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Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years
J Richard Jennings1, Alicia F Heim2, Lei K Sheu2
1From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.). jenningsjr@upmc.edu.
Insights
Brain changes like working memory and blood flow may predict future high blood pressure (BP) in prehypertensive adults. These brain factors, not initial BP, appear to influence BP progression over time.
Area of Science:
- Neuroscience
- Cardiovascular Health
- Cognitive Aging
Background:
- Hypertension is linked to cognitive decline, but blood pressure reduction doesn't always reverse it.
- This suggests high blood pressure may not directly cause cognitive decline, but rather share common underlying mechanisms.
- Essential hypertension might initiate brain changes that later manifest as cognitive issues alongside elevated blood pressure.
Purpose of the Study:
- To investigate if cognitive function and brain blood flow responses in prehypertensive individuals predict future blood pressure progression.
- To explore the relationship between brain function, blood flow, and the development of hypertension in midlife.
Main Methods:
- 154 midlife adults with prehypertension underwent neuropsychological testing and arterial spin labeling MRI to assess regional cerebral blood flow (rCBF) response during cognitive challenges.
- Neuropsychological measures included memory, executive function, working memory, mental efficiency, and attention.
- Multiple regression models analyzed whether initial BP, cognitive scores, and rCBF responses predicted BP levels after 2 years.
Main Results:
- Working memory performance and frontostriatal rCBF response to cognitive challenges significantly predicted 2-year follow-up blood pressure.
- Initial blood pressure levels did not predict subsequent cognitive performance or regional cerebral blood flow.
- These findings indicate that brain function changes may precede or coincide with the progression of blood pressure toward hypertensive levels.
Conclusions:
- Cognitive and cerebrovascular function in prehypertension are significant predictors of future blood pressure progression.
- Brain changes, rather than initial blood pressure, may be key drivers in the development of hypertension.
- Early detection of altered brain function could offer new avenues for preventing hypertension and cognitive decline.
Abstract:
Hypertension is a presumptive risk factor for premature cognitive decline. However, lowering blood pressure (BP) does not uniformly reverse cognitive decline, suggesting that high BP per se may not cause cognitive decline. We hypothesized that essential hypertension has initial effects on the brain that, over time, manifest as cognitive dysfunction in conjunction with both brain vascular abnormalities and systemic BP elevation. Accordingly, we tested whether neuropsychological function and brain blood flow responses to cognitive challenges among prehypertensive individuals would predict subsequent progression of BP. Midlife adults (n=154; mean age, 49; 45% men) with prehypertensive BP underwent neuropsychological testing and assessment of regional cerebral blood flow (rCBF) response to cognitive challenges. Neuropsychological performance measures were derived for verbal and logical memory (memory), executive function, working memory, mental efficiency, and attention. A pseudo-continuous arterial spin labeling magnetic resonance imaging sequence compared rCBF responses with control and active phases of cognitive challenges. Brain areas previously associated with BP were grouped into composites for frontoparietal, frontostriatal, and insular-subcortical rCBF areas. Multiple regression models tested whether BP after 2 years was predicted by initial BP, initial neuropsychological scores, and initial rCBF responses to cognitive challenge. The neuropsychological composite of working memory (standardized beta, -0.276; se=0.116; P=0.02) and the frontostriatal rCBF response to cognitive challenge (standardized beta, 0.234; se=0.108; P=0.03) significantly predicted follow-up BP. Initial BP failed to significantly predict subsequent cognitive performance or rCBF. Changes in brain function may precede or co-occur with progression of BP toward hypertensive levels in midlife.