Functional health and White Matter Hyperintensities as Effect Modifiers of Blood Pressure

摘要: Objective: To determine whether cerebral small vessel disease or disability modify the effect of systolic blood pressure (SBP) treatment on cognitive and vascular outcomes in older patients with recent lacunar stroke.Methods: Participants aged≥ 65 years of the Secondary Prevention of Small Subcortical Strokes Trial were randomized to a higher (130-149mmHg) or lower (< 130mmHg) SBP target. The primary outcome was change in cognitive function (Cognitive Abilities Screening Instrument); secondary outcomes were incident mild cognitive impairment, stroke, major vascular events (allstroke, myocardial infarction), and all-cause death. Results were stratified by severity of white matter hyperintensities (WMH; none/mild, moderate, severe) on baseline MRI, and by disability (no vs.≥ 1 limitations in activities of daily living). Results: 1,263 participants (mean age 73.8±5.9 years, 40% women) were included. Participants with severe WMH or disability had worse cognitive function at baseline and after a mean followup of 3.9 years. No significant interactions existed between treatment group and effect modifiers (WMH, disability) for change in cognitive function (p for interaction 0.42 and 0.66, respectively). A lower SBP target appeared more beneficial among those with worse WMH burden for vascular outcomes (p for interaction= 0.01 for stroke and 0.03 for major vascular events). Conclusions: There was no difference in the effect of lowering SBP to< 130mmHg on cognitive function by cerebral small vessel disease or disability among older adults with a history of lacunar stroke. Those with evidence of small vessel disease may derive greater benefit …