Major risk factors for the appearance of white-matter lesions on MRI in hypertensive patients with controlled blood pressure

Figures & data

Table 1 Patient characteristics

Number of patients	185
Age year [Mean (SD)]	70 (7)
Male n (%)	84 (45)
Height cm [Mean (SD)]	157 (9)
Weight kg [Mean (SD)]	60 (11)
BMI kg/m^2 [Mean (SD)]	24.3 (3.7)
Waist circumference cm [Mean (SD)]	88 (10)
Duration of hypertension [Median (Q1–Q4)]	10.0 (5.0–20.0)
Current smoking or past smoking n (%)	56 (30)
Current smoking n (%)	21 (11)
Regular alcohol drinkers n (%)	50 (27)
Hyperlipidemia n (%)	101 (55)
Diabetes mellitus n (%)	38 (21)
Hyperuricemia n (%)	18 (10)
Protenuria n (%)	6 (3)
Laboratory data
T-cho mg/dL [Mean (SD)]	202 (30)
TG mg/dL [Mean (SD)]	154 (89)
HDL-cho mg/dL [Mean (SD)]	55 (15)
LDL-cho (direct method) mg/dL [Mean (SD)]	117 (25)
LDL-cho (indirect method) mg/dL [Mean (SD)]	116 (28)
Serum creatinine mg/dL [Mean (SD)]	0.8 (0.2)
eGFR mL/min/1.73 m^2 [Mean (SD)]	69.7 (14.7)
Past medical history
Cardiac infarction n (%)	3 (2)
Angina pectoris n (%)	16 (9)
Aortic disease n (%)	1 (0.5)
Peripheral artery disease n (%)	1 (0.5)
Heart failure n (%)	8 (4)
Blood pressure, heart rate, rAIx
SBP mmHg [Mean (SD)]	139 (17)
DBP mmHg [Mean (SD)]	79 (10)
PP mmHg [Mean (SD)]	60 (13)
HR/min [Mean (SD)]	72 (11)
SBP2 mmHg [Mean (SD)]	139 (18)
CSBP mmHg [Mean (SD)]	143 (20)
CPP mmHg [Mean (SD)]	64 (16)
rAIx% [Mean (SD)]	84 (15)
rAIx@75% [Mean (SD)]	83 (13)
Current medication
CCBs n (%)	107 (58)
β-blockers n (%)	4 (2)
ACE-Is n (%)	44 (24)
ARBs n (%)	128 (69)

Abbreviations: BMI, body mass index; Q1, ≤5 years; Q2, 5–10 years; Q3, 10–20 years; Q4, >20 years; T-cho, total lipoprotein cholesterol; TG, triglyceride; HDL-cho, high-density lipoprotein cholesterol; LDL-cho, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; SBP, brachial systolic blood pressure; DBP, brachial diastolic blood pressure; PP, brachial pulse pressure; HR, heart rate; SBP2, secondary systolic pressure; CSBP, central systolic blood pressure; CPP, central pulse pressure; rAIx, radial augmentation index; rAI×@75, radial augmentation index normalized for a heart rate of 75/minute; CCB, calcium channel blockers; ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers.

Table 2 Distribution of MRI findings in white-matter lesions

MRI findings	Number of cases (%)
	0		1		2		3
Fazekas scale
DWMH	14 (8)		96 (52)		60 (32)		15 (8)
PVH	83 (45)		86 (46)		15 (8)		1 (1)
	0	1	2	3	4	5	6
Scheltens scale
DWMH
Frontal	81 (44)	76 (41)	7 (4)	18 (10)	2 (1)	1 (1)	0 (0)
Parietal	21 (11)	64 (35)	27 (15)	31 (47)	23 (11)	8 (4)	13 (7)
Occipital	103 (56)	54 (29)	8 (4)	16 (9)	1 (1)	2 (1)	1 (1)
Temporal	157 (85)	23 (12)	1 (1)	4 (3)	0 (0)	0 (0)	0 (0)
PVH caps
Frontal	83 (45)	92 (50)	10 (5)	–	–	–	–
Occipital	90 (49)	67 (36)	28 (15)	–	–	–	–
Lat ventricular bands	170 (94)	10 (5)	2 (1)	–	–	–	–

Abbreviations: DWMH, deep white-matter hyperintensities; PVH, periventricular hyperintensities.

