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Microinfarcts and blood pressure trajectories: response to Dr Niu et al.

Journal of Human Hypertension volume 32, page 385 (2018)Cite this article

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We appreciate the comments expressed by Dr. Niu on our recent publication on microinfarcts and blood pressure trajectories. We agree with Dr. Niu that more research is needed to understand the relationship between the blood pressure trajectories and microinfarcts [1], and prospective studies using high field MRI imaging will improve our understanding of this relationship. The possibility of the microinfarcts occurring in “early old age” or “ young” adulthood seems unlikely since microinfarcts are relatively uncommon in autopsied individuals ages 65–74 but increase steeply with age [2]. Dr. Niu suggests that it is possible that a positive blood pressure slope earlier in life may be associated with the development of subcortical microinfarcts. One of the strengths of our population based study is that we were able to determine whether midlife hypertension was associated with microinfarcts. As reported in our results, midlife hypertension alone was not associated with the development of microinfarcts. Certainly it is possible that the combination of midlife increasing blood pressure slopes in combination with declining blood pressure trajectories late in life would make individuals susceptible to microinfarcts, which we did not investigate in the current study. In the ARIC study, the pattern of a prior history of hypertension (approximately 15 years) with subsequent hypotension concurrent with neuroimaging was associated with smaller brain volumes [3]. Other key lines of evidence that microinfarcts may be associated with declining blood pressures include the fact that individuals who have microinfarcts at autopsy have atrophy in a watershed distribution [4]. Similarly, others have shown that greater numbers of microinfarcts occur in watershed zones than in other brain regions suggesting a contribution of hypoperfusion in their development [5]. While the association between declining blood pressure late in life and subcortical microinfarcts does not prove causation, dismissing the possibility altogether would seem unwise.

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References

  1. Graff-Radford J, Raman MR, Rabinstein AA, Przybelski SA, Lesnick TG, Boeve BF, et al. Association between microinfarcts and blood pressure trajectories. JAMA Neurol. 2018;75(2):212–8.

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  2. Longstreth WT, Sonnen JA, Koepsell TD, Kukull WA, Larson EB, Montine TJ. Associations between micro-infarcts and other macroscopic vascular findings on neuropathologic examination in two databases. Alzheimer Dis Assoc Disord. 2009;23(3):291–4.

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  4. Raman MR, Preboske GM, Przybelski SA, Gunter JL, Senjem ML, Vemuri P, et al. Antemortem MRI findings associated with microinfarcts at autopsy. Neurology. 2014;82(22):1951–8.

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  5. Suter OC, Sunthorn T, Kraftsik R, Straubel J, Darekar P, Khalili K, et al. Cerebral hypoperfusion generates cortical watershed microinfarcts in Alzheimer disease. Stroke. 2002;33(8):1986–92.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Jonathan Graff-Radford, Alejandro A. Rabinstein & David S. Knopman

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Timothy G. Lesnick

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    R. Ross Reichard

  4. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Kejal Kantarci

Authors
  1. Jonathan Graff-Radford
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  2. Alejandro A. Rabinstein
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  3. Timothy G. Lesnick
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  4. R. Ross Reichard
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  5. David S. Knopman
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  6. Kejal Kantarci
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Correspondence to Jonathan Graff-Radford.

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Graff-Radford, J., Rabinstein, A.A., Lesnick, T.G. et al. Microinfarcts and blood pressure trajectories: response to Dr Niu et al.. J Hum Hypertens 32, 385 (2018). https://doi.org/10.1038/s41371-018-0058-x

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