Subclinical cerebral lesion accumulation on serial magnetic resonance imaging (MRI) in patients with hypertension: risk factors

Objectives - We investigated the occurrence in hypertensive patients of new subclinical changes in the brain by serial magnetic resonance imaging (MRI). Methods - MRI was performed serially in 98 hypertensive subjects without neurologic deficits at least once a year for 3 years. All received antihypertensive medicines. Blood pressure, serum lipids, diabetes mellitus, body mass index (BMI), and other clinical factors were correlated with results. Results - Seventy-nine patients had unchanged MRI findings, while 19 developed new lesions (silent lacunar infarct and etat crible in 3, silent lacunar infarct in 9, and etat crible in 7). Follow-up systolic blood pressures were significantly higher than individual baselines in the unchanged group, while the follow-up diastolic blood pressures in the new lesion group were significantly lower than in the unchanged group. BMI was significantly lower in the new lesion group. Follow-up HbA1c levels in both groups were significantly higher than at baseline. Diabetes mellitus was significantly more frequent in the new lesion group than in the unchanged group. No significant differences were apparent in serum lipids level, prescribed antihypertensive medications, and other potential risk factors. Conclusions - New subclinical MRI changes in hypertensive subjects occurred relatively frequently (19 of 98 subjects, or 19.4%). An excessive fall in diastolic blood pressure, diabetes mellitus, and low BMI emerged as candidate risk factors for these changes.