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Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions: Magnetic Resonance Imaging Substudy of the PreDIVA Trial (Prevention of Dementia by Intensive Vascular Care).
- Source :
-
Stroke [Stroke] 2017 Jul; Vol. 48 (7), pp. 1842-1848. Date of Electronic Publication: 2017 Jun 08. - Publication Year :
- 2017
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Abstract
- Background and Purpose: This study aimed to evaluate the effect of a nurse-led multidomain cardiovascular intervention on white matter hyperintensity (WMH) progression and incident lacunar infarcts in community-dwelling elderly with hypertension.<br />Methods: The preDIVA trial (Prevention of Dementia by Intensive Vascular Care) was an open-label, cluster-randomized controlled trial in community-dwelling individuals aged 70 to 78 years. General practices were assigned by computer-generated randomization to 6-year nurse-led, multidomain intensive vascular care or standard care. Of 3526 preDIVA participants, 195 nondemented participants with a systolic blood pressure ≥140 mm Hg were consecutively recruited to undergo magnetic resonance imaging at 2 to 3 and 5 to 6 years after baseline. WMH volumes were measured automatically, lacunar infarcts assessed visually, blinded to treatment allocation.<br />Results: One hundred and twenty-six participants were available for longitudinal analysis (64 intervention and 62 control). Annual WMH volume increase in milliliter was similar for intervention (mean=0.73, SD=0.84) and control (mean=0.70, SD=0.59) participants (adjusted mean difference, -0.08 mL; 95% confidence interval, -0.30 to 0.15; P =0.50). Analyses suggested greater intervention effects with increasing baseline WMH volumes ( P for interaction=0.03). New lacunar infarcts developed in 6 (9%) intervention and 2 (3%) control participants (odds ratio, 2.2; 95% confidence interval, 0.4-12.1; P =0.36).<br />Conclusions: Nurse-led vascular care in hypertensive community-dwelling older persons did not diminish WMH accumulation over 3 years. However, our results do suggest this type of intervention could be effective in persons with high WMH volumes. There was no effect on lacunar infarcts incidence but numbers were low.<br />Clinical Trial Information: URL: http://www.isrctn.com/ISRCTN29711771. Unique identifier: ISRCTN29711771.<br /> (© 2017 American Heart Association, Inc.)
- Subjects :
- Aged
Cerebrovascular Disorders diagnostic imaging
Cerebrovascular Disorders epidemiology
Cerebrovascular Disorders therapy
Cluster Analysis
Dementia epidemiology
Dementia therapy
Female
Humans
Independent Living trends
Long-Term Care trends
Longitudinal Studies
Male
Stroke, Lacunar epidemiology
Stroke, Lacunar therapy
Treatment Outcome
Dementia diagnostic imaging
Disease Progression
Magnetic Resonance Imaging trends
Nurse's Role
Stroke, Lacunar diagnostic imaging
White Matter diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 48
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 28596452
- Full Text :
- https://doi.org/10.1161/STROKEAHA.117.017207