Cerebral white matter lesions and hypertension status in the elderly Korean: the Ansan Study

There is evidence of an association of hypertension with white matter lesions (WMLs), leukoaraiosis, in the human brain in the United States, Europe and Japan. However, no study on this association has been reported in Korea. Community-dwelling elderly subjects aged over 61 years were randomly selected from samples of the Ansan Health Study, while their blood pressures (BPs) were measured using a highly standardized protocol. Hypertension was defined as a systolic BP ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg or as reported treatment with hypertensive medication, and further subclassified with respect to its subtypes and control status. WMLs were determined by a 1.5-T MRI scan and further categorized into five subgroups with respect to its severity. Hypertension status, such as uncontrolled hypertension even after antihypertensive medication (adjusted odd ratio [OR] = 6.07; 95% CI, 2.08-17.78), isolated systolic hypertension before medication (OR = 2.66; 95% CI, 1.08-6.57), and hypertension before medication (OR = 2.55; 95% CI, 1.19-5.46) were significantly and independently correlated with the presence and severity of WMLs. Advancing age (OR = 1.76; 95% CI, 1.38-2.25), lacunar infarction (OR = 3.19; 95% CI, 1.83-5.58), and cigarette smoking (OR = 1.10; 95% CI, 1.03-1.18) were significantly related to the presence and severity of WMLs. Regular and tight control for hypertension should be exercised to prevent WMLs among the elderly with hypertension.