Antihypertensive Treatment and Change in Blood Pressure Are Associated With the Progression of White Matter Lesion Volumes. The Three-City (3C)–Dijon Magnetic Resonance Imaging Study

International audienceBackground—Blood pressure (BP) is recognized as a major risk factor for white matter lesions (WMLs), but longitudinal data are scarce, and there is insufficient evidence for the benefit of antihypertensive therapy on WML progression. We studied the relationship between BP change and WML volume progression over time in a sample of 1319 elderly individuals who had 2 cerebral magnetic resonance imaging examinations 4 years apart. We also examined the impact of antihypertensive treatment on WML progression. Methods and Results—Subjects were participants from the Three-City (3C)–Dijon Magnetic Resonance Imaging Study, a prospective population-based cohort of elderly Ն65 years of age. WML volumes and their progression were estimated with the use of a fully automatic procedure. We performed ANCOVA models first to assess the association between BP change and WML progression and second to estimate the relation between antihypertensive treatment and WML load progression. Baseline and change in BP were significant predictors of higher WML progression over time after controlling for potential confounders. Among subjects with high SBP (Ն160 mm Hg) at baseline not treated by antihypertensive medication, antihypertensive treatment started within 2 years was related to a smaller increase in WML volume at a 4-year follow-up (0.24 cm 3 ; SEϭ0.44 cm 3) than no hypertensive treatment (1.60 cm 3 ; SEϭ0.26 cm 3 ; Pϭ0.0008) on multivariable modeling. Conclusions—Our findings reinforce the hypothesis that hypertension is a strong predictor of WML and that adequate treatment may reduce the course of WML progression. Because WMLs are linked to both dementia and stroke risks, these results could have implications for future preventive trials. (Circulation. 2011;123:266-273.) Key Words: aging Ⅲ hypertension Ⅲ magnetic resonance imaging Ⅲ blood pressure Ⅲ cerebrovascular disorders Ⅲ leukoaraiosis W hite matter lesions (WMLs) are frequently observed on brain magnetic resonance imaging (MRI) of the elderly and are associated with increased risks of developing depression, stroke, and dementia. 1,2–5 The exact physiopathol-ogy of these lesions is not yet fully understood, but they are considered to reflect ischemic small-vessel disease, and their associations with vascular factors, especially hypertension have been reported. 3,6 –