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Blood Pressure Lowering Regimen Delays the Progression of White Matter Hyperintensities in Patients With Stroke 

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  


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