Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

Abstract

Several potential vascular risk factors exist for the development and accumulation of small vessel disease of the brain and stroke in older people. In older people followed up for several years, we and others have reported that white matter hyperintensity lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in neurologic function. In this article, we review blood pressure (BP) as a risk factor for the development and pathogenesis of small vessel disease and stroke in older persons. The research efforts have focused on ambulatory BP measurements, which have proven to be a stronger indicator than clinic pressures for the progression of small vessel disease in older people as well as the development of stroke. Based on relations among 24 hours systolic BP levels, the accrual of small vessel disease, and relations with cognitive function and mobility, we have designed the INFINITY trial, a novel interventional study that uses ambulatory BP to guide antihypertensive therapy addressed at improving functional decline.