hypertension

Higher blood pressure linked to greater brain damage in older adults

  • A clinical trial found that hypertensive older adults who took medication to keep their systolic blood pressure around 130 showed markedly fewer white matter lesions than those maintaining a level of 145.
  • A large, long-running study found that higher blood pressiure was linked to more brain lesions and more tau tangles.
  • A long-running study found that both higher amyloid-beta levels and higher vascular risk were linked to faster cognitive decline, with the factors interacting to be worse than additive.

Lowering blood pressure prevents worsening brain damage in elderly

A clinical trial involving 199 hypertensive older adults (average age 81) found that those who took medicine to keep their 24-hour systolic blood pressure around 130 mm Hg for three years showed 40% less accumulation of white matter lesions compared with those taking medicine to maintain a systolic blood pressure around 145 mm Hg.

60% of the patients maintained their target blood pressure throughout the full three years, and data from these alone showed an even bigger difference in number of brain lesions.

The study used around-the-clock ambulatory blood pressure monitors, which measured participants' blood pressure during all activities of daily living.

Participants had an average systolic blood pressure around 150 mm Hg at the beginning of the trial.

The research was presented at the American College of Cardiology's 68th Annual Scientific Session.

https://www.eurekalert.org/pub_releases/2019-03/acoc-lbp031819.php

Brain lesions linked to higher blood pressure in older adults

A long-running study tracking 1,288 older adults (65+) until their deaths found that the risk and number of brain lesions increased with higher blood pressure. High blood pressure was also linked to increased risk of protein tangles in the brain.

Two-thirds of the subjects had high blood pressure, while about half had one or more brain infarcts. Those with an upper blood pressure of 147 had a 46% higher chance of having one or more lesions.

https://www.the-scientist.com/news-opinion/higher-blood-pressure-has-links-to-brain-lesions-in-older-adults-64495

Vascular risk interacts with amyloid levels to increase age-related cognitive decline

Data from 223 participants in the Harvard Aging Brain Study found that both elevated brain amyloid levels and higher vascular risk were associated with more rapid cognitive decline, with the most rapid changes seen in those with both factors. The interaction between the two factors appears to be synergistic rather than simply additive — that is, the interaction between vascular factors and amyloid burden produces more risk than would be predicted from simply adding the two together.

https://www.eurekalert.org/pub_releases/2018-05/mgh-vri052118.php

Reference: 

Arvanitakis, Z., Capuano, A. W., Lamar, M., Shah, R. C., Barnes, L. L., Bennett, D. A., & Schneider, J. A. (2018). Late-life blood pressure association with cerebrovascular and Alzheimer disease pathology. Neurology, 91(6), e517. https://doi.org/10.1212/WNL.0000000000005951

[4499] Rabin, J. S., Schultz A. P., Hedden T., Viswanathan A., Marshall G. A., Kilpatrick E., et al.
(2018).  Interactive Associations of Vascular Risk and β-Amyloid Burden With Cognitive Decline in Clinically Normal Elderly Individuals: Findings From the Harvard Aging Brain Study.
JAMA Neurology. 75(9), 1124 - 1131.

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Smoking, hypertension, diabetes & obesity each linked to poor brain health

  • A large study has found that smoking, high blood pressure, diabetes, and obesity are each linked to more brain atrophy, and damage to white matter.
  • The more of these you have, the greater the shrinkage and damage.

Brain scans of 9,772 people aged 44 to 79, who were enrolled in the UK Biobank study, have revealed that smoking, high blood pressure, high pulse pressure, diabetes, and high BMI — but not high cholesterol — were all linked to greater brain shrinkage, less grey matter and less healthy white matter.

Smoking, high blood pressure, and diabetes were the most important factors, but there was also a compound effect, with the number of vascular risk factors being associated with greater damage to the brain. On average, those with the highest vascular risk had nearly 3% less volume of grey matter, and one-and-a-half times the damage to their white matter, compared to people who had the lowest risk.

The brain regions affected were mainly those involved in ‘higher-order’ thinking, and those known to be affected early in the development of dementia.

The associations were as strong for middle-aged adults as for older ones, suggesting the importance of tackling these factors early.

While the effect size was small, the findings emphasize how vulnerable the brain is to vascular factors even in relatively healthy adults. This also suggests the potential of lifestyle changes for fighting cognitive decline.

Although this study didn't itself examine cognitive performance in its participants, other studies have shown links between cognitive impairment and vascular risk factors, particularly diabetes, obesity, hypertension, and smoking.

https://www.eurekalert.org/pub_releases/2019-03/esoc-shb030719.php

Cognitive decline in type 2 diabetes linked to white matter hyperintensities

While type 2 diabetes has been associated with cognitive problems, the mechanism has been unclear. Now a study involving 93 people with type 2 diabetes has found that greater white matter hyperintensities (indicative of cerebral small vessel disease) were associated with decreased processing speed (but not with memory or executive function).

https://www.eurekalert.org/pub_releases/2018-09/w-rem091818.php

Reference: 

Cox, Simon R. et al. 2019. Associations between vascular risk factors and brain MRI indices in UK Biobank. European Heart Journal. doi:10.1093/eurheartj/ehz100

[4395] Mankovsky, B., Zherdova N., van den Berg E., Biessels G.-J., & de Bresser J.
(2018).  Cognitive functioning and structural brain abnormalities in people with Type 2 diabetes mellitus.
Diabetic Medicine. 35(12), 1663 - 1670.

 

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