Limited value of blood pressure levels in predicting white matter hyperintensities progression among community dwelling older adults living in a rural setting

Introduction: This study aims to assess the impact of blood pressure (BP) on progression of white matter hyperintensities (WMH) of presumed vascular origin in community-dwelling older adults living in rural Ecuador. Methods: Atahualpa residents aged ≥60 years receiving baseline and follow-up brain MRIs after a median of 6.5 years were included. Multilevel logistic regression models, which accounted for WMH severity at baseline, were fitted to assess the risk of WMH progression according to BP levels and other covariates. Results: Analysis included 263 participants. WMH progression increased 3.45 times (95% C.I.: 1.94 - 4.96) among non-hypertensive individuals but 6.15 times (95% C.I.: 3.18 - 9.12) among those with arterial hypertension. However, overlapping of confidence intervals make such difference non-significant. Likewise, no differences in WMH progression were noticed when steady and pulsatile components of BP were used as independent variables. Conclusions: High BP is not an independent predictor of WMH progression in the study population.