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Intensive Blood Pressure Lowering Increases Cerebral Blood Flow in Older Subjects With Hypertension

Lookup NU author(s): Dr Dinesh Tryambake, Dr Jiabao He, Dr Michael Firbank, Professor John O'Brien, Professor Andrew Blamire, Professor Gary Ford

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Abstract

Hypertension is associated with reduced cerebral blood flow (CBF). Intensive (<130/80 mm Hg) blood pressure (BP) lowering in older people might give greater reduction in cardiovascular risk, but there are concerns that this might produce hypoperfusion which may precipitate falls and possibly stroke. We determined the effect of intensive compared with usual BP lowering on CBF in hypertensive older subjects. Individuals aged >70 years with a history of systolic hypertension on 1 or no BP lowering drugs were recruited from primary care (n=37; age, 75 +/- 4 years; systolic BP, >150 mm Hg) and randomized to receive intensive (target BP, <130/80 mm Hg) or usual (target BP, <140/85 mm Hg) BP lowering for 12 weeks, with reviews every 2 weeks. CBF, determined using 3T arterial spin labeling MRI, and 24-hour ambulatory BP were performed at baseline and after 12 weeks of treatment. Baseline BP (ambulatory or in clinic) and baseline gray matter CBF were not significantly different between the groups. After treatment, BP was reduced significantly in both groups but fell more in the intensive group (26/17 versus 15/5 mm Hg; P<0.01). Over the same period, gray matter CBF increased significantly in the intensive group (7 +/- 11 mL/min per 100 g; P=0.013) but was unchanged in the usual BP target group (-3 +/- 9 mL/min per 100 g; P=0.23); P<0.01 for comparison. Intensive BP lowering in older people with hypertension increases CBF, compared with BP lowering to usual target. These findings suggest hypertension in older people shifts the autoregulatory CBF curve rightward and downward and is reversible with BP lowering.


Publication metadata

Author(s): Blamire AM; He JB; Tryambake D; O'Brien JT; Ford GA; Firbank MJ

Publication type: Article

Publication status: Published

Journal: Hypertension

Year: 2013

Volume: 61

Issue: 6

Pages: 1309-1315

Print publication date: 01/06/2013

Online publication date: 25/03/2013

Acceptance date: 01/03/2013

ISSN (print): 0194-911X

ISSN (electronic): 1524-4563

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1161/HYPERTENSIONAHA.112.200972

DOI: 10.1161/HYPERTENSIONAHA.112.200972


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