Intensive BP Control Slowed White Matter Disease in Older Adults
Several studies have suggested that people with hypertension have a greater chance of accumulating white matter lesions and experiencing later-in-life cognitive impairment and dementia. Intensive lowering of systolic blood pressure (BP) slowed white matter disease in adults age 75 and older with hypertension after 3 years of treatment, according to new research
The clinical trial, Intensive Versus Standard Ambulatory Blood Pressure Lowering to Prevent Functional Decline In the Elderly (INFINITY), compared intensive systolic BP control (130 mm Hg or lower) with standard control (145 mm Hg or lower) in 199 adults age 75 or older who had high BP and white matter lesions that were visible on magnetic resonance imaging.
BP was managed with one or more medications and monitored over 24 hours using a small digital device that took readings while participants went about their daily activities. Compared with clinic-based measurements, these ambulatory BP readings provided closer monitoring of BP fluctuations and more refined medication adjustments to help participants achieve their assigned BP target.
The researchers found that, after 3 years of treatment, further accumulation of white matter lesions was reduced by 40% in the intensive-control group compared with the standard-control group. The intensive-control group also had fewer nonfatal cardiovascular events such as heart attack, heart failure, and stroke.
However, there were no differences between the two groups in cognitive performance or mobility as measured by gait speed, balance tests, and other measures. According to the researchers, this result could be due to the study’s short 3-year duration. White matter deterioration progresses slowly over decades before functional impairments appear.
For more info, see:
White, W.B. et al. (2019). Effects of intensive versus standard ambulatory blood pressure control on cerebrovascular outcomes in older people (INFINITY). Circulation, 140(20), 1626-1635. https://doi.org/10.1161/CIRCULATIONAHA.119.041603
Gottesman, R.F. (2019). To INFINITY and beyond: What have we learned and what is still unknown about blood pressure lowering and cognition? Circulation, 140(20), 1636-1638. https://doi.org/10.1161/CIRCULATIONAHA.119.042827.