Subcortical Microinfarcts Associated With Decreased Blood Pressure in Elderly

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The findings have implications for setting blood pressure targets for elderly individuals.
The findings have implications for setting blood pressure targets for elderly individuals.

In patients age ≥70 years, subcortical microinfarcts are associated with steadily declining blood pressure (BP), according to study findings published in JAMA Neurology.

A total of 303 elderly participants from the population-based Mayo Clinic Study of Aging who were autopsied following death were included in the analysis. The investigators compared baseline and BP trajectories with individuals who had no microinfarcts vs those with cortical microinfarcts or subcortical microinfarcts.

Antemortem BP measurements were available in 297 of the 303 participants. A total of 47 (15.8%) autopsied participants exhibited chronic microinfarcts, the majority of whom were male (63.8%). Cortical microinfarcts, subcortical microinfarcts, and infratentorial microinfarcts were found in 30 (63.8%), 19 (40.4%), and 4 (8.5%) of the autopsied patients, respectively.

There were no differences among participants in baseline systolic (mean difference, -1.48; 95% CI, -7.30-4.34; P =.62) and diastolic (mean difference of slope, -0.90; 95% CI, -3.93-2.13; P =.56) BP measurements when compared with those who did not have microinfarcts. Despite these baseline findings, greater yearly declines in systolic (mean difference of slope, 4.66; 95% CI, 0.13-9.19; P =.04) and diastolic (mean difference, 3.33; 95% CI, 0.61-6.06; P =.02) BP were noted in individuals with subcortical microinfarcts.

Because the investigators limited sampling to specific regions of the brain, it is possible that the total microinfarct burden in these patients was underestimated. In addition, this study could not draw causal inferences because it reported only associations between BP and microinfarcts.

In addition to subcortical microinfarcts being associated with BP, the investigators note that, “the presence of microinfarcts is associated with cognitive decline, which is an important consideration when setting BP targets in elderly individuals.”

Reference

Graff-Radford J, Raman MR, Rabinstein AA, et al. Association between microinfarcts and blood pressure trajectories [published online December 4, 2017]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.3392

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