Sr. Heckbert et al., THE ASSOCIATION OF ANTIHYPERTENSIVE AGENTS WITH MRI WHITE-MATTER FINDINGS AND WITH MODIFIED MINI-MENTAL-STATE-EXAMINATION IN OLDER ADULTS, Journal of the American Geriatrics Society, 45(12), 1997, pp. 1423-1433
OBJECTIVES: To examine the association of antihypertensive regimen wit
h magnetic resonance imaging (MRI) white matter hyperintensity and wit
h cognitive impairment in older adults. DESIGN: Cross-sectional study.
SETTING: The Cardiovascular Health study, an observational prospectiv
e cohort study of risk factors for coronary heart disease and stroke i
n men and women 65 years of age and older. PARTICIPANTS: 1268 men and
women with pharmacologically treated hypertension. MEASUREMENTS: Infor
mation on medication use, medical history, and health habits was colle
cted at clinic examinations. Participants completed the Modified Mini-
Mental State Examination (3MS) and underwent MRI examination. Without
clinical information, study neuroradiologists assigned an overall grad
e of white matter signal intensity on MRI on a scale from 0 (no findin
gs) to 9 (extensive findings). RESULTS: Adjusted mean white matter gra
de was higher for users of calcium channel blockers (2.59, P = .007) a
nd users of loop diuretics (2.60, P = .015) than for users of beta blo
ckers (2.12). The association was present for both dihydropyridine and
non-dihydropyridine calcium channel blockers. Adjusted mean 3MS score
s were lower for users of calcium channel blockers (89.6, P < .002), e
specially dihydropyridines, and users of loop diuretics (89.7, P < .00
6) than for users of beta blockers (92.3). No statistically significan
t association could be shown for users of other drug regimens, includi
ng thiazides and ACE inhibitors. CONCLUSION: In this study, users of a
ntihypertensive regimens which included calcium channel blockers or lo
op diuretics had more severe white matter hyperintensity on MRI and wo
rse performance on 3MS than users of beta blockers.