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Hypertension

03 September 2018

Intensive blood pressure control may help preserve brain health

Preliminary evidence indicates that aggressively treating high blood pressure reduces the risk of mild cognitive impairment and dementia.

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Strict blood pressure control not only benefits your heart, it might also help save your brain, preliminary research suggests.

Older adults whose systolic blood pressure (the top number in a reading) was kept at 120mm Hg or less saw a 19% decrease in their risk for mental difficulties known as mild cognitive impairment, according to recent trial results.

Damage and inflammation

Intensive blood pressure control also lowered the risk for mild mental impairment and dementia combined by 15%, said lead researcher Dr Jeff Williamson, of Wake Forest School of Medicine in Winston-Salem, North Carolina.

Patients with lower blood pressure also had fewer brain lesions develop, the researchers reported.

In South Africa, according to the Heart and Stroke Foundation, more than one in three adults live with high blood pressure and it is responsible for one in every two strokes and two in every five heart attacks. High blood pressure, or hypertension, is one of the most serious risks factors for death from heart diseases and strokes, responsible for 13% of all deaths globally.

Although these findings are preliminary, they are the strongest evidence so far that aggressively treating high blood pressure reduces the risk of mild cognitive impairment and dementia, said Williamson, a professor of gerontology and geriatric medicine.

He couldn't say for sure how blood pressure and dementia risk are intertwined. But "one leading hypothesis is that higher pressure affects the lining of very thin arteries in the brain," Dr Williamson said. "Over time, that can cause damage and inflammation."

Everyone with dementia goes through a stage of mild cognitive impairment, he said. "It's not an inconsequential stage," Dr Williamson noted. "People who have this kind of memory impairment have trouble doing things like managing their finances or following a recipe or playing a game."

A healthy old age

Keith Fargo, director of scientific programmes and outreach at the Alzheimer's Association, said the findings suggest it's best to get blood pressure under control sooner rather than later.

"If you want to have a healthy old age, in terms of your cognition, you don't want to wait to start thinking about your blood pressure," he said.

The study was an offshoot of the well-known SPRINT trial.

SPRINT (Systolic Blood Pressure Intervention Trial) found that keeping blood pressure tightly controlled could prevent heart attacks and strokes in older adults. Those findings were a key factor behind revised blood pressure guidelines that reduced the target for normal systolic blood pressure from 140mm Hg to 120mm Hg.

In the SPRINT MIND trial, researchers assessed the mental state of more than 9 300 people with high blood pressure, average age 68. The participants were treated to maintain a systolic blood pressure of less than 140mm Hg or less than 120mm Hg. The lower reading was considered intensive blood pressure control.

Recruitment for the trial began in 2010, and cognitive assessment continued until June 2018.

Beneficial effect of intensive blood pressure therapy

Those receiving intensive blood pressure control took at least one extra blood pressure drug, Dr Williamson said. All commonly used blood pressure medications were included, and the rate of side effects was similar in both treatment groups.

In a related project, Dr Ilya Nasrallah, an assistant professor of radiology at the University of Pennsylvania, and colleagues performed MRIs on more than 670 participants.

Patients whose blood pressure was intensively controlled had less damage to their brain's white matter than those with uncontrolled blood pressure, the researchers reported. This kind of damage to the brain is a sign of impending dementia or Alzheimer's disease.

"There is a beneficial effect to the structure of the brain in having intensive blood pressure therapy," Dr Nasrallah said.

But lower blood pressure isn't a one-size-fits-all remedy for brain ageing, cautioned Dr Sam Gandy, director of the Mount Sinai Center for Cognitive Health in New York City.

Gandy said recent research has indicated that reducing blood pressure too fast might damage the brain and bring on cognitive impairment. "The timing and a patient's age and the rate of blood pressure lowering must be kept in mind so that one does not overdo the blood pressure lowering and do harm," Dr Gandy said.

Results from the SPRINT MIND trial were scheduled for presentation at the Alzheimer's Association meeting, in Chicago.

 

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Hypertension expert

Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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