Reduced cerebral blood flow in older men with higher levels of blood pressure

Waldstein, Shari R.; Lefkowitz, David M.; Siegel, Eliot L.; Rosenberger, William F.; Spencer, Robert J.; Tankard, Carol F.; Manukyan, Zorayr; Gerber, Evie J.; Katzel, Leslie I.

doi:10.1097/hjh.0b013e328335c34f

Cited by 42 publications

(39 citation statements)

References 26 publications

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“…These may be later manifestations of progression toward hypertension given the age of our participants and the two-year follow-up. While we only observed trends, others have found progression of BP over ten years of follow-up to relate to enlarged ventricles 35 and declines in overall CBF 36 37. .…”

Section: Discussioncontrasting

confidence: 67%

Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years

et al. 2017

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Hypertension is a presumptive risk factor for premature cognitive decline. However, lowering blood pressure (BP) does not uniformly reverse cognitive decline, suggesting that high BP per se may not cause cognitive decline. We hypothesized that essential hypertension has initial effects on the brain that, over time, manifest as cognitive dysfunction in conjunction with both brain vascular abnormalities and systemic BP elevation. Accordingly, we tested whether neuropsychological function and brain blood flow responses to cognitive challenges among pre-hypertensive individuals would predict subsequent progression of BP. Midlife adults (n=154, mean age=49, 45% male) with pre-hypertensive BP underwent neuropsychological testing and assessment of regional cerebral blood flow (rCBF) response to cognitive challenges. Neuropsychological performance measures were derived for verbal and logical memory (Memory), Executive Function, Working Memory, Mental Efficiency, and Attention. A pseudo-continuous arterial spin labelling magnetic resonance imaging sequence compared rCBF responses to control and active phases of cognitive challenges. Brain areas previously associated with BP were grouped into composites for frontoparietal, frontostriatal, and insular-subcortical rCBF areas. Multiple regression models tested whether BP after two years was predicted by initial BP, initial neuropsychological scores, and initial rCBF responses to cognitive challenge. The neuropsychological composite of Working Memory (standardized beta=−0.276, se=0.116, p=0.02) and the frontostriatal rCBF response to cognitive challenge (standardized beta = 0.234, se=0.108, p=0.03) significantly predicted follow-up BP. Initial BP failed to significantly predict subsequent cognitive performance or rCBF. Changes in brain function may precede or co-occur with progression of BP toward hypertensive levels in midlife.

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Section: Discussioncontrasting

confidence: 67%

Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years

et al. 2017

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“…29 Another study, not only in a healthy but also younger population (mean age, 67 years), showed that only in men higher BP was associated with lower CBF. 30 However, no association between low BP and reduced CBF was found in any of these studies. Furthermore, higher BP among persons with atherosclerosis was associated with a decline in CBF during 5-year follow-up, 31 and previous findings in hypertensive older persons aged ≥70 years showed that CBF increased in persons who were more intensively treated for hypertension.…”

Section: Discussionmentioning

confidence: 70%

Blood Pressure Is Not Associated With Cerebral Blood Flow in Older Persons

et al. 2015

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Abstract-Many studies showing a relation between low blood pressure (BP) and adverse health outcomes in older persons suggest that low BP gives rise to reduced cerebral blood flow (CBF). However, limited evidence is available about this association. Baseline data of 203 participants in the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) trial were used (mean age, 81 years, using antihypertensive medication and with mild cognitive deficits). BP, BP changes on standing, and CBF derived from pseudo-continuous arterial spin-labeling magnetic resonance imaging were assessed in all participants. In 102 participants who were randomly assigned to 4-month continuation (n=47) or discontinuation of antihypertensive treatment (n=55), BP and CBF change were evaluated at 4-month follow-up. Systolic and diastolic BP were not associated with CBF (B=−0.21, P=0.50 and B=−1.07, P=0.07), neither were mean arterial pressure, pulse pressure, and BP changes on standing. In subgroups of participants with small vessel-related cerebral pathologies, including high white matter hyperintensity volume, microbleeds, and lacunar infarcts, or in participants with lower cognition or diabetes mellitus, no association was found between any BP parameters and CBF. Furthermore, compared to the continuation group, CBF change at 4 months was not different in the discontinuation group (B=−0.12, P=0.23). Contrary to the notion that lower BP in old age is associated with decreased CBF, our data do not show this association in older persons using antihypertensive medication and with mild cognitive deficits. Also, this association was not present in subgroups of more vulnerable persons, reflected by small vessel-related cerebral pathologies, lower cognition, or diabetes mellitus.

