Summary: A recent study suggests that intensive blood pressure treatment with a target of less than 120 mm Hg can reduce the risk of adverse cerebrovascular events and improve overall brain health in adults over 50. Patients who more intensely managed their hypertension had fewer white matter lesions in the brain. White matter lesions are associated with an increased risk of Alzheimer’s disease, cognitive decline, and accelerated brain aging.
Source: UT San Antonio
Intensive blood pressure treatment significantly reduces the risk of adverse cerebrovascular events such as stroke.
New research from The University of Texas Health Science Center at San Antonio (UT Health San Antonio) shows evidence of how the brain benefits from consistently lower blood pressure.
The study, published March 1 in JAMA Network Open, is a follow-up analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), a multicenter clinical trial that compared intensive systolic blood pressure control (target less than 120 mm Hg) versus standard control (target less than 140 mm Hg). SPRINT enrolled participants aged 50 or older with hypertension and without diabetes or a history of stroke.
“Our study demonstrates that lowering systolic blood pressure to below 120 mm Hg is more effective in preserving brain health compared to standard treatment goals,” said corresponding author Mohamad Habes, PhD, assistant professor of radiology and director of the neuroimaging core at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases.
The Biggs Institute at UT Health San Antonio, in collaboration with The University of Texas Rio Grande Valley, is the state’s only National Institute on Aging-designated Alzheimer’s Disease Research Center (ADRC).
Patients receiving intensive blood pressure treatment showed reduced white matter lesions in frontal and posterior deep white matter, and improved blood flow, indicating better overall brain health, Habes said. White matter lesions are among the changes that can be associated with Alzheimer’s disease, non–Alzheimer’s disease cognitive impairment and advanced brain aging, he said.
The paper highlights that intensive blood pressure treatment can slow down vascular brain injury, potentially contributing to the preservation of cognitive function in older adults, said Tanweer Rashid, PhD, of the Biggs Institute’s neuroimage analytics laboratory and neuroimaging core.
“Our study shows that specific areas have greater benefit, representing sensitive regions to track in future trials evaluating small-vessel disease,” Rashid said.
The paper acknowledges the need for further research to determine the optimal blood pressure targets and treatment strategies for various population groups and to assess potential side effects of intensive blood pressure treatment, Habes said.
About this neurology and brain aging research news
Original Research: Open access.
“Association of Intensive vs Standard Blood Pressure Control With Regional Changes in Cerebral Small Vessel Disease Biomarkers” by Mohamad Habes et al. JAMA Network Open
Association of Intensive vs Standard Blood Pressure Control With Regional Changes in Cerebral Small Vessel Disease Biomarkers
Little is known about the associations of strict blood pressure (BP) control with microstructural changes in small vessel disease markers.
To investigate the regional associations of intensive vs standard BP control with small vessel disease biomarkers, such as white matter lesions (WMLs), fractional anisotropy (FA), mean diffusivity (MD), and cerebral blood flow (CBF).
Design, Setting, and Participants
The Systolic Blood Pressure Intervention Trial (SPRINT) is a multicenter randomized clinical trial that compared intensive systolic BP (SBP) control (SBP target <120 mm Hg) vs standard control (SBP target <140 mm Hg) among participants aged 50 years or older with hypertension and without diabetes or a history of stroke. The study began randomization on November 8, 2010, and stopped July 1, 2016, with a follow-up duration of approximately 4 years. A total of 670 and 458 participants completed brain magnetic resonance imaging at baseline and follow-up, respectively, and comprise the cohort for this post hoc analysis. Statistical analyses for this post hoc analysis were performed between August 2020 and October 2022.
At baseline, 355 participants received intensive SBP treatment and 315 participants received standard SBP treatment.
Main Outcomes and Measures
The main outcomes were regional changes in WMLs, FA, MD (in white matter regions of interest), and CBF (in gray matter regions of interest).
At baseline, 355 participants (mean [SD] age, 67.7 [8.0] years; 200 men [56.3%]) received intensive BP treatment and 315 participants (mean [SD] age, 67.0 [8.4] years; 199 men [63.2%]) received standard BP treatment. Intensive treatment was associated with smaller mean increases in WML volume compared with standard treatment (644.5 mm3 vs 1258.1 mm3).
The smaller mean increases were observed specifically in the deep white matter regions of the left anterior corona radiata (intensive treatment, 30.3 mm3 [95% CI, 16.0-44.5 mm3]; standard treatment, 80.5 mm3 [95% CI, 53.8-107.2 mm3]), left tapetum (intensive treatment, 11.8 mm3 [95% CI, 4.4-19.2 mm3]; standard treatment, 27.2 mm3 [95% CI, 19.4-35.0 mm3]), left superior fronto-occipital fasciculus (intensive treatment, 3.2 mm3 [95% CI, 0.7-5.8 mm3]; standard treatment, 9.4 mm3 [95% CI, 5.5-13.4 mm3]), left posterior corona radiata (intensive treatment, 26.0 mm3 [95% CI, 12.9-39.1 mm3]; standard treatment, 52.3 mm3 [95% CI, 34.8-69.8 mm3]), left splenium of the corpus callosum (intensive treatment, 45.4 mm3 [95% CI, 25.1-65.7 mm3]; standard treatment, 83.0 mm3 [95% CI, 58.7-107.2 mm3]), left posterior thalamic radiation (intensive treatment, 53.0 mm3 [95% CI, 29.8-76.2 mm3]; standard treatment, 106.9 mm3 [95% CI, 73.4-140.3 mm3]), and right posterior thalamic radiation (intensive treatment, 49.5 mm3 [95% CI, 24.3-74.7 mm3]; standard treatment, 102.6 mm3 [95% CI, 71.0-134.2 mm3]).
Conclusions and Relevance
This study suggests that intensive BP treatment, compared with standard treatment, was associated with a slower increase of WMLs, improved diffusion tensor imaging, and FA and CBF changes in several brain regions that represent vulnerable areas that may benefit from more strict BP control.
ClinicalTrials.gov Identifier: NCT01206062