/day blood pressure ratio >1) have elevated periventricular white matter hyperintensity volume on MRI and lower memory scores on neuropsychological testing. Fisher et al. noted that they had similar findings in a prior cohort, although their reverse dippers had higher white matter hyperintensity volume in all locations. Chesebro responded that they may have only seen a regional, rather than global, relationship between white matter hyperintensities and blood pressure because their participants were younger than those included in the study by Fisher et al. Chesebro et al. and Fisher et al. agree that (1) these findings support nighttime administration of antihypertensives and (2) additional studies on tract-specific analysis of white matter changes in this patient population are needed. Chesebro et al. further noted that more research on the optimal timing and frequency of blood pressure assessment is warranted. Cimolai reiterated the importance of these findings in demonstrating the intimate connection between hypertension and cerebrovascular disease. In “White Matter Hyperintensities Mediate the Association of Nocturnal Blood Pressure With Cognition,” Chesebro et al. reported that patients with hypertension who have reverse dipping of blood pressure (night/day blood pressure ratio >1) have elevated periventricular white matter hyperintensity volume on MRI and lower memory scores on neuropsychological testing. Fisher et al. noted that they had similar findings in a prior cohort, although their reverse dippers had higher white matter hyperintensity volume in all locations. Chesebro responded that they may have only seen a regional, rather than global, relationship between white matter hyperintensities and blood pressure because their participants were younger than those included in the study by Fisher et al. Chesebro et al. and Fisher et al. agree that (1) these findings support nighttime administration of antihypertensives and (2) additional studies on tract-specific analysis of white matter changes in this patient population are needed. Chesebro et al. further noted that more research on the optimal timing and frequency of blood pressure assessment is warranted. Cimolai reiterated the importance of these findings in demonstrating the intimate connection between hypertension and cerebrovascular disease.