Gronewold J, Jokisch M, Schramm S, et al. - In this study, white matter hyperintensities (WMHs) are identified as a marker of advanced hypertension pathology, and therefore, early treatment should avert WMHs.

• WMHs of presumed vascular origin are implicated in the pathogenesis of cognitive decline.

• A total of 560 participants of the 1000BRAINS study, selected from the population-based Heinz Nixdorf Recall study (65.2±7.5 years; 51.4% men), were analyzed to examine the link of systolic blood pressure (SBP), diastolic blood pressure (DBP), and antihypertensive medications with WMH volume.

• Multivariable linear regression models showed significant link with WMH volume of the following: continuous SBP (β=0.63 cm ³ per 10 mm Hg), DBP (0.64 cm ³ per 5 mmHg), and antihypertensive treatment (1.23 cm ³ ).

• With respect to treatment efficacy, significantly increased WMH volume (4.24 cm ³ [2.36–6.13]) was detected in only participants with hypertension despite treatment (treated BP ≥140 or ≥90 mm Hg) vs normotensive without treatment (untreated BP <120/<80 mm Hg).