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Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension

Dinesh Tryambake1, Jiabao He, Michael J Firbank

  • 1Institute for Ageing and Health, Newcastle University, Stroke Research Group, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.

Hypertension (Dallas, Tex. : 1979)
|March 27, 2013
PubMed

Insights

Intensive blood pressure lowering in older adults with hypertension significantly increased cerebral blood flow (CBF). This suggests that lowering blood pressure to a more intensive target can improve brain perfusion in elderly individuals.

Area of Science:

  • Neurology
  • Cardiology
  • Geriatrics

Background:

  • Hypertension is linked to reduced cerebral blood flow (CBF).
  • Intensive blood pressure (BP) reduction in older adults may increase cardiovascular benefits but raises concerns about hypoperfusion, potentially leading to falls or stroke.
  • The autoregulation of CBF in hypertensive older individuals requires further investigation.

Purpose of the Study:

  • To investigate the effect of intensive versus usual BP lowering on CBF in hypertensive older subjects.
  • To determine if intensive BP lowering improves or impairs cerebral perfusion in the elderly.
  • To understand the autoregulatory response of CBF to BP reduction in this population.

Main Methods:

  • A randomized controlled trial involving 37 hypertensive individuals over 70 years old.
  • Participants were assigned to either intensive (target BP <130/80 mm Hg) or usual (target BP <140/85 mm Hg) BP lowering for 12 weeks.
  • Cerebral blood flow was measured using 3T arterial spin labeling MRI at baseline and after treatment.

Main Results:

  • Both groups achieved significant BP reduction, with a greater reduction in the intensive group (26/17 mm Hg vs. 15/5 mm Hg).
  • Gray matter CBF significantly increased in the intensive BP lowering group (7±11 mL/min per 100 g) but remained unchanged in the usual BP lowering group (-3±9 mL/min per 100 g).
  • The difference in CBF change between the groups was statistically significant (P<0.01).

Conclusions:

  • Intensive BP lowering in older hypertensive individuals increases gray matter CBF compared to usual BP targets.
  • These findings suggest that hypertension in older adults may impair autoregulation of CBF, a condition reversible with intensive BP management.
  • Intensive BP control may be safe and beneficial for cerebral perfusion in elderly hypertensive patients.

Keywords:
MRIagingblood flowblood pressurecardiovascular disease

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