Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics

Objective To determine whether higher blood pressure mean (BPM) or hemoglobin Alc 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 (Delta WMH) between a baseline and month-40 MRI, and the primary predictor is BPM and Alc between the MRIs. Additional analyses compared Delta WMH 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 Alc, was associated with WMH progression. The Delta WMH 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). Delta WMH was lower in the intensive vs standard blood pressure control randomization arm (Delta WMH = 0.67 +/- 0.95 vs 1.16 +/- 1.13 cm(3), p < 0.001), but there was no difference in the glycemic control arms = 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.