For adults with high blood pressure, greater blood pressure control than what's currently considered standard is associated with fewer adverse changes of the brain, which could mean lower risks of dementia and cognitive impairment, according to new research published in the Journal of the American Medical Association.
Specifically, the magnetic resonance imaging (MRI) study of 449 adults showed that those with high blood pressure who achieved systolic blood pressure of less than 120 mm Hg - known as "intensive" blood pressure control - had a small but significantly lower amount of white matter lesions on their brain but a slightly greater decrease in brain volume than similar patients who achieved the current standard for healthy blood pressure of 140 mm Hg.
"The great news from this research is that high blood pressure is a treatable condition, and if you treat high blood pressure aggressively, you could have a positive benefit on cognition and brain structure," said R. Nick Bryan, M.D., Ph.D., chair and professor of the Department of Diagnostic Medicine at Dell Medical School at The University of Texas at Austin. "Though the benefit may be small, it's one of the few impactful cognition-related interventions we have."
White matter brain lesions are well-documented to be associated with a greater likelihood or intensity of cognitive decline. According to the American Heart Association, high blood pressure is considered 130 mm Hg or higher.
The current study supports the findings of a related study published in January that showed intensive blood pressure control is associated with fewer incidents of cognitive adverse events. Both studies were part of a larger body of NIH-funded research known as Systolic Blood Pressure Intervention Trial (SPRINT), designed to determine the protective value of lower blood pressure for heart, kidney and brain health. Previous research within SPRINT also showed that intensive blood pressure control among people with hypertension is linked to better outcomes in terms of risks of heart attack, heart failure and death.
In the current study, researchers compared MRI scans of adults age 50 and older, average age 67 years old, with systolic blood pressure between 130 and 180 mm Hg at baseline and four years later, noting white matter lesions and brain volume.
The next step in this investigation is to understand the effects of intensive blood pressure control among younger adults, such as those in their 40s, said Bryan. "We need to understand how aggressive should we be with blood pressure control when we're earlier on in the process," he said.
Reference: Nasrallah, I. M., Pajewski, N. M., Auchus, A. P., Chelune, G., Cheung, A. K., Cleveland, M. L., … Bryan, R. N. (2019). Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions. JAMA, 322(6), 524–534. https://doi.org/10.1001/jama.2019.10551
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