The following is a summary of “Nonhypertensive White Matter Hyperintensities in Stroke: Risk Factors, Neuroimaging Characteristics, and Prognosis,” published in the November 2023 issue of Cardiology by Lim et al.

This study delved into the intricacies of nonhypertensive white matter hyperintensity (WMH) in individuals experiencing acute ischemic stroke or transient ischemic attack. A cohort of 2,283 patients with hypertension and 1,003 without hypertension, drawn from a larger pool of 10,602 patients, was examined. The research focused on assessing the connections between moderate-to-severe WMH and established risk factors, functional recovery, and a composite outcome of recurrent stroke, myocardial infarction, and all-cause mortality. Additionally, a subgroup analysis consisting of 351 patients without hypertension, alongside age- and sex-matched pairs with hypertension and moderate-to-severe WMH, allowed for a detailed investigation of WMH, lacunes, and microbleeds. 

Approximately 35% of patients without hypertension and 65% of patients with hypertensive stroke showed moderate-to-severe WMH. These WMH patterns exhibited associations with age, gender, and previous stroke, irrespective of hypertension status. Among patients without hypertension, WMH correlated with initial systolic blood pressure and was more frequently located in the anterior temporal region. On the other hand, among hypertensive patients, WMH showed a connection with small vessel occlusion as a stroke mechanism and was prevalent in the periventricular region close to the posterior horn of the lateral ventricle. Additionally, patients without hypertension demonstrated a higher incidence of occipital microbleeds, while patients with hypertension displayed increased instances of deep subcortical lacunes. 

The study found that moderate-to-severe WMH was significantly associated with functional outcomes at three months and a one-year cumulative incidence of the composite outcome, though the latter lost significance after adjustments. These associations between WMH and outcomes were consistently observed regardless of hypertensive status, suggesting a parallel impact of WMH on clinical outcomes in both groups.

Source: ahajournals.org/doi/10.1161/JAHA.123.030515