Table 3 Comparison of clinical parameters between low and high Fazekas scores

Score grade		FDWMH			FPVH
		0–1	2–3	P value	0	1–3	P value
Number of patients		110	75		83	102
Age (years)	Mean (SD)	67 (5)	74 (6)	<0.0001	67 (5)	72 (7)	<0.0001
BMI (kg/m^2)	Mean (SD)	24.1 (3.6)	24.6 (3.9)	0.38	23.7 (3.3)	24.9 (4.0)	0.03
Male	n (%)	49 (45)	35 (47)	0.78	39 (47)	45 (44)	0.7
Current or past smoking	n (%)	34 (31)	22 (29)	0.82	29 (35)	27 (26)	0.21
Hyperlipidemia	n (%)	60 (55)	41 (55)	0.99	49 (59)	52 (51)	0.27
Diabetes mellitus	n (%)	23 (21)	15 (20)	0.88	18 (22)	20 (20)	0.73
SBP (mmHg)	Mean (SD)	139 (17)	139 (16)	0.78	138 (16)	140 (17)	0.28
DBP (mmHg)	Mean (SD)	79 (10)	78 (11)	0.58	79 (9)	79 (11)	0.67
PP (mmHg)	Mean (SD)	60 (13)	61 (13)	0.77	58 (12)	62 (13)	0.059
CPP (mmHg)	Mean (SD)	64 (16)	64 (15)	0.85	62 (16)	66 (16)	0.17
SBP2 (mmHg)	Mean (SD)	129 (19)	131 (18)	0.6	128 (18)	132 (19)	0.17
CSBP (mmHg)	Mean (SD)	144 (20)	142 (20)	0.66	142 (20)	144 (21)	0.4
rAIx (%)	Mean (SD)	85 (16)	84 (12)	0.63	84 (15)	84 (14)	0.88
rAIx@75 (%)	Mean (SD)	83 (13)	83 (12)	0.95	82 (13)	84 (13)	0.45
HR/min	Mean (SD)	71 (12)	73 (10)	0.14	71 (12)	73 (10)	0.14
Serum creatinine (mg/dL)	Mean (SD)	0.71 (0.16)	0.83 (0.24)	<0.0001	0.71 (0.16)	0.80 (0.23)	0.007
eGFR (mL/min/1.73 m^2)	Mean (SD)	74.1 (13.2)	63.2 (14.5)	<0.0001	74.3 (12.4)	65.9 (15.4)	<0.0001
Duration of hypertension (years)	Median (interquartile range)	10 (5–15)	15 (8–20)	0.0002	10 (5–15)	12 (5.75–20)	0.0059

Abbreviation: FDWMH, deep white-matter hypertintensities of Fazekas scale; FPVH, periventricular hyperintensites of Fazekas scale; BMI, body mass index; SBP, brachial systolic blood pressure; DBP, brachial diastolic blood pressure; PP, brachial pulse pressure; CPP, central pulse pressure; SBP2, secondary systolic blood pressure; CSBP, central systolic blood pressure; rAIx, radial augmentation index; rAIx@75, radial augmentation index normalized for a heart rate of 75/min; HR, heart rate; eGFR, estimated glomerular filtration rate.

