More aggressive hypertension treatment could protect the ageing brain while reducing the risk of heart attacks and strokes…

Elderly people with high blood pressure (hypertension) who took medicine to keep their 24-hour systolic blood pressure around 130 mm Hg for three years showed significantly less accumulation of harmful brain lesions compared with those taking medicine to maintain a systolic blood pressure around 145 mm Hg.

This is according to research presented at the American College of Cardiology’s 68th Annual Scientific Session.

However, the reduction in brain lesions, visible as bright white spots on a magnetic resonance imaging (MRI) scan, did not translate to a significant improvement in mobility and cognitive function. Researchers said it is likely that three years was too short a time for such benefits to become apparent.

“With the intensive 24-hour blood pressure treatment we reduced the accrual of this brain damage by 40 percent in a period of just three years. That is highly clinically significant, and I think over a longer time period intensive reduction of the ambulatory blood pressure will have a substantial impact on function in older persons, as well,” said William B. White, MD, professor of medicine at the University of Connecticut School of Medicine’s Calhoun Cardiology Centre and one of the study’s principal investigators.

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 Age-related brain damage: cerebrovascular disease

The study is the first to demonstrate an effective way to slow the progression of cerebrovascular disease, a condition common in older adults that restricts the flow of blood to the brain.

By reducing blood flow to the brain, cerebrovascular disease causes a gradual build-up of lesions that represent areas with damaged nerve cells in the brain’s white matter.

Older people with more of these lesions tend to have slower reflexes, problems with mobility and more signs of cognitive decline.

How high blood pressure damages the brain

Having high systolic blood pressure over a long period of time is known to exacerbate damage to small arteries in the deep regions of the brain, but it was not previously known whether the process could be stopped or slowed by controlling ambulatory blood pressure.

The study included 199 people with an average age of 81 years old, average systolic blood pressure around 150 mm Hg and evidence of some cerebrovascular disease on an MRI scan.

Half the participants received standard blood pressure control and half received more intensive blood pressure control while the research team used around-the-clock ambulatory blood pressure monitors to measure participants’ blood pressure during all activities of daily living.

Patients receiving standard blood pressure control maintained an average systolic blood pressure of 146 mm Hg, close to the study’s target level of 145 mm Hg. Patients receiving the more intensive treatment had an average systolic blood pressure of 131 mm Hg, close to the target level of 130 mm Hg.

In addition to seeing beneficial effects in the brain, those who kept their blood pressure lower were also less likely to suffer major cardiovascular events, such as a heart attack or stroke.

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Source: American College of Cardiology via www.sciencedaily.com

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