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Updated: May 10, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter
Michael L Alosco1, Adam M Brickman, Mary Beth Spitznagel
1Department of Psychology, Kent State University, Kent, OH.
Insights
In heart failure (HF), low systemic perfusion and high blood pressure shrink brain volume. Their combination worsens white matter hyperintensities (WMH) in HF patients.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Reduced systemic perfusion and comorbidities like hypertension contribute to adverse brain changes in heart failure (HF).
- Hypertension is a common comorbidity in HF and accelerates brain atrophy in aging populations.
- The independent and interactive effects of blood pressure and systemic perfusion on brain structure in HF remain under-investigated.
Purpose of the Study:
- To investigate the independent and interactive effects of blood pressure and systemic perfusion on brain structure in older adults with HF.
Main Methods:
- Forty-eight older adults with HF were assessed using impedance cardiography for systolic blood pressure and cardiac index (systemic perfusion).
- Brain magnetic resonance imaging was performed to quantify total brain volume, gray matter volume (total and subcortical), and white matter hyperintensities (WMH) volume.
Main Results:
- Decreased cardiac index was significantly associated with smaller subcortical gray matter volume (P < .01).
- Higher systolic blood pressure was linked to reduced total gray matter volume (P = .03).
- The combination of higher blood pressure and lower cardiac index exacerbated WMH (P = .048).
Conclusions:
- Elevated blood pressure and systemic hypoperfusion are associated with reduced brain volume in HF patients.
- These factors interact to worsen white matter hyperintensities (WMH) in the context of HF.
- Further prospective research is needed to elucidate the long-term effects of blood pressure on the brain in HF.
Background:
Reduced systemic perfusion and comorbid medical conditions are key contributors to adverse brain changes in heart failure (HF). Hypertension, the most common co-occurring condition in HF, accelerates brain atrophy in aging populations. However, the independent and interactive effects of blood pressure and systemic perfusion on brain structure in HF have yet to be investigated.
Methods:
Forty-eight older adults with HF underwent impedance cardiography to assess current systolic blood pressure status and cardiac index to quantify systemic perfusion. All participants underwent brain magnetic resonance imaging to quantify total brain, total and subcortical gray matter volume, and white matter hyperintensities (WMH) volume.
Results:
Regression analyses adjusting for medical and demographic factors showed decreased cardiac index was associated with smaller subcortical gray matter volume (P < .01), and higher systolic blood pressure predicted reduced total gray matter volume (P = .03). The combination of higher blood pressure and lower cardiac index exacerbated WMH (P = .048).
Conclusions:
Higher blood pressure and systemic hypoperfusion are associated with smaller brain volume, and these factors interact to exacerbate WMH in HF. Prospective studies are needed to clarify the effects of blood pressure on the brain in HF, including the role of long-term blood pressure fluctuations.
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