PMID- 30737332
OWN - NLM
STAT- MEDLINE
DCOM- 20191211
LR  - 20221207
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 92
IP  - 11
DP  - 2019 Mar 12
TI  - Blood pressure, glycemic control, and white matter hyperintensity progression in 
      type 2 diabetics.
PG  - e1168-e1175
LID - 10.1212/WNL.0000000000007093 [doi]
AB  - OBJECTIVE: To determine whether higher blood pressure mean (BPM) or hemoglobin 
      A1c is associated with progression of white matter hyperintensity (WMH) on MRI in 
      patients with type 2 diabetes, and whether intensive blood pressure or glycemic 
      control can reduce that progression. METHODS: We performed a secondary analysis 
      of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes 
      (ACCORD MIND) research materials. The primary outcome is change in WMH volume 
      (DeltaWMH) between a baseline and month-40 MRI, and the primary predictor is BPM and 
      A1c between the MRIs. Additional analyses compared DeltaWMH in the intensive vs 
      standard glycemic control randomization arms (n = 502) and intensive vs standard 
      blood pressure control randomization arms (n = 314). RESULTS: Higher systolic 
      BPM, but not diastolic BPM or A1c, was associated with WMH progression. The DeltaWMH 
      in tertiles of increasing systolic BPM (115 +/- 4, 127 +/- 3, and 139 +/- 6 mm Hg) was 
      0.7, 0.9, and 1.2 cm(3) (p < 0.001). DeltaWMH was lower in the intensive vs standard 
      blood pressure control randomization arm (DeltaWMH = 0.67 +/- 0.95 vs 1.16 +/- 1.13 
      cm(3), p < 0.001), but there was no difference in the glycemic control arms (p = 
      0.917). CONCLUSION: In ACCORD MIND, higher systolic blood pressure was associated 
      with WMH progression. The intensive blood pressure control intervention reduced 
      this progression. Comorbid diabetes and hypertension has synergistic deleterious 
      properties that increase the risk of micro- and macrovascular complications. 
      These results provide further support for an aggressive approach to blood 
      pressure control in type 2 diabetics.
CI  - (c) 2019 American Academy of Neurology.
FAU - de Havenon, Adam
AU  - de Havenon A
AUID- ORCID: 0000-0001-8178-8597
AD  - From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of 
      Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, 
      Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA. 
      adam.dehavenon@hsc.utah.edu.
FAU - Majersik, Jennifer J
AU  - Majersik JJ
AD  - From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of 
      Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, 
      Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
FAU - Tirschwell, David L
AU  - Tirschwell DL
AD  - From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of 
      Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, 
      Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
FAU - McNally, J Scott
AU  - McNally JS
AD  - From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of 
      Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, 
      Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
FAU - Stoddard, Gregory
AU  - Stoddard G
AD  - From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of 
      Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, 
      Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
FAU - Rost, Natalia S
AU  - Rost NS
AD  - From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of 
      Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, 
      Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
LA  - eng
GR  - R01 NS082285/NS/NINDS NIH HHS/United States
GR  - R01 NS086905/NS/NINDS NIH HHS/United States
GR  - U24 NS107228/NS/NINDS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20190208
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Aged
MH  - Blood Glucose
MH  - *Blood Pressure
MH  - Diabetes Mellitus, Type 2/complications/*metabolism/therapy
MH  - Disease Progression
MH  - Female
MH  - Glycated Hemoglobin/*metabolism
MH  - Humans
MH  - Hypertension/complications/*therapy
MH  - Leukoaraiosis/complications/*diagnostic imaging
MH  - Male
MH  - Middle Aged
MH  - White Matter/*diagnostic imaging
PMC - PMC6511110
EDAT- 2019/02/10 06:00
MHDA- 2019/12/18 06:00
PMCR- 2020/03/12
CRDT- 2019/02/10 06:00
PHST- 2018/04/24 00:00 [received]
PHST- 2018/11/01 00:00 [accepted]
PHST- 2019/02/10 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2019/02/10 06:00 [entrez]
PHST- 2020/03/12 00:00 [pmc-release]
AID - WNL.0000000000007093 [pii]
AID - NEUROLOGY2018900795 [pii]
AID - 10.1212/WNL.0000000000007093 [doi]
PST - ppublish
SO  - Neurology. 2019 Mar 12;92(11):e1168-e1175. doi: 10.1212/WNL.0000000000007093. 
      Epub 2019 Feb 8.