Ambulatory blood pressure and the brain: a 5-year follow-up

Neurology. 2005 Jun 14;64(11):1846-52. doi: 10.1212/01.WNL.0000164712.24389.BB.


Objective: To determine if initial values of casual and ambulatory systolic blood pressure (SBP) predict white matter hyperintensities, insular subcortex hyperintensities, and brain atrophy 5 years later in a group of healthy elderly individuals.

Methods: The authors studied 155 healthy men and women, aged 55 to 79 years. Two 24-hour ambulatory blood pressure (BP) sessions assessed BP level and variability during waking and sleep. Hyperintensities and total brain volume were quantified by MRI. Procedures were repeated 5 years later in 78% (121) of subjects.

Results: Hyperintensities and brain atrophy increased over time, with greater increases among older subjects. The presence of increased BP level and variability initially and again 5 years later had negative consequences for the brain. Independent of age, the greater the initial SBP, the greater the likelihood that individuals would have severe white matter hyperintensities after 5 years. Also, elevated casual SBP was associated with severe insular subcortex hyperintensities and greater SBP sleep variability with increased brain atrophy.

Conclusions: Among healthy elderly individuals whose initial, average, casual blood pressure (BP) was relatively low (116.9/71.1 mm Hg), small increases in casual and 24-hour ambulatory BP measures were associated with greater brain atrophy and subcortical lesions after 5 years.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Atrophy / etiology*
  • Atrophy / pathology
  • Atrophy / physiopathology
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Brain Ischemia / etiology*
  • Brain Ischemia / pathology
  • Brain Ischemia / physiopathology
  • Cerebral Cortex / pathology
  • Cerebral Cortex / physiopathology
  • Cerebrovascular Circulation / physiology
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Hypertension / physiopathology
  • Leukoaraiosis / etiology*
  • Leukoaraiosis / pathology
  • Leukoaraiosis / physiopathology
  • Longitudinal Studies
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neocortex / pathology
  • Neocortex / physiopathology
  • Nerve Fibers, Myelinated / pathology
  • Predictive Value of Tests
  • Stroke / etiology*
  • Stroke / pathology
  • Stroke / physiopathology


  • Antihypertensive Agents