BP, hypertension in AF may lead to increased risk for brain lesions
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BP and hypertension may be associated with risk for white matter lesions in atrial fibrillation but not with large noncortical or cortical infarcts, according to data published in Hypertension.
In addition, BP and hypertension were not associated with neurocognitive function in patients with AF.
The Swiss-AF study
Using data form the Swiss-AF study, researchers included 1,738 patients with AF (mean age, 73 years; 73% men) in this cross-sectional analysis. Mean BP in this cohort was 135/79 mm Hg and 67% were on BP-lowering therapies. All participants underwent a brain MRI, and any lesions were classified as large noncortical or cortical infarcts, small noncortical infarcts, microbleeds or white matter lesions (graded according to the Fazekas scale).
Overall, 99% of participants presented white matter lesions (54% with Fazekas score of 2), 22% had large noncortical or cortical infarcts, 21% had small noncortical infarcts and 22% experienced microbleeds.
White matter lesions and BP
Researchers observed a linear increase of the prevalence of white matter lesions with a Fazekas score of at least two, small noncortical infarcts and microbleeds in addition to volume of white matter lesions across systolic BP categories (< 120 mm Hg, 120-140 mm Hg, 140-160 mm Hg and 160 mm Hg; P for all < .02). However, there was no difference across categories of diastolic BP (< 70 mm Hg, 70-80 mm Hg, 80-90 mm Hg and 90 mm Hg).
Compared with patients with systolic BP of less than 120 mm Hg, the risk for white matter lesions of Fazekas score of at least two increased as systolic BP increased (P for trend < .001):
- systolic BP of 120 mm Hg to 140 mm Hg (adjusted OR = 1.25; 95% CI, 0.94-1.66);
- systolic BP of 140 mm Hg to 160 mm Hg (aOR = 1.41; 95% CI, 1.03-1.93); and
- systolic BP of 160 mm Hg or greater (aOR = 2.54; 95% CI, 1.65-3.95).
Moreover, the adjusted beta-coefficient for white matter lesions for every 5 mm Hg increase in systolic BP was 0.04 (95% CI, 0.02-0.05; P < .001) and 0.04 for each increase in diastolic BP (95% CI, 0.01-0.06; P = .004).
“From a prognostic standpoint, white matter lesions are important because patients with white matter lesions face an increased risk of stroke, cognitive impairment and vascular dementia,” Stefanie Aeschbacher, PhD, from the cardiology division of the department of medicine at the University Hospital Basel in Switzerland, and colleagues wrote. “For example, different types of brain lesions have been found to be associated with cognitive decline in a general population and large infarcts and white matter lesions have been shown to be associated with lower cognitive function in our cohort of patients with AF. Moderate to severe white matter lesions (defined as Fazekas 2), present in over half of our study population, are known to be common in elderly populations and their extent by volume in our study is high.”
Every 5 mm Hg increase in systolic BP raised the risk for small noncortical infarcts (OR = 1.05; 1.01-1.08; P = .006).
Researchers found no consistent association between BP and hypertension with volume of small noncortical infarcts; however, the presence of microbleeds was associated with hypertension but neither systolic nor diastolic BP.
According to the study, there was no association between BP and neurocognitive function when using the Montreal Cognitive Assessment score or any other neurocognitive tests.
Researchers observed an inverse association between hypertension and the Montreal Cognitive Assessment score for the prevalence of white matter lesions of Fazekas score of two or greater (P = .007), but the association was not significant among patients with a Fazekas score of less than two.
“BP and hypertension in patients with AF are strongly associated with white matter lesions and to a lesser extent with small noncortical infarcts, but not with large noncortical or cortical infarcts,” the researchers wrote. “Our data suggest that the presence and extent of white matter lesions are altered by the burden of hypertension. Further studies are needed to assess the effect of more aggressive BP control on brain lesions in patients with AF.”
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