Objective:

1. Average ambulatory daytime blood pressure, but not office blood pressure is associated with progression of cerebrovascular disease and cognitive decline in older people Objective: A prospective cohort study in subjects 75 to 89 years of age to determine relations among ambulatory and clinic BP, progression of white matter lession (white matter hyperintensity volume), and functional capabilities in older people ABPM, Clinic brachial BP, magnetic resonance imaging, gait studies and neuro-psychological testing were performed at baseline an 24 months White WB. Circulation. 2011;124:2312-2319

2. Characteristics of the patient population atbaseline and 24 months

3. Changes in ABPM, but not in Brachial BP, predict white matterlesions and functionalparameterdecline *significant

4. Ambulatory blood pressure Clinicblood pressure Ambulatorybloodpressure, but not office brachial BP predicts white matterlesions « Increasedambulatorysystolic BP, but not clinic BP, frombaseline to 24 months of follow-up wasassociatedwithincreased white matterhyperintensity volume » .

5. Implications of the findings • Only the HYpertension in the VeryElderly Trial (HYVET) has studied the benefits of antihypertensivetherapy in an age group similar to that in the presentstudy. • The presentstudydemonstratesfor the first time the importance of 24-hour systolic BP in the progression of brain white matterlesionburden, associatedwithimpairment of cognitive function in older people • Of interestisthat the mean values in the highesttertile of clinic and 24-hour systolic BP are 153 and 144 mm Hg, respectively. • The 24-hour systolic BP mightbe a potentialtarget for intervention in the elderly to reduce progression of microvasculardisease of the brain, and thusfavorably affect function.