Table 4 Comparison of clinical parameters between low and high Scheltens scores

Score grade		SDWMH frontal			SDWMH parietal			SDWMH occipital			SDWMH temporal
		0–2	3–6	P value	0–2	3–6	P value	0–2	3–6	P value	0–2	3–6	P value
Number of patients		164	21		112	73		165	20		181	4
Age (years)	Mean (SD)	69 (6)	74 (7)	0.005	68 (5)	73 (7)	<0.0001	70 (7)	73 (5)	0.03	70 (7)	66 (3)	0.2
BMI (kg/m^2)	Mean (SD)	24.4 (3.8)	24.0 (3.2)	0.7	24.1 (3.5)	24.7 (4.1)	0.28	24.4 (3.7)	23.6 (4.1)	0.33	24.3 (3.8)	24.2 (2.5)	0.95
Male	n (%)	71 (43)	13 (62)	0.11	53 (47)	31 (42)	0.52	72 (43)	12 (60)	0.7	81 (45)	3 (75)	0.23
Current or past smoking	n (%)	48 (29)	8 (38)	0.41	35 (31)	21 (29)	0.72	50 (30)	6 (30)	0.21	54 (30)	2 (50)	0.39
Hyperlipidemia	n (%)	92 (56)	9 (43)	0.25	61 (54)	40 (55)	0.96	91 (55)	10 (50)	0.27	97 (54)	4 (100)	0.07
Diabetes mellitus	n (%)	34 (21)	4 (19)	0.86	26 (23)	12 (16)	0.26	34 (21)	4 (20)	0.73	38 (21)	0 (0)	0.3
SBP (mmHg)	Mean (SD)	139 (17)	136 (15)	0.34	139 (17)	140 (17)	0.75	139 (17)	138 (14)	0.28	139 (17)	141 (15)	0.81
DBP (mmHg)	Mean (SD)	79 (10)	79 (11)	0.96	79 (10)	79 (11)	0.99	79 (10)	81 (11)	0.67	79 (10)	89 (9)	0.06
PP (mmHg)	Mean (SD)	61 (13)	58 (13)	0.43	60 (12)	61 (14)	0.54	61 (13)	57 (11)	0.059	60 (13)	53 (9)	0.23
CPP (mmHg)	Mean (SD)	65 (16)	61 (14)	0.3	64 (16)	65 (16)	0.63	64 (16)	63 (14)	0.17	64 (16)	55 (14)	0.25
SBP2 (mmHg)	Mean (SD)	130 (19)	129 (17)	0.79	129 (18)	132 (19)	0.31	129 (19)	134 (16)	0.17	130 (18)	132 (19)	0.75
CSBP (mmHg)	Mean (SD)	144 (20)	140 (17)	0.43	143 (20)	144 (20)	0.71	143 (20)	144 (18)	0.4	143 (20)	144 (20)	0.95
rAIx (%)	Mean (SD)	85 (15)	81 (14)	0.28	84 (16)	84 (13)	0.96	84 (15)	87 (10)	0.88	84 (15)	78 (16)	0.36
rAIx@75 (%)	Mean (SD)	83 (13)	81 (13)	0.54	83 (13)	83 (12)	0.66	82 (13)	86 (11)	0.45	83 (13)	79 (12)	0.54
HR (/min)	Mean (SD)	71 (11)	75 (11)	0.12	71 (11)	73 (10)	0.18	72 (11)	73 (8)	0.14	72 (11)	78 (12)	0.29
Serum creatinine (mg/dL)	Mean (SD)	0.75 (0.20)	0.84 (0.16)	0.051	0.73 (0.17)	0.81 (0.24)	0.006	0.76 (0.21)	0.79 (0.18)	0.48	0.76 (0.20)	0.89 (0.12)	0.21
eGFR (mL/minute/1.73 m^2)	Mean (SD)	70.5 (0.20)	63.2 (12.2)	0.03	73.3 (13.7)	64.2 (14.5)	<0.001	69.9 (14.8)	68.1 (13.7)	0.6	69.9 (14.8)	62.5 (4.4)	0.32
Duration of hypertension (years)	Median (interquartile range)	10 (5–19.5)	15 (10–25)	0.009	10 (5–15)	15 (9–20)	0.0014	10 (5–20)	13.5 (6.5–19.25)	0.48	10 (5–20)	12.5 (2.75–34.25)	0.91

Abbreviations: SDWMH, deep white-matter hypertintensities of Scheltens scale; BMI, body mass index; SBP, brachial systolic blood pressure; DBP, brachial diastolic blood pressure; PP, brachial pulse pressure; CPP, central blood pressure; SBP2, secondary systolic blood pressure; CSBP, central systolic blood pressure; rAIx, radial augmentation index; rAIx@75, radial augmentation index normalized for a heart rate of 75/minute; HR, heart rate; eGFR, estimated glomerular filtration rate.