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Blood Pressure Is Not Associated With Cerebral Blood Flow in Older Persons
Jessica C Foster-Dingley1, Justine E F Moonen2, Anton J M de Craen2
1From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.). j.c.foster-dingley@lumc.nl.
Insights
Low blood pressure (BP) in older adults using antihypertensive medication does not decrease cerebral blood flow (CBF). This study found no association between BP and CBF, even in vulnerable subgroups.
Area of Science:
- Neurology
- Gerontology
- Cardiovascular Medicine
Background:
- Low blood pressure (BP) in older individuals is often linked to adverse health outcomes, with reduced cerebral blood flow (CBF) hypothesized as a cause.
- Existing evidence directly linking low BP to decreased CBF in the elderly, particularly those on antihypertensive medication, is limited.
- Understanding this relationship is crucial for managing hypertension in older adults and preventing cognitive decline.
Purpose of the Study:
- To investigate the association between blood pressure (BP) and cerebral blood flow (CBF) in older individuals with mild cognitive deficits.
- To determine if antihypertensive treatment discontinuation affects the BP-CBF relationship.
- To examine this association in vulnerable subgroups, including those with cerebral pathologies, lower cognition, or diabetes.
Main Methods:
- Utilized baseline data from 203 participants (mean age 81) in the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) trial.
- Assessed BP, BP changes upon standing, and CBF using pseudo-continuous arterial spin-labeling MRI.
- Evaluated BP and CBF changes at 4-month follow-up in 102 participants randomized to continue or discontinue antihypertensive treatment.
Main Results:
- No significant association was found between systolic BP, diastolic BP, mean arterial pressure, pulse pressure, or BP changes on standing and CBF.
- Subgroup analyses revealed no BP-CBF association in participants with white matter hyperintensities, microbleeds, lacunar infarcts, lower cognition, or diabetes.
- CBF change at 4 months did not differ between groups continuing or discontinuing antihypertensive treatment.
Conclusions:
- Contrary to prevailing notions, lower blood pressure is not associated with decreased cerebral blood flow in older adults using antihypertensive medication and with mild cognitive deficits.
- This lack of association persists even in more vulnerable elderly individuals with specific cerebral pathologies or comorbidities.
- The findings suggest that current antihypertensive management strategies in this population may not compromise cerebral perfusion.
Abstract:
Many studies showing a relation between low blood pressure (BP) and adverse health outcomes in older persons suggest that low BP gives rise to reduced cerebral blood flow (CBF). However, limited evidence is available about this association. Baseline data of 203 participants in the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) trial were used (mean age, 81 years, using antihypertensive medication and with mild cognitive deficits). BP, BP changes on standing, and CBF derived from pseudo-continuous arterial spin-labeling magnetic resonance imaging were assessed in all participants. In 102 participants who were randomly assigned to 4-month continuation (n=47) or discontinuation of antihypertensive treatment (n=55), BP and CBF change were evaluated at 4-month follow-up. Systolic and diastolic BP were not associated with CBF (B=-0.21, P=0.50 and B=-1.07, P=0.07), neither were mean arterial pressure, pulse pressure, and BP changes on standing. In subgroups of participants with small vessel-related cerebral pathologies, including high white matter hyperintensity volume, microbleeds, and lacunar infarcts, or in participants with lower cognition or diabetes mellitus, no association was found between any BP parameters and CBF. Furthermore, compared to the continuation group, CBF change at 4 months was not different in the discontinuation group (B=-0.12, P=0.23). Contrary to the notion that lower BP in old age is associated with decreased CBF, our data do not show this association in older persons using antihypertensive medication and with mild cognitive deficits. Also, this association was not present in subgroups of more vulnerable persons, reflected by small vessel-related cerebral pathologies, lower cognition, or diabetes mellitus.
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