September 6, 2005
By Sahar
Bedrood B.S. and Asher Kimchi M.D.
Paris, France - White
matter hyperintensities (WMHs) are observed on brain MRI’s
in elderly people and people with stroke. They are areas of
demyelination and infarct that manifest in clinical outcomes
such as dementia, depression and gait disturbances. High
blood pressure is known to be a risk factor for WMH and they
are said to increase over time. Carole Dufouil, PhD et al
from the INSERM in France studied whether lowering blood
pressure would reduce the incidence of WMHs. This study,
published in the September 13, 2005 issue of Circulation
journal found that an active blood pressure-lowering regimen
stopped or delayed the progression of WMHs in patients with
cerebrovascular disease.
The study conducted an MRI-based
assessment of WMHs in a substudy of a randomized trial of
blood pressure lowering patients with a history of
cerebrovascular disease. The substudy comprised of 192
patients who had a cerebral MRI both at baseline and after a
mean follow-up time of 36 months. Patients were assigned to
a combination of perindopril plus indapamide (or their
placebo) or to a single therapy with perindopril (or
placebo).
The risk of new WMH
was reduced by 43% (05%CI-7% to 89%) in the active treatment
group compared with the placebo group (p=0.17). The mean
total volume of new WMHs was significantly reduced in the
active treatment group (0.4 mm3 [SE= 0.8])
compared with the placebo group (2.0 mm3
[SE=0.7]; P=0.012).
This
placebo-controlled, double-blind trial of a blood
pressure-lowering regimen significantly lowered the total
volume of incident WMHs in patients who received the
medication than in patients who received placebo over 3
years of follow-up. WMHs are strongly associated with
hypertension and this study suggests that treatment of
hypertension may stop or delay the progression of WMHs in
patients with cerebrovascular disease.
Co-authors: Carole
Dufouil PhD, John Chalmers MD, PhD, Oguzhan Coskun MD,
Véronique Besançon MD, Marie-Germaine Bousser MD, Pierre
Guillon PhD, Stephen MacMahon PhD, Bernard Mazoyer MD, PhD,
Bruce Neal MD, PhD, Mark Woodward PhD, Nathalie
Tzourio-Mazoyer MD, PhD, Christophe Tzourio MD, PhD*,
for the PROGRESS MRI Substudy Investigators
