Do blood pressure medications help to improve signs of brain small vessel disease?

This study looked at the effect of blood pressure (BP)-lowering medications on cerebral small vessel disease (CVSD). It found that maintaining systolic blood pressure (SBP; BP when the heart beats) between 110-129 mmHg reduced the progression of white matter hyperdensities, one of the signs of CVSD on brain scans.

Cerebral small vessel disease (CSVD) is a condition affecting the small blood vessels in the brain. CVSD is often seen on brain scans. On scans, small areas of damage to the brain can be seen in the form of white matter hyperintensities (WMH). Another sign of CVSD on brain scans is brain atrophy or shrinking of the brain. CVSD can result in strokes, dementia, or mental health problems.

It is not clear if blood pressure treatment can improve signs of CVSD on brain scans.

This study reviewed the results of 7 studies involving a total of 1,944 patients aged 60-78. All patients had evidence of CSVD on brain scans. The relation between BP medications and worsening of CSVD on brain scans was evaluated. 

Patients with lower BP levels on treatment (SBP of 110-129 mmHg) showed less progression of WMH than patients with higher BP levels. Blood pressure treatment did not have any effect on brain atrophy.

This study showed that strict blood pressure control reduces the progression of WMH on brain scans, one of the signs of CVSD.  

This study is based on previous studies, some of which are small or imperfectly designed. Further studies are needed to explore this question.