血压变化和脑输液下降:对SPRINT MIND试验的后期分析
Isabel J Sible1, Daniel A Nation2,3
1Department of Psychology University of Southern California Los Angeles CA.
Journal of the American Heart Association
|June 10, 2023
概括
高血压变化 (BPV) 与脑血流 (CBF) 的下降有关,特别是在标准高血压治疗中. 强化治疗可以减轻这种风险,特别是在像海马这样的关键大脑区域.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 医疗成像医学成像
背景情况:
- 血压变化 (BPV) 是已知的脑血管疾病和痴呆症的风险因素,可能由大脑低输液介导.
- 观察性研究将高血压与大脑血流减少联系起来,但严格控制的血压设置的证据是有限的.
研究的目的:
- 在SPRINT MIND试验中研究BPV与CBF变化的关系,比较密集治疗与标准抗高血压治疗.
- 为了确定BPV是否影响CBF,在特定的大脑区域的衰减,包括整个大脑,灰质,白质,海马体,副海马体,和脑内皮层.
主要方法:
- 针对289名参与者进行的SPRINT MIND试验的后期分析.
- 在随机化后的9个月内,从4次血压测量中计算出BPV.
- 在基线和4年随访时使用伪连续动脉旋转标记MRI评估的大脑血流 (CBF).
主要成果:
- 在标准抗高血压治疗 (P=0.03) 的所有测量区域中,较高的BPV与CBF下降有关.
- 这种关联在中间时区域特别强烈.
- 在密集治疗组中,高血压值与CBF衰退仅在海马体 (P=0.03) 相关.
结论:
- 升高的BPV与CBF下降有关,特别是在标准降血压策略下.
- 这些发现表明,BPV可能会导致CBF下降的风险,即使是严格控制的平均血压.
- 中间部区域显示了BPV和CBF下降之间的强有力的关系,与之前的研究一致.
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