Intensive BP control tied to increase in whole-brain cerebral blood flow
USA: Intensive antihypertensive treatment compared to the standard one is associated with increased, rather than decreased, cerebral perfusion, especially in patientss with a history of cardiovascular disease (CVD). This is the main finding of secondary analysis of the SPRINT MIND randomized clinical trial that was published in the journal JAMA Neurology online on March 7, 2022.
Antihypertensive treatments in hypertension patients benefits cerebrovascular health and cognitive function. However, there is no clarity on whether a intensive blood pressure (BP) targeted leads to cerebrovascular health and cognitive function. Considering this, Sudipto Dolui, Department of Radiology, University of Pennsylvania, Philadelphia, and colleagues aimed to investigate the association of intensive systolic blood pressure (SBP) control vs standard control with whole-brain cerebral blood flow (CBF) in the substudy of the Systolic Blood Pressure Intervention Trial (SPRINT) randomized clinical trial.
The study compared the efficacy of 2 different blood pressure–lowering strategies with longitudinal brain magnetic resonance imaging (MRI) including arterial spin labeled perfusion imaging for quantifying CBF. The study included 1267 adults 50 years or older with hypertension and increased cardiovascular risk but free of diabetes or dementia. They were screened for the SPRINT substudy from 6 sites in the US. Randomization began in November 2010 with final follow-up MRI in July 2016.
Subjects with baseline CBF measures were randomized to receive an intensive SBP target less than 120 mm Hg or standard SBP target less than 140 mm Hg. Change in whole-brain CBF from baseline was the primary outcome.
The mean (SD) age of 547 participants with CBF measured at baseline was 67.5 years and 219 (40.0%) were women; 315 completed follow-up MRI at a median of 4.0 years after randomization.
Salient findings of the study were as follows:
- Mean whole-brain CBF increased from 38.90 to 40.36 (difference, 1.46) mL/100 g/min in the intensive treatment group, with no mean increase in the standard treatment group (37.96 to 37.12; difference, –0.84 mL/100 g/min; between-group difference, 2.30).
- Gray, white, and periventricular white matter CBF showed similar changes.
- The association of intensive vs standard treatment with CBF was generally similar across subgroups defined by age, sex, race, chronic kidney disease, SBP, orthostatic hypotension, and frailty, with the exception of an indication of larger mean increases in CBF associated with intensive treatment among participants with a history of cardiovascular disease.
To conclude, intensive compared to standard antihypertensive treatment was associated with increased, rather than decreased, cerebral perfusion, most notably in participants with a history of cardiovascular disease.
Reference:
Dolui S, Detre JA, Gaussoin SA, et al. Association of Intensive vs Standard Blood Pressure Control With Cerebral Blood Flow: Secondary Analysis of the SPRINT MIND Randomized Clinical Trial. JAMA Neurol. Published online March 07, 2022. doi:10.1001/jamaneurol.2022.0074
KEYWORDS: JAMA, intensive antihypertensive treatment, cerebral blood flow, hypertension, cognitive function, cerebral perfusion, BP lowering, blood pressure, cardiovascular disease, BP, BP control
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