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“…27 Narrowing of the vessel lumen and an increased wall/lumen ratio are typically demonstrated in animal models 8,28,29 and humans with hypertension. 9,30 Furthermore, cerebral blood flow is attenuated in elderly patients with hypertension 31,32 and is related to white matter lesions 33 and small vessel disease, 34 a finding which is contradictory to studies indicating that cerebral autoregulation is intact in hypertensive patients. 35 Our data are the first to show that in middle-aged hypertensive humans without cerebral stenotic disease, total arterial cerebral blood flow (Table 1) and cerebral perfusion in all brain regions measured (Table 3) are lower compared with age-matched normotensive participants.…”

Section: Discussionmentioning

confidence: 93%

Is High Blood Pressure Self-Protection for the Brain?

Warnert

Rodrigues

Burchell

et al. 2016

Circulation Research

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H igh blood pressure (BP) affects ≈25% of the world's population and is the largest single contributor to global mortality. 1 Hypertension represents a significant economic burden to public healthcare providers, where the global cost of nonoptimal BP is estimated to be US$370 billion (10% of healthcare expenditure). 2Remarkably, despite the availability of many pharmacological treatments, BP is poorly controlled with a recent report stating that only 53% of patients prescribed antihypertensive medication have BP controlled.3 This reflects the well-known heterogeneity of the syndrome, including epigenetic and inherited factors contributing to the unknown causes in 95% of patients. Despite the devastating consequences of hypertension (eg, stroke, kidney failure, coronary heart disease, and death 1,2 ), the mechanisms that lead to the onset of hypertension in humans are poorly understood. It is well established that elevated sympathetic nerve activity (SNA) contributes to the development of hypertension in most humans, [5][6][7] but what initiates this remains unclear. Experimental data from hypertensive rats and observations in postmortem human studies suggest that blood flow to the brain might be important in setting the operating level of SNA and, thus, systemic arterial pressure. Rationale: Data from animal models of hypertension indicate that high blood pressure may develop as a vital mechanism to maintain adequate blood flow to the brain. We propose that congenital vascular variants of the posterior cerebral circulation and cerebral hypoperfusion could partially explain the pathogenesis of essential hypertension, which remains enigmatic in 95% of patients.Objective: To evaluate the role of the cerebral circulation in the pathophysiology of hypertension. Methods and Results:We completed a series of retrospective and mechanistic case-control magnetic resonance imaging and physiological studies in normotensive and hypertensive humans (n=259). Interestingly, in humans with hypertension, we report a higher prevalence of congenital cerebrovascular variants; vertebral artery hypoplasia, and an incomplete posterior circle of Willis, which were coupled with increased cerebral vascular resistance, reduced cerebral blood flow, and a higher incidence of lacunar type infarcts. Causally, cerebral vascular resistance was elevated before the onset of hypertension and elevated sympathetic nerve activity (n=126). Interestingly, untreated hypertensive patients (n=20) had a cerebral blood flow similar to age-matched controls (n=28). However, participants receiving antihypertensive therapy (with blood pressure controlled below target levels) had reduced cerebral perfusion (n=19). Finally, elevated cerebral vascular resistance was a predictor of hypertension, suggesting that it may be a novel prognostic or diagnostic marker (n=126). Conclusions:

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Reduced cerebral blood flow in older men with higher levels of blood pressure

Cited by 42 publications

References 26 publications

Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years

Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years

Blood Pressure Is Not Associated With Cerebral Blood Flow in Older Persons

Is High Blood Pressure Self-Protection for the Brain?

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