Control Your Blood Pressure to Fight Age-related Brain Damage
Control Your Blood Pressure to Fight Age-related Brain Damage

In this nationwide study,
called the Systolic Blood Pressure Intervention Trial (SPRINT), hundreds of
participants were involved who were screened for brain lesions
using

‘Intensive control of blood pressure can slow the progression of age-related brain damage. Hypertension leads to accumulation of white matter lesions in the brain, causing cognitive disorders, which can be prevented by controlling high blood pressure.’
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The study revealed
that intensively controlling the blood pressure (BP) wasmuch more effective than standard BP-lowering therapies in
slowing the accumulation of lesions in the white matter of the brain. These
findings corroborate earlier NIH studies, which showed that intensive therapy significantly reduces the risk of
occurrence of mild cognitive impairment
.

“These initial results support a growing body of
evidence suggesting that controlling blood pressure may not only reduce the
risk of stroke and heart
disease
but also of age-related cognitive loss,”
says Dr. Walter
J. Koroshetz, who is one of the study leaders. He adds: “I strongly urge people to know your blood pressure and discuss with
your doctors how to optimize control. It may be a key to your future brain
health.”

Study Team

The study team
included senior clinical scientists from several institutes under the National
Institutes of Health, USA, who jointly led the investigation. These included
Dr. Walter
J. Koroshetz, MD, Director of the National Institute of Neurological Disorders
and Stroke (NINDS); Dr. Richard J. Hodes, MD, Director of the National Institute on Aging (NIA);
Dr. Clinton B. Wright, MD, MS, Director of the Division of Clinical Research at
NINDS; and Dr. Lenore J. Launer, PhD, a Senior Investigator in the Laboratory
of Epidemiology and Population Science at NIA.

Brain Pathology and Its Association with Hypertension

The brain is made
up of two nervous tissue layers, known as white matter and grey matter. The
outer layer of the brain consists of grey matter, which is made up of the cell
bodies of nerve cells or neurons. The inner layer of the brain consists of
white matter, made up of axons, which are thin nerve extensions originating
from the cell bodies of neurons.

There are literally
billions of axons within the white matter that connect the neurons together.
The axons are covered by a fatty layer of myelin that provides protection and
insulation and facilitates the rapid conduction of nerve impulses.

White
matter lesions can be detected by MRI
and are characterized by thinning of the
myelin sheath, increased glial cell (supporting cells of the brain tissue)
responsiveness to injury, and leaky blood vessels in the brain, as well as
increased risk of occurrence of multiple strokes. Importantly, these
pathological changes are associated with high BP or hypertension

Verification of the Link between Hypertension
and Cognitive Brain Disorders

Several studies
have indicated that hypertension can elevate the risk of formation of white
matter lesions, as well as the development of
cognitive disorders such as Alzheimer’s disease and dementia in later life.

These findings were
verified in a randomized clinical trial called SPRINT Memory and Cognition in
Decreased Hypertension (MIND). This clinical trial, which is considered to be
the ‘Gold Standard’, evaluated whether controlling the BP could slow-down or prevent the accumulation of
white matter lesions in age-associated brain disorders. The findings have been
published in the Journal of the American
Medical Association (JAMA).

“These findings on white matter lesions – primarily in
the aggressive control of blood pressure – are encouraging as we continue to
advance the science of understanding and addressing the complexities of brain
diseases such as Alzheimer’s and related dementias,”
says Hodes.

Key Features of the SPRINT Study

  • The NIH-supported SPRINT study, conducted between
    2010-2015, evaluated the effect of standard BP control versus intensive BP
    control on cardiovascular health and mortality
  • Over 9,300 adults aged 50 years and above at high
    risk of developing cardiovascular disease (CVD) were included in the
    SPRINT cohort
  • The cohort was divided into the following two
    groups:
  • The results showed the following:
    • Group 1:
      Standard therapy lowered the systolic BP below 140 mmHg
    • Group 2: Intensive
      therapy lowered the systolic BP below 120 mmHg
  • 3.3 years of intensive therapy significantly
    reduced the incidence of CVD and mortality

Key Features of the SPRINT MIND Study

  • The
    SPRINT MIND study was initiated by NIA and NINDS, which included 27
    clinical sites
  • The
    SPRINT MIND study evaluated the effect of BP-lowering therapies (standard
    or intensive) on cognitive function of the brain through MRI
  • 449
    participants underwent MRI at enrollment and after 4 years
  • During
    the 4-year span, the average volume of the white matter lesions was
    measured by MRI
  • The
    results showed the following:
    • Intensive Therapy Group: Average increase in the total volume
      of white matter lesions was 0.92 cm3
    • Standard Therapy Group: Average increase in the total volume
      of white matter lesions was 1.45 cm3
  • Brain
    volume slightly decreased in the intensive therapy group compared to the
    standard therapy group

Future Plans

The scientists conducting the SPRINT MIND study are planning to evaluate
the effect of controlling the blood pressure on the formation of white matter
lesions in vital areas of the brain that are affected by age-related brain
disorders. Moreover, they intend to elucidate the underlying reasons why some
patients are more responsive to treatment than others.

Concluding Remarks

The SPRINT MIND
study clearly showed that intensive therapy significantly reduced the
accumulation of brain white matter lesions arising from hypertension.

“SPRINT MIND has produced promising initial results in
the battle against the nation’s growing problem with aging brain disorders.
Both the brain scans and the cognitive tests reinforce the potential benefits
that intensive
blood pressure management
may have on the brain,”
says Launer. She
adds: “We hope that these findings will
become the foundation for future studies on how to protect the brain throughout
a person’s life.”

Funding Source

The study was part
of the National Institutes of Health’s Systolic Blood Pressure Intervention
Trial (SPRINT), which was jointly funded by the National Heart, Lung, and Blood
Institute, the National Institute on Aging, the National Institute of Diabetes
and Digestive and Kidney Diseases, the National Institute of Neurological
Disorders and Stroke, and the United States Department of Veterans Affairs,
USA. Takeda Pharmaceuticals provided the drugs azilsartan and
chlorthalidone.

Reference :

  1. Intensive blood pressure control may slow age-related brain damage(https://www.ninds.nih.gov/News-Events/News-and-Press-Releases/Press-Releases/Intensive-blood-pressure-control-may-slow-age)

Source: Medindia

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