Intensive BP control tied to better brain health

Intensive blood pressure control resulted in fewer white matter brain lesions than standard BP control in a recent study of nearly 450 hypertensive patients, suggesting stricter hypertension management could have significant benefits for brain health.

For their study, published August 13 in the Journal of the American Medical Association, R. Nick Bryan, MD, PhD, and colleagues considered “intensive” BP control as a systolic value of less than 120 mmHg—10 mmHg under what the American Heart Association now considers high blood pressure. The work was part of an NIH-funded project known as the Systolic Blood Pressure Intervention Trial, or SPRINT, and built on an earlier SPRINT study that found intensive BP control resulted in fewer adverse cognitive events.

Bryan and co-authors’ current study tracked four-year MRI results from adults diagnosed with hypertension, none of whom had a prior history of diabetes or stroke. Patients presented with systolic BPs ranging from 130 to 180 mmHg and were randomized to a systolic BP goal of either less than 120 mmHg (355 patients) or less than 140 mmHg (315 patients).

The authors found that, in the intensive group, mean white matter lesion volume increased from 4.57 cubic centimeters at baseline to 5.49 cubic centimeters at four years. That was compared to an increase from 4.40 to 5.85 cubic centimeters in the standard treatment group—a between-group difference of 0.54 cubic centimeters.

Mean total brain volume decreased from 1,134.5 cubic centimeters to 1,104 cubic centimeters in the intensive group and from 1,134 to 1,107.1 cubic centimeters in the standard treatment group (between-group difference in change of -3.7 cubic centimeters).

“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,” Bryan said in a statement. “Though the benefit may be small, it’s one of the few impactful cognition-related interventions we have.”

He said his team’s next step is to understand the effects of intensive BP control on younger adults, since this study focused on patients in their sixties and seventies.

“We need to understand how aggressive should we be with blood pressure control when we’re earlier on in the process,” he said.