Neuroimaging Signatures of Cerebral Small Vessel Disease at Blood Pressure Cutoff Levels of 130/80 and 140/90 mmHg: A Population-Based Study in Community-Dwellers Aged ≥ 60 Years

Introduction: Recent guidelines suggest that a blood pressure cutoff of 130/80 mmHg should be used to define arterial hypertension. This contrasts with the previously accepted cutoff of 140/90 mmHg. Aim: Using the Atahualpa Project cohort, we aimed to assess the cutoff that better correlates with signatures of cerebral small vessel disease (SVD), which are related to arterial hypertension. Methods: Of 437 Atahualpa residents aged ≥ 60 years, 363 (83%) underwent brain MRI and blood pressure determinations. Using logistic regression models, we evaluated the association between SVD and the two different cutoffs, after adjusting for demographics and cardiovascular risk factors. Using receiver operator characteristics curve analysis, we calculated sensitivity, specificity, and the area under the curve for the predictive value of the two cutoffs for detecting signatures of SVD. Results: A comparison between the old and new cutoffs showed no differences in the ability to predict subjects with white matter hyperintensities, deep cerebral microbleeds or basal ganglia perivascular spaces. However, the new cutoff improved the identification of individuals with lacunar infarctions, which went from no association using the old cutoff (p = 0.097) to a significant association using the new cutoff (p = 0.036). The new cutoff was more sensitive but less specific than the old cutoff for identifying signatures of cerebral SVD. Areas under the curve were non-significantly higher for the old than for the new cutoffs for all the lesions of interest. Conclusions: The new blood pressure cutoff is consistently more sensitive but less specific than the old cutoff for detecting signatures of cerebral SVD. The most striking effect of the new cutoff is the improvement in the identification of lacunar infarctions.