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Abstract Details

Intensive vs. Standard Blood Pressure Control in White Matter Disease Progression: Systematic Review and Meta-analysis
Cerebrovascular Disease and Interventional Neurology
P5 - Poster Session 5 (8:00 AM-9:00 AM)
4-010

To conduct a systematic review and meta-analysis of the effect of intensive blood pressure (BP) control on slowing the progression of white matter disease (WMD). We hypothesize that tight blood pressure control slows the progression of WMD.
WMD, a common manifestation of cerebral small vessel disease, is associated with greater risk of stroke and dementia. The association of hypertension with WMD is well known; however, less is known about the effect of intensive BP control in slowing the progression of WMD. 
We searched PubMed (1966 to 2019) and bibliographies to identify randomized trials and prospective studies that compared changes in WMD volume in patients with hypertension who underwent intensive versus standard BP control. Primary outcome was change in WMD volume from baseline. A random-effects estimate was computed based on Mantel-Haenszel methods. The pooled estimates with 95% confidence intervals were compared between the two groups, and displayed as forest plot. 
The search identified 5 studies with 3,853 patients with hypertension with serial brain scans, of whom 2,360 received intensive treatment (target BP<120mmHg in 2 studies, <140mmHg in 2 studies, undefined in 1 study); 1,493 received standard treatment, followed for average of 3.86 years. Mean age was 68yo, and 48% were women. WMD progression was lower in the intensive vs standard treatment group (0.41±0.53 vs 1.11±0.38 cm3, p<0.001). The pooled results from the random-effects model showed that intensive BP control slowed WMD progression by -0.9 cm3 (95% CI, -1.38 to -0.41cm3, by study end ranged 2.3-6.0 years) more than standard treatment. 

This meta-analysis suggests that tight BP control is more effective than standard treatment in slowing the progression of WMD.

Authors/Disclosures
Michelle P. Lin, CRC (Mayo Clinic Florida)
PRESENTER 		Dr. Lin has nothing to disclose.
No disclosure on file
James F. Meschia, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) The institution of Dr. Meschia has received research support from NINDS. The institution of Dr. Meschia has received research support from NINDS.
Nilufer Taner, MD, PhD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) The institution of Dr. Taner has received research support from NIH.
Erik Middlebrooks Erik Middlebrooks has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Scientific Corp. Erik Middlebrooks has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Siemens Healthineers. Erik Middlebrooks has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Journal of Neuroradiology.
Neethu Gopal, MBBS (Mayo Clinic, Neurology Department) No disclosure on file
Thomas G. Brott, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Brott has nothing to disclose.