NEW BLOOD PRESSURE TARGETS IN NON-DIABETIC PATIENTS AND INSULIN RESISTANCE IN BRAIN

Area of Science:

• Cardiovascular Medicine
• Neuroendocrinology

Background:

• Eighth Joint National Committee (JNC 8) recommended systolic blood pressure <150 mmHg for adults >60.
• SPRINT trial demonstrated benefits of intensive systolic blood pressure control (<120 mmHg).

Purpose of the Study:

• To evaluate the impact of intensive systolic blood pressure reduction on cardiovascular outcomes.
• To explore the role of insulin in brain regions regulating appetite and metabolism.
• To identify factors associated with brain insulin resistance.

Main Methods:

• Analysis of randomized controlled trial data (SPRINT).
• Review of neurobiological functions of insulin in specific brain areas.
• Examination of genetic and lifestyle factors linked to insulin resistance.

Main Results:

• Intensive systolic blood pressure lowering to <120 mmHg reduced cardiovascular events and all-cause mortality.
• Insulin modulates body weight and metabolism via hypothalamic, prefrontal cortex, hippocampal, and fusiform gyrus pathways.
• Pregnancy, obesity, age, and genetic variants (IRS1, FTO, MC4R, CNR2, APOE) are associated with brain insulin resistance.

Conclusions:

• Intensive blood pressure management is crucial for reducing cardiovascular risk.
• Brain insulin signaling is vital for energy homeostasis and is implicated in obesity and metabolic disorders.
• Understanding brain insulin resistance mechanisms may offer new therapeutic targets.