Late-Life High Blood Pressure and Enlarged Perivascular Spaces in the Putaminal Regions of Community-Dwelling Japanese Older Persons

Abstract

Background Enlarged perivascular spaces (EPVS) of the brain may be involved in dementia, such as Alzheimer’s disease and cerebral small vessel disease (CSVD). Hypertension has been reported to be a risk factor for dementia and CSVD, but the association between blood pressure (BP) and perivascular spaces is still unclear. The aim of this study was to determine the association between BP and EPVS volumes and to examine the interactions of relevant factors. Methods A total of 9296 community-dwelling subjects aged ≥65 years participated in a brain magnetic resonance imaging and health status screening examination. Perivascular volume was measured using a software package based on deep learning that was developed in-house. The associations between BP and EPVS volumes were examined by analysis of covariance and multiple regression analysis. Results Mean EPVS volumes increased significantly with rising systolic and diastolic BP levels ( P for trend = .003, P for trend<.001, respectively). In addition, mean EPVS volumes increased significantly for every 1-mmHg-increment in systolic and diastolic BPs (both P values <.001). These significant associations were still observed in the sensitivity analysis after excluding subjects with dementia. Conclusions The present data suggest that higher systolic and diastolic BP levels are associated with greater EPVS volumes in cognitively normal older people.

A Systematic Review and Meta-Analysis of Automated Methods for Quantifying Enlarged Perivascular Spaces in the Brain

“…Eleven out of thirteen studies identified a positive association between hypertension and PVS burden (Ballerini et al, 2019; Huang, Zhu, et al, 2021b; Wang et al, 2021; Wang, Chappell, et al, 2016; Cheng et al, 2022; Hadad et al, 2022; Charisis et al, 2023; Evans et al, 2023; Tachibana et al, 2024; Zebarth et al, 2023; Duperron et al, 2023). Duperron et al, (2023), the largest study amongst the ones included, found causal associations of high blood pressure with BG and hippocampal PVS, and of BG PVS and hippocampal PVS with stroke, accounting for blood pressure, even after Mendelian randomisation.…”