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.
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.
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).
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.
CLINICAL TRIAL INFORMATION: URL: http://www.isrctn.com/ISRCTN29711771. Unique 
identifier: ISRCTN29711771.