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Original Investigation
February 2018

Association Between Microinfarcts and Blood Pressure Trajectories

Author Affiliations
  • 1Department of Neurology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
  • 3Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
  • 4Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
  • 5Department of Radiology, Mayo Clinic, Rochester, Minnesota
JAMA Neurol. 2018;75(2):212-218. doi:10.1001/jamaneurol.2017.3392
Key Points

Question  Are blood pressure slopes associated with the development of microinfarcts?

Findings  In this population-based study of 303 patients who underwent autopsy, those with microinfarcts did not differ on baseline blood pressure compared with those with no microinfarcts. Yet, participants with subcortical microinfarcts had a greater annual decline of blood pressure.

Meaning  Subcortical microinfarcts were associated with declining blood pressure, and the presence of microinfarcts is associated with cognitive decline, which is an important consideration when setting blood pressure targets in elderly individuals.


Importance  Cerebral microinfarcts are associated with increased risk of cognitive impairment and may have different risk factors than macroinfarcts. Subcortical microinfarcts are associated with declining blood pressure (BP) in elderly individuals.

Objective  To investigate BP slopes as a risk factor for microinfarcts.

Design, Setting, and Participants  From the population-based Mayo Clinic Study of Aging, 303 of 1158 individuals (26.2%) in this cohort study agreed to have an autopsy between November 1, 2004, and March 31, 2016. Cerebral microinfarcts were identified and classified as cortical or subcortical. Baseline and BP trajectories were compared for groups with no microinfarcts, subcortical microinfarcts, and cortical microinfarcts. A secondary logistic regression analysis was performed to assess associations of subcortical microinfarcts with midlife hypertension, as well as systolic and diastolic BP slopes.

Main Outcomes and Measures  The presence of cerebral microinfarcts using BP slopes.

Results  Of the 303 participants who underwent autopsy, 297 had antemortem BP measurements. Of these, 177 (59.6%) were men; mean (SD) age at death was 87.2 (5.3) years. The autopsied individuals and the group who died but were not autopsied were similar for all demographics except educational level with autopsied participants having a mean of 1 more year of education (1.06; 95% CI, 0.66-1.47 years; P < .01). Among 297 autopsied individuals with antemortem BP measurements, 47 (15.8%) had chronic microinfarcts; 30 (63.8%) of these participants were men. Thirty (63.8%) had cortical microinfarcts, 19 (40.4%) had subcortical microinfarcts, and 4 (8.5%) had only infratentorial microinfarcts. Participants with microinfarcts did not differ significantly on baseline systolic (mean difference, −1.48; 95% CI, −7.30 to 4.34; P = .62) and diastolic (mean difference of slope, −0.90; 95% CI, −3.93 to 2.13; P = .56) BP compared with those with no microinfarcts. However, participants with subcortical microinfarcts had a greater annual decline (negative slope) of systolic (mean difference of slope, 4.66; 95% CI, 0.13 to 9.19; P = .04) and diastolic (mean difference, 3.33; 95% CI, 0.61 to 6.06; P = .02) BP.

Conclusions and Relevance  Subcortical microinfarcts were associated with declining BP. Future studies should investigate whether declining BP leads to subcortical microinfarcts or whether subcortical microinfarcts are a factor leading to declining